difference between coursework and research

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💡 Taught Masters vs Research Masters:

There are many types of Master’s degrees, and most of these are Taught Masters . In the United Kingdom, such programmes are also called postgraduate taught or PGT for short. They typically require completing a set number of modules and a thesis (also called dissertation), plus sometimes work experience through a placement. The type of dissertation you will undertake will depend on the type of Master’s degree you are enrolled in, and might for example include your own small research project. Most postgraduate taught degrees have these elements of independent work and research to varying extents.

In contrast, a Research Master ’ s degree will focus on, you guessed it, research. In the UK, such programmes are also called postgraduate research or PGR (although this term may also refer to doctorate programmes). Rather than attending classes every semester and completing module assignments, you will need to focus on an independent research project – under supervision, of course. The course will still include a few taught modules, most often on research methodologies, but it will require you to work independently for most of the time.

Master’s degrees in the UK are usually one year full-time or two years part-time, but in other countries the duration may differ.

Remember: A final dissertation will be compulsory for all Master ’ s degrees. However, a dissertation for an MRes will typically be longer than that for an MA or MSc.

Typically, Research Masters will lead to an MRes degree. At some universities, however, you'll instead be awarded an MPhil (Master of Philosophy) or MLitt (Master of Letters). For more information, have a look at our detailed glossary.

🤔 Is a Research Master’s the same as a PhD?

No, a Research Master’s degree is not the same as a PhD. Although for both degrees you will need to complete a dissertation based on an independent research project, there are notable differences:

• The first difference is the duration : A Master’s degree will typically last one to two years, while a PhD usually takes up about three to five years. The research project you’ll undertake during a doctorate degree will therefore be longer and broader than one you would pursue in a Master’s degree.
• As a PhD student, you’re expected to publish research papers in journals before you are awarded your degree. MRes students might occasionally do that during or after their studies, but it’s rarely obligatory.
• As a PhD student, you’ll most often be expected to take on other duties , such as teaching.

If you wish to pursue doctoral research and a career in academia, a research Master’s degree could be a great option for you as it will allow you to get to grips with and gather valuable experience and training on independent research early on in your studies.

👀 Overview: What’s the difference?

There are a few differences between Taught Masters and Research Masters , and not all of them are obvious.

The table below outlines some of the main elements to consider when choosing which of the two degrees to pursue after your Bachelor’s degree:

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🏛️ Which should you choose?

The choice between a taught Master’s and a research Master’s depends on a few factors.

• First of all, do you enjoy research more than coursework? Then an MRes may be more suitable – but remember that any Master’s degree, especially an MSc, will have a research component.
• Then, it’s crucial to understand how you like to work and study. Do you particularly enjoy working independently? Perhaps then you can consider an MRes. In a taught Master’s, you’ll have a more solid structure, timetables and regular deadlines to keep you on track, but these may not be as readily available during an MRes, so consider which environment you are more likely to thrive in.  
• Another important consideration is what you want to do after your Master’s degree. If you want to enter the labour market immediately, and you are not particularly interested in focusing on research training, then perhaps a taught Master’s degree is more suited.

💸 Is there a difference in fees between Taught and Research Masters?

No, normally, you won’t find a huge difference in tuition fees between taught and research Master’s degrees. Only in some instances, Postgraduate Research Masters tend to be cheaper.

📝 Can I do a PhD after taking a Taught Master’s Degree?

Yes, you can pursue a PhD after any type of Master’s course, provided that you have a degree in a relevant subject. All taught postgraduate degrees involve some independent work and research, especially for your dissertation, which will prepare you for further research should you choose to pursue a PhD.

Some taught Masters require more independent research work than others, particularly when it comes to the dissertation after completing the taught modules. Consult the curriculum or ask admissions staff to get a better idea of what to expect.

While a taught Master’s degree won’t prevent you from doing a PhD further down the line, it’s vital that you have a good idea of what requirements you will have to fulfil in order to be admitted to the PhD, and how you can best prepare.

If you already have a clear idea of what field you’d like to conduct your doctoral research in, you could take advantage of the joint Master’s – PhD programmes on offer at some universities.

These four-year programmes – also called “combined” or “integrated” degrees – offer the chance to complete a Master’s degree in the first year and to progress seamlessly to PhD research in the next three.

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Author: Claudia Civinini

Claudia has many years of experience as a reporter and writer on international education and student mobility. Originally from Italy, she holds a BA in Communication and Media Studies from the University of Genova; a Graduate Diploma in Education, Secondary Education and Teaching from the Australian Catholic University; and a joint MSc in Educational Neuroscience from UCL and Birkbeck, University of London. Claudia has previously worked as Chief Reporter for the English Language Gazette, as Senior Reporter for the PIE News (Professionals in International Education), and as Reporter for Tes.

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Course-based Vs Research-based Master’s Programs || Which Is Best For You?

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If getting a master’s degree is in your academic or career plans, then you need to fully understand what it entails. Getting a master’s degree is a great way to advance your career or kick-start a new career. However, there are different types of master’s degrees offered by universities. This article will discuss course-based and research-based masters to help you understand what they mean and how they are different.

Course-based programs

Course-based master’s degree programs are designed for students who want to learn new skills, gain knowledge, and advance their careers. These structured programs offer students a set of courses to complete for their degree. The courses are designed to provide students with the necessary skills and knowledge to succeed in their chosen careers.

Research-based programs

Research-based master’s degree programs are designed for students who want to conduct research, develop new knowledge, and contribute to their field. These programs are research-intensive and require students to conduct original research and write a thesis or dissertation. The research conducted should contribute to the knowledge base of the field.

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Differences between Course-Based and Research-Based Master’s Degree Programs

Though both programs have their unique advantages, they are tailored to different career goals and learning styles. Here are four major differences between course-based programs and research-based degree programs:

• Approach to learning

The main difference between course-based and research-based master’s degree programs is the approach to learning. As earlier stated, course-based programs offer students a set of courses to complete for their degree. These programs are often referred to as taught master’s programs and are structured around a predetermined curriculum.

On the other hand, research-based programs are not structured, and students have to conduct their research independently. This program requires students to be self-motivated, independent, and have excellent research skills.

2. Duration

Another difference between course-based and research-based master’s degree programs is the length of time it takes to complete the program. Course-based programs typically take one to two years to complete, while research-based programs usually take two to three years to complete due to the time required for extensive research. Course-based programs are an excellent choice for people looking to advance their careers quickly.

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3. Purpose  

Course-based master’s degree programs are designed to equip students with practical skills and knowledge directly applicable to their chosen profession. Students can choose from a variety of courses and tailor their programs to meet their interests and career goals.

Research-based programs, however, are research-intensive and require students to conduct original research and write a thesis or dissertation. Students have the freedom to choose their research topic and conduct their research independently. Research-based master’s degrees are best for students interested in pursuing academic careers or roles that require advanced research skills.

4. Curriculum and Assessment

While course-based programs may include a small research project, the emphasis is primarily on coursework. The majority of your time in a course-based program is spent attending lectures, seminars, and workshops. Assessment is primarily through exams, coursework, and projects.

Research-based or thesis-based programs are centred on independent research and academic exploration. The core of the program is the research thesis. The thesis serves as the culmination of the program, showcasing a student’s ability to conduct independent research, analyze data, and present findings coherently.

Now that you have an idea of the key differences between both master’s programs, you need to consider your learning style and career goals before choosing one that is right for you. If you’re looking to gain practical skills and enter a specific industry, then a course-based program will be a better choice, however, if your goal is to pursue a PhD, then, a more appropriate choice would be a research-based master’s.

Preparing to study abroad can be overwhelming, if you need further guidance on degree options, application requirements and schools to apply to for your degree or counselling regarding the best master’s degree program for you, please click here to chat with our counsellors. 

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Future Students

Scripting must be enabled to use this site., difference between postgraduate research and coursework, what is the difference between postgraduate coursework and postgraduate research programs.

There are a few key differences between postgraduate coursework and postgraduate research programs.

Postgraduate Coursework

Postgraduate coursework programs deliver content through a set unit program (similar to an undergraduate Bachelor degree), but at a more advanced level. Coursework will allow you to deepen your knowledge within a discipline, or to pursue a new or additional study area at an advanced level.

Postgraduate degrees which can be studied through coursework include Graduate Certificates , Graduate Diplomas and Masters degrees.

Postgraduate Research

Postgraduate research programs (also known as Higher Degree Research ) allow you to develop your knowledge and experience within your field by completing a major research project under the supervision of an academic .

Postgraduate research degrees which you can study include Masters by research or Doctorate ( PhD ) programs.

Additional Information

For a comprehensive list of courses available, please refer to the Prospective Student Catalogue , or for further information view our Postgraduate Study page.

For further information regarding postgraduate coursework programs, please contact the Future Students Team through the Contact Us tab, online Live Chat , phone to 1800 818 865, or via Facebook .

For further information regarding postgraduate research programs, please submit your enquiry to Higher Degree Research through the Contact Us tab, or phone (02) 6773 3715 for assistance.

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• Taught Masters vs Research Masters Degrees

Taught Masters vs Research Masters - Which is Right for Me?

Written by Ben Taylor

Masters degrees can be either postgraduate taught programmes (PGT) or postgraduate research programmes (PGR). Taught Masters are typically 12 months long full-time and are delivered through a series of modules comprised with regular coursework and assessments. Research Masters are also usually 12 months long however the course is predominantly comprised of independent research supported by a supervisor.

There’s a big contrast between these two kinds of Masters, and one type may be more suitable for your goals than the other. This page will explain the key differences between taught Masters and research Masters, and hopefully help you decide which kind of postgraduate programme is right for you.

Taught vs research Masters – what’s the difference?

The difference between postgraduate taught degrees and postgraduate research degrees largely comes down to the level of independence you have during your studies.

Research Masters require students to undertake extensive research training, while postgraduate taught Masters involve a mixture of lectures, seminars and coursework.

• Taught Masters (PGT) degrees are a lot like undergraduate programmes. You’ll complete a series of modules following a set timetable of seminars, lectures and other activities. You’ll be much more responsible for studying independently in your free time, but the academics in charge of your course will lead you through it.
• Research Masters (PGR) degrees are more independent in nature. You won’t have as many timetabled units (in fact, you may not have any). Instead, you’ll focus on one or more extended projects. You’ll still receive support and guidance from an expert supervisor, but the focus of your programme will be on your own research work.

The majority of Masters-level programmes are taught courses. They include popular degrees like the Master of Arts (MA) and Master of Science (MSc) , as well as shorter Postgraduate Certificate (PGCert) and Postgraduate Diploma (PGDip) courses.

You can study these courses to acquire more advanced skills and training for a profession, or as a preparation for postgraduate research at PhD level.

Postgraduate research programmes are also available at Masters level. These include the Master of Research (MRes) and Master of Philosophy (MPhil) . Some Masters qualifications, such as the Master of Letters (MLitt) , can actually be taught or research degrees.

Masters by research vs Masters by coursework

A Masters by coursework is usually professional and vocational in nature, involving a series of set modules, while a Masters by research entails the completion of a significant, independent research project. This terminology is more common in Australia .

Writing a dissertation

Taught Masters do involve a substantial piece of research in its own right: the dissertation . This will be your chance to undertake an extended individual project, pursuing your own specific academic interests in a way that forms a significant part of your postgraduate course.

Should I study a taught or research Masters?

Your choice of PGT degree or PGR degree should depend on your career goals, academic interests and the way in which you prefer to study:

• If you want to acquire more advanced subject knowledge and gain an additional qualification before entering the employment market, a taught postgraduate course such as an MA or MSc may be best for you. We've taken a look at how the MA, MSc and MRes compare over on our blog.
• If you have a specific profession in mind, you could be better served by an accredited taught programme. This will usually be a Postgraduate Certificate or Diploma , but may also take the form of a full taught course, such as the Masters in Social Work or a Legal Practice Course .
• If you are interested in academic research – or a profession in which research skills are valuable – you may wish to think about an MRes . This will allow you to focus on an independent project in order to gain associated research skills, or evaluate whether a longer research degree (such as a PhD ) is likely to appeal to you.
• If you are considering an academic career , you might be able to register for an MPhil after your undergraduate degree and upgrade to a PhD upon making sufficient progress.

Can I do a PhD after taking a taught Masters?

Most PhD programmes ask that applicants have any kind of Masters in an appropriate subject. So, even if you study a taught Masters degree, you’ll be eligible to take a PhD if you satisfy the various entry requirements.

Of course, if you already know that you want to study at PhD level, then it’s worth considering a research Masters if there’s one available in your subject. An MRes would be ideal preparation for PhD study, allowing you to undertake more extensive research and receive specific training in appropriate methods. Another option would be to register for an MPhil and then upgrade to a PhD .

Is there a difference in fees for taught and research Masters?

In some cases, you can expect a research Masters to be cheaper than its taught equivalent. This is normally the case in the Humanities, where an MRes could cost less than an MA. Similarly, the yearly tuition fees for a PhD are often cheaper than a taught Masters.

Things are different in the Sciences, however: an MRes in a scientific subject usually has the same fees as an MSc degree. Both kinds of Masters typically involve extensive laboratory work.

The table below shows a summary of this data, reflecting the tendency for some research programmes to be cheaper than their taught counterparts.

* Based on the 2021-22 Reddin Survey of UK postgraduate fees , published by the Complete University Guide , as well as additional research and calculation by FindAMasters. Figures given are broad averages only and will not necessarily reflect fees for specific courses.

Is funding the same for taught and research Masters?

Essentially, the funding situation for taught and research Masters is the same. Check out our guide to Masters funding for more information on financing your course.

It’s worth noting that the UK government’s postgraduate loans are available for all Masters (including the MPhil). Standalone MPhils are not eligible for the PhD loans , but these loans are available for MPhils that are intended to become a PhD.

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Masters by Coursework vs. Research

What is the difference between research and masters by coursework.

If you’re on the verge of taking the leap into the realm of higher education, you’ve likely encountered a pivotal crossroads: the choice between pursuing a Master’s by Coursework or a Master’s by Research. This decision is not one to be taken lightly, for it can profoundly shape your educational journey and, in turn, your future career.

Differences Between Masters by Coursework and Research

The primary differences between Master’s by Coursework and Master’s by Research lie in their program structures and objectives. Master’s by Coursework programs emphasize structured coursework, offering a predetermined curriculum covering a wide range of topics within a field of study. In contrast, Master’s by Research programs prioritize original research, with students delving deeply into a specific research topic under faculty guidance. The former typically takes 1-2 years, focusing on knowledge and skill acquisition through exams and assignments, while the latter involves research progress assessments and the completion of a thesis or dissertation. These distinctions make the choice between the two pathways crucial, depending on your career goals and preferred learning style.

Program Structure

Master’s by coursework.

In a Master’s by Coursework program, the emphasis is on structured coursework. You’ll follow a predetermined curriculum, taking a series of classes that cover a broad range of topics related to your field of study. These courses are designed to provide you with a well-rounded knowledge base and skill set in your chosen area.

Typically, a Master’s by Coursework program is completed within one to two years, making it a shorter and more focused option. However, the workload can be quite intense, with multiple assignments, exams, and projects to complete during each semester.

Master’s by Research

On the flip side, a Master’s by Research program is all about diving deep into a specific research topic. Instead of following a structured curriculum, you’ll have more autonomy in shaping your academic journey. The heart of this program lies in conducting original research under the guidance of a faculty advisor.

Master’s by Research programs tend to be more flexible in terms of duration. While they can often be completed in two years, the timeline may extend based on the complexity of your research and the pace at which you work.

Curriculum and Courses

In a Master’s by Coursework program, you’ll follow a structured curriculum that includes a variety of courses. These courses are designed to cover a wide range of topics within your field of study, ensuring that you gain a comprehensive understanding of the subject matter.

The benefits of this structured approach include exposure to various aspects of your field and the opportunity to build a diverse skill set. However, it may leave you with limited time for independent research.

In a Master’s by Research program, the curriculum is more flexible and research-driven. While you may still have some coursework requirements, they are typically minimal and are chosen to support your research objectives. The majority of your time and effort will be devoted to your research project.

Research Component

In a Master’s by Coursework program, the research component is typically limited or even absent. While some programs may include a small research project or a capstone project, the primary focus is on coursework and the acquisition of knowledge and skills.

This research experience is invaluable if you’re planning to pursue a Ph.D. or a career in research, as it provides you with hands-on experience in the research process. Your Master’s thesis or dissertation is a tangible product of your research efforts and serves as a demonstration of your research skills.

Assessment Methods

Assessment in a Master’s by Coursework program primarily involves exams, assignments, and projects related to the courses you take. These assessments are designed to evaluate your understanding of the course material and your ability to apply the knowledge and skills you’ve acquired.

In a Master’s by Research program, the assessment process is quite different. While you may have some coursework assessments related to your research skills, the primary focus is on your research progress and the quality of your Master’s thesis or dissertation.

Thesis/Dissertation Requirement

A thesis or dissertation is typically not required in a Master’s by Coursework program. Instead, you’ll graduate upon successfully completing the required coursework and meeting any other program-specific requirements, such as passing comprehensive exams or completing a capstone project.

The focus in this type of program is on the coursework and the acquisition of knowledge and skills rather than on producing original research. As a result, you won’t have to invest the same level of time and effort in writing a lengthy research document.

Career Opportunities and Future Prospects

A Master’s by Coursework program is well-suited for individuals who are seeking to enter the workforce immediately after graduation. It provides a strong foundation of knowledge and practical skills that are directly applicable to various careers.

A Master’s by Research program is an excellent choice if you have a strong interest in research and plan to pursue a career in academia, research institutions, or specialized fields that require advanced research skills.

While graduates of Master’s by Research programs can also enter the workforce, their career paths often lead to roles that involve research, analysis, and contributions to the advancement of knowledge in their respective fields.

Financial Considerations

The cost of a Master’s by Coursework program can vary widely depending on the institution, location, and specific program. Generally, these programs have tuition fees that cover the cost of instruction, resources, and facilities.

Funding for research-based master’s programs often comes from research grants and projects, and students may be expected to actively contribute to the research efforts of their department or faculty advisor. This can provide valuable research experience but may not offer the same financial stability as a coursework-based program.

Faculty Interaction and Mentorship

In a Master’s by Coursework program, you will interact with faculty members primarily in a classroom setting. While you may have opportunities to seek guidance or discuss coursework-related questions, the level of faculty mentorship tends to be less intensive compared to Master’s by Research programs.

Master’s by Research programs offer a unique advantage in terms of faculty interaction and mentorship. You will work closely with a faculty advisor who is an expert in your research area. This advisor guides your research project, offers critical feedback, and helps you navigate the complexities of your field.

Research Facilities and Resources

However, some coursework programs do provide access to research facilities, especially if they include a capstone project or research-oriented courses. It’s essential to inquire about the availability of such resources when considering a program.

Time Commitment

Master’s by Coursework programs are known for their relatively shorter duration, typically ranging from one to two years. The structured coursework and regular semester schedules keep the program on a well-defined timeline.

Master’s by Research programs offer more flexibility in terms of time commitment. While they can often be completed within two years, the actual duration may vary based on the complexity of your research and the time required to collect and analyze data.

The extended timeline allows you to delve deeply into your research and ensures that you have ample time to produce a comprehensive thesis or dissertation. However, it also means that you must be self-motivated and disciplined to manage your research effectively.

Funding and Scholarships

Funding opportunities for Master’s by Research programs may differ from coursework-based programs. In many cases, students in research-focused master’s programs receive stipends, research assistantships, or fellowships that provide financial support during their studies.

These funding options are typically linked to research projects and may require you to work on specific research initiatives within your department or research group. While they can offer financial stability, they also come with research responsibilities.

International Considerations

International students may find it easier to secure admission to coursework programs since they primarily assess academic qualifications and standardized test scores. However, the availability of scholarships and financial aid may vary by country and institution.

Transition to Ph.D. Programs

If your long-term goal is to pursue a Ph.D., a Master’s by Coursework can be a viable pathway, but it may require additional steps. To transition to a Ph.D. program, you may need to demonstrate research experience and readiness by engaging in independent research projects or gaining research-related work experience.

Many universities and institutions offer streamlined pathways from Master’s by Research to Ph.D. programs, allowing you to seamlessly continue your research journey. This transition is often facilitated by strong faculty relationships and research contributions.

Masters by Coursework or Research: Which One is Right Choose for You?

Program Structure : In a Master’s by Coursework program, you’ll engage in structured coursework that covers a range of subjects within your field of study. The curriculum is predetermined, and you’ll attend classes, participate in discussions, and complete assignments.

Duration : Typically, Master’s by Coursework programs can be completed in one to two years, making them a shorter and more focused option.

Research Component : Master’s by Coursework programs often have limited or no research requirements, making them suitable for those who prefer coursework over research.

Thesis/Dissertation : Thesis or dissertation work is typically not required in Master’s by Coursework programs.

Duration : Master’s by Research programs usually take one to two years, but the timeline can vary depending on the complexity of your research.

Research Component : Research is the heart of this program, and you’ll be expected to actively engage in research activities throughout your studies.

Which One is Right for You?

Master’s by coursework may be a better fit if:, master’s by research may be a better fit if:.

The main difference lies in the program structure and focus. Master’s by Coursework programs emphasize structured coursework and skill acquisition, while Master’s by Research programs prioritize original research in a specific field.

In Master’s by Coursework, assessment methods include exams, assignments, and projects related to coursework. Master’s by Research assesses research progress and requires the completion and defense of a thesis or dissertation.

Research is limited in Master’s by Coursework programs, with the primary focus on coursework. Some programs may include small research projects or capstone projects.

Both program types may offer financial assistance such as scholarships, assistantships, and grants, but the availability and criteria can vary.

Master’s by Coursework programs are often attractive to international students due to their structured nature. However, Master’s by Research programs can provide substantial research experience for those seeking research-oriented careers.

Consider your career goals, interests, and preferred learning style. Master’s by Coursework is suitable for those seeking practical skills, while Master’s by Research is ideal for research enthusiasts and those planning Ph.D. pursuits.

Yes, you can transition, but you may need to supplement your coursework-based program with additional research experience to meet Ph.D. program requirements.

Yes, Master’s by Research programs often offer extensive access to research facilities, laboratories, and library resources to support your research endeavors.

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Master by Coursework vs. Master by Research: Which One to Choose?

“In preparing for your future academic degree, prospective Master’s degree students should comprehend various academic and non-academic aspects that will be experienced at the study destination, including the pathways of graduate studies.

In this article, Yogi Saputra Mahmud (Content Director for Australia, New Zealand, and Pacific Islands) will help you understand more about the differences between Master by Coursework vs. Master by Research, as well as some advice to select a pathway of graduate studies.”

Before starting your initial journey as a master’s degree student overseas, it is essential to explore the programs you wish to take. University websites will always become the best source of information for you to examine the desired courses. For instance, before I decided to pursue a Master’s degree in Teaching English to Speakers of Other Languages (TESOL) , I started my investigation by visiting several university websites all over the globe. Ultimately, I chose Monash University as my study destination as it offers a very unique course pathway that supported my future career.

At Monash University, I also experienced working as a Student Engagement Officer who helped students in their course progression. At that time, I realised that different universities might have different types of graduate studies offered to prospective students. Some Master degree programs are specifically designed for a full-coursework, a full-research, and coursework with a partial research pathway during the study, which will be exemplified further below.

Master by Coursework

On its website, Edith Cowan University outlines that A Masters by Coursework “is a professional qualification involving the study of a specified set of core units and a selection of eligible elective units” ( ECU, 2019 ). In other words, Master by Coursework students are required to enrol in classes that belong to compulsory units and choose several elective units for a certain number of credit hours throughout their study. During the study, you are also expected to complete assignments/projects/exams specified in each class or unit.

An example of Masters by Full Coursework pathway that I will illustrate here is Master of Business at Monash University . As an industry-focused graduate program, Master of Business enormously creates a professionally developed and socially responsible business practitioner. Therefore, the full coursework type allows you to immerse yourself in practical understanding to become an effective business practitioner.

As shown in the picture above, a Master of Business course requires its students to complete 96 credit points consisting of three major parts, including Advanced Preparatory, Mastery Knowledge, and Application Studies. Students will have to take core units and some elective units based on their interests in each part. In my perspective, the full coursework type will allow students to scrutinise theoretical and practical understandings in a particular field. Furthermore, it also enables students to tailor their expertise in their area based on their selection of core and elective units throughout their academic journey.

Master by Coursework + Partial Research

Besides the full coursework pathway, some Master’s degree programs also offer a partial research stream as an alternative pathway in the Masters by Coursework program. Usually, the partial research stream requires the students to complete a minor thesis comprising less than 15,000 words.

There are several requirements that you must fulfil to take this pathway. For instance, I personally took this pathway when I was studying at Monash University. Regarding this, the Master of TESOL course offers a Master by Coursework for prospective students. However, this course also has an alternative research pathway for those who achieve satisfactory results (75 of 100) from the first to the third semester. Since other courses may have different requirements, you are advised to check the university website or the course handbook to investigate them further.

As can be identified in the picture below, Master of TESOL at Monash University offers either a Master of Full Coursework or Master of Coursework + a partial research pathway. I believe that both types provide different advantages for prospective students. In this case, students who prefer a Master of Full Coursework type will have a more comprehensive experience in teaching and other professional development programs. Similarly, those who select a partial research pathway will improve their research experience and capacity, which can become an essential milestone for their future academic trajectory at Ph.D.

Master by Research

In a Master by Research program, students are required to submit “a completed thesis based on an independent research project” ( ECU, 2019 ). Furthermore, students will engage with a research supervisor throughout the completion of their research project. In this graduate study type, students will not have to attend any course units (core or elective units). However, there might be some preliminary classes to support their understanding of their research project, including classes in research methodology and statistics. Therefore, it is essential to explore the course progression and requirement in the university website or course handbook.

An example that I will illustrate here is the Master of Engineering Science (Research) at Monash University. This course is offered with two years and four years duration for full-time and part-time study respectively. Regarding this, students have to complete a research project in the areas of chemical engineering, civil engineering, electrical and computer systems, materials, and mechanical engineering. In each area of research, students will also be able to explore several subthemes that they are interested in. Ultimately, students are required to submit a thesis of not more than 50,000 words to complete their Master by Research degree.

In the other Master by Research courses, students will also find areas of research that can be selected as the theme of your research project. In addition, communication between yourself as the prospective student and a prospective supervisor is also necessary to ensure that the suitability of the research project, as well as the approval from the prospective supervisor to supervise you throughout the academic program. You can find the list of prospective supervisors by entering the following keyword in the Google search box: “find a supervisor + University name + Faculty/Department name.”

Which One to Choose?

As stated earlier, each type of graduate studies has its particular characteristics. In this regard, Masters by Full Coursework pathway allow you to deepen theoretical and practical insights about a specific area of knowledge. For instance, a Master by Full Coursework pathway at Master of TESOL course allows the students to immerse in teaching and classroom supervision, further supporting the key developments of becoming an effective teacher after completing the study. In other words, a Master by Full Coursework pathway is suitable for those who are planning to have a future career as a professional/expert in a particular field (e.g., business practitioner, education practitioner, and many more).

However, some Masters by Full Coursework pathway also offers a partial research pathway for those planning to extend their understanding of research. The partial research along with Masters by Full Research pathways are essential for students who would like to pursue a Doctoral degree since most Ph.D. programs require their applicants to have prior experience in completing a substantial amount of research in the form of a Master’s thesis. Furthermore, those who intend to become researchers, analysts, and university lecturers will also benefit from taking these pathways since the professions require them to engage in rigorous research and other academic projects.

Main Takeaways

It is important for you to explore the available pathways in the Master’s degree course that you desire. Every pathway at the graduate level has its own characteristics and strengths that ultimately affect your overall academic trajectory. Moreover, selecting a particular Master’s degree pathway should be based on the future career that you want to have.

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Coursework or research?

What's the difference between postgraduate degree coursework and higher degree research.

At UTS, you could pursue postgraduate studies by coursework or research.

Postgraduate Degree Coursework

Doing it by coursework means, you’ll attend classes, write assessments, sit for exams and work your way through a set of subjects – a structured program. You could potentially add a research project using your elective.

Programs offered through postgraduate coursework are:

Master of Quantitative Finance

Master of Science – offered in five majors and a no specific major.

Master of Science (Extension) – offered in five majors and a no specific major

Graduate Certificate in Science

Graduate Certificate in Mathematics

Higher Degree Research

Doing postgraduate study by research means, you’ll undertake supervised study and research, guided by an academic supervisor. You’ll work independently on your chosen project with the aim of producing, presenting and submitting a final thesis. The final thesis is your original research and investigation, backed by evidence.

Programs offered through higher degree research are:

Masters by Research  - Science

Masters by Research  - Mathematical Sciences

Doctor of Philosophy (PhD) - Science

Doctor of Philosophy (PhD) – Mathematical Sciences

So, what kind of projects can I undertake as my higher research degree?

You can undertake any project or discipline, as long as the Faculty and UTS has the expertise in the area, and the relevant supervisor agrees to supervise you.

We strongly encourage you to visit the Faculty’s research areas and use the Find a Supervisor  tool, to search a supervisor of your research interest.

Find a Supervisor

Once you've found a potential supervisor, it's important to make contact with them to discuss your research project proposal andmake sure they agree to supervise you.

Are you still confused on which research project to undertake?

You can hear from some of our  current and past research students’ experiences here . This may help you to decide what research project is right for you.

What if I change my mind, after...

I have started a postgraduate coursework program at UTS Science, but now I want to pursue a higher degree research?

You can transfer from your current UTS Science postgraduate coursework degree into the UTS  Master of Science (Honours) . You’ll need to line up a faculty academic to be your supervisor. Entry into the Master of Science (Honours) is through an internal course transfer via the UTS Master of Science or UTS Master of Science (Extension). There is no direct entry into the UTS Master of Science (Honours).

I have started one of the UTS Science postgraduate coursework masters, e.g. Master of Science or Master of Science (Extension),or the Master of Quantitative Finance, but I can no longer continue my studies?

You can exit your degree through the UTS Graduate Diploma in Science or the UTS Graduate Diploma in Quantitative Finance, which are dependent on the number of subjects you have completed.

Want more information?

Attend a science and maths postgraduate info session.

Download the Science and Maths Postgraduate Course Guide . For information on the application process, here’s a step by step guide on how to apply .

Want to talk to someone?

Contact our course directors:

Ken Rodgers Higher Degree Research Programs Director [email protected]

Bernadette Saunders Postgraduate Coursework Programs Director [email protected]

UTS acknowledges the Gadigal people of the Eora Nation, the Boorooberongal people of the Dharug Nation, the Bidiagal people and the Gamaygal people, upon whose ancestral lands our university stands. We would also like to pay respect to the Elders both past and present, acknowledging them as the traditional custodians of knowledge for these lands.

Difference between taught vs research masters postgraduate programmes

Postgraduate studies offer a wide range of opportunities for students looking to further their education and career prospects.

Choosing the right postgraduate programme can be overwhelming, especially when faced with the choice between taught and research-based master’s degrees.

While both options lead to a master’s degree, they differ significantly in their approach, content and outcome.

Taught master’s programs are structured, classroom-based courses that provide students with in-depth knowledge and practical skills in a specific subject. Research-based master’s programs, on the other hand, focus on cutting-edge research in a particular field and are designed to equip students with advanced research skills and expertise.

In this article, we explore the differences between taught vs research masters programmes, to help you decide the best path to pursue based on your interests and career goals.

Taught masters vs research masters – what’s the difference?

Postgraduate students can choose between two main types of master’s programmes: a taught master’s and a research master’s. The differences between these two types of programmes can be seen in their:

• assessment methods,
• and overall focus.

Taught master’s, also known as coursework or postgraduate taught degrees, typically have a fixed and structured timetable.

These programmes include a structured curriculum with modules and seminars that aim to provide students with a broader understanding of a specific field.

The proportion of taught courses and research projects in a taught master’s programme is normally 2/3 taught courses to 1/3 research project. Examples of taught master’s degrees are Master of Arts (MA), Master of Science (MSc), Postgraduate Diploma (PGDip), and Postgraduate Certificate (PGCert).

On the other hand, research degrees, also known as masters by research, focus on independent research in a particular area of study under the guidance of a supervisor.

These programmes have no set timetable and research is the primary focus.

The proportion of research projects and taught courses in a research master’s programme is reversed from a taught master’s with the majority of the effort being in research projects. Examples of research master’s degrees are Master of Research (MRes) and Master of Philosophy (MPhil).

The assessment methods also differ between the two types of programmes. Taught master’s programmes generally require a final project or exam, while research master’s programmes culminate in the submission of a dissertation that is solely assessed based on the quality of the research conducted.

Should I study a taught or research masters degree?

Choosing between a taught or research Masters ultimately depends on individual preferences and goals.

A taught postgraduate course generally focuses on providing a structured programme based on pre-existing knowledge and skills, leading to a diploma or MSc certification.

On the other hand, a research postgraduate programme, such as an MRes, emphasises research skills and independent study, leading to a research-based qualification.

If one prefers to study in a traditional classroom setting and wants to acquire further knowledge in a specific area, a taught course may be more suitable.

If you are more interested in becoming an expert in a particular field and honing their research skills, then a research Masters may be more appropriate.

It’s important to consider your career goals and choose the programme that best aligns with those aspirations.

What about the other types of masters degrees?

Apart from the popularly known MBA (Master of Business Administration), there are several other types of masters degree available.

Some of the common ones include MSc (Master of Science), MRes (Master of Research), MPhil (Master of Philosophy), and various other taught or research masters.

MSc programs are popular among students looking to advance their knowledge in a scientific field, such as engineering, medicine, or environmental science. For example, the MSc Immunology and Immunotherapy program at the University of Birmingham focuses on subjects like cancer genomics and immunology, providing a balance of taught elements and research opportunities.

MRes programs, on the other hand, focus on research, preparing students for a career in academia or research-based roles in industry.

For instance, the MRes Cancer Sciences program at the University of Birmingham allows students to spend about six to seven months working on a research project after completing their taught modules, providing extensive hands-on experience.

MPhil programs, like the MRes, are often seen as a stepping stone towards a PhD and are mainly research-based. They may involve rotations between different projects, with the final project often leading to a PhD topic.

MPhil programs sometimes stand alone as qualifications, but they usually involve no teaching elements, consisting solely of independent research projects.

Other taught or research masters cover a wide range of subject areas and may focus on specific industries or have a broader perspective. For instance, there are masters programs in ancient history, archaeology, political science, marketing, and communications, among others.

Postgraduate studies are a great way to gain specialized knowledge and develop professional skills , making a taught or research master’s degree a valuable qualification for various career paths.

When considering a postgraduate program, it is important to research the course details and seek advice from current or former students to ensure it aligns with your future goals and interests.

Is there a  tuition fee difference between taught vs research masters?

There is typically a difference in tuition fees between taught and research masters programs. Taught masters programs, such as MSc degrees, are structured around coursework and are usually completed within one to two years.

They often require more resources, such as faculty time and classroom space, which can drive up the cost. In comparison, research masters programs, like MRes degrees, focus on independent research and usually have less contact time with professors, which can result in lower tuition fees.

However, there are exceptions, and tuition fees can vary from program to program.

Taught masters degrees may be more affordable than research masters due to their structure and the prevalence of such programs.

It is essential to research and compare the costs and benefits of each type of program and consider how it aligns with one’s personal and professional objectives.

Wrapping up – taught and research masters

Postgraduate students have a choice between two main types of master’s programs: taught and research-based. Taught programs are structured, classroom-based courses, while research-based programs focus on independent research.

The decision to choose between a taught or research master’s program ultimately depends on individual preferences, goals, and career aspirations.

It is important to carefully research and compare the costs and benefits of each type of program and consider how it aligns with one’s personal and professional objectives.

Key takeaways include:

• Taught master’s programs are structured, classroom-based courses, while research-based programs focus on independent research.
• Taught programs provide a broader understanding of a specific field, while research-based programs offer deeper insight into a particular research area.
• The decision to choose between a taught or research master’s program depends on individual preferences, goals, and career aspirations.
• There is typically a difference in tuition fees between taught and research master’s programs.
• the need to consider individual preferences and career aspirations,
• the difference in structure and focus between taught and research-based programs,
• and the difference in tuition fees.

 Postgraduate studies offer a valuable opportunity for students to gain specialized knowledge and develop professional skills, making a taught or research master’s degree a valuable qualification for various career paths.

Dr Andrew Stapleton has a Masters and PhD in Chemistry from the UK and Australia. He has many years of research experience and has worked as a Postdoctoral Fellow and Associate at a number of Universities. Although having secured funding for his own research, he left academia to help others with his YouTube channel all about the inner workings of academia and how to make it work for you.

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What is the difference between postgraduate coursework and research programs?

Postgraduate coursework programs have a set study plan structure. Students are required to complete all required assignments or assessments to pass the units on their study plans. Postgraduate research  qualifications are awarded following the completion of a major thesis, involving independent original research under the supervision of a senior academic.

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• How it works

How Are Coursework And Dissertation Similar?

Published by Alvin Nicolas at April 9th, 2024 , Revised On April 23, 2024

The academic journey is a path paved with various challenges, and coursework and dissertations stand as two prominent milestones. While they may appear vastly different at first glance, a closer look reveals many similarities. Both coursework and dissertations play crucial roles in equipping students with the knowledge, skills, and critical thinking necessary for academic success. Let’s look into how coursework and dissertations are similar. 

Coursework & Dissertations: Building Blocks Of Knowledge

A well-structured dissertation rests upon a solid foundation of knowledge acquired through coursework. Coursework acts as a stepping stone, introducing students to core concepts, theories, and methodologies within a specific discipline. 

Through lectures, discussions, and smaller assignments, students develop a basic understanding of the field and its established research areas. This knowledge base serves as a springboard for the more in-depth research undertaken in a dissertation.

For instance, imagine a student pursuing a dissertation on the ethical implications of artificial intelligence (AI) . Their coursework in computer science and philosophy would have provided them with a grasp of AI functionalities and ethical frameworks.

This foundational knowledge becomes the launchpad for their dissertation research, allowing them to research deeper into specific ethical concerns surrounding AI development.

They Help Develop Research & Writing Skills

Both coursework and dissertations hone a student’s research and writing abilities, which are crucial tools for finishing academic studies. Coursework assignments, ranging from essays to research papers, equip students with the skills to:

Formulate Research Questions

Coursework often involves tasks that require students to identify and analyse problems within a specific field. This ability to frame research questions effectively translates directly to the dissertation stage.

Evaluate And Use Scholarly Sources

Coursework assignments typically necessitate the use of credible academic sources . Students learn how to find relevant research papers, critically evaluate their content, and integrate them into their writing. These skills form the bedrock for the extensive literature review required in a dissertation.

Develop A Sound Argument

Whether writing an essay or a dissertation chapter, students must build a clear and well-supported argument.

Coursework assignments provide opportunities to practice constructing arguments, presenting evidence, and drawing logical conclusions – all skills essential for crafting a compelling dissertation.

The experience gained from coursework allows students to approach their dissertations with a sharpened research arsenal. They become adept at navigating academic databases, critically analysing sources , and constructing a robust argument that contributes to their chosen field.

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Cultivating Critical Thinking & Analysis

Coursework and dissertations both encourage critical thinking and analysis, fostering an inquisitive intellectual spirit.  Through coursework assignments, students learn to:

Challenge Assumptions

Effective coursework often involves examining established ideas and perspectives. Students are encouraged to analyse arguments critically, identify potential biases , and form their own informed opinions.

This critical thinking skill becomes crucial in the dissertation stage, where students must critically evaluate existing research within their chosen field.

Analyse Evidence

Coursework assignments often involve interpreting data, weighing arguments, and drawing conclusions based on evidence. This ability to analyse evidence effectively paves the way for the rigorous research methodologies employed in dissertation writing.

Form Independent Judgements

Coursework discussions and assignments encourage students to engage with diverse viewpoints and develop their own well-reasoned arguments.

This ability to think independently and form independent judgments proves invaluable in dissertation research, where students must make original contributions to their field.

By cultivating these critical thinking skills, coursework prepares students for the independent research journey that forms the core of a dissertation.

Structure & Organisation

Both coursework assignments and dissertations adhere to established academic structures. This focus on organisation helps students develop clear communication skills and ensures the clarity and coherence of their work.

Logical Structure

Both coursework and dissertations follow a logical structure, typically starting with an introduction , progressing through well-developed body paragraphs, and concluding with a strong summary. This format ensures a clear flow of information and facilitates reader comprehension.

Proper Citation

Effective academic writing demands proper citation practices .  Coursework assignments provide students with opportunities to practice essential citation styles such as APA, Harvard , or MLA. These skills are crucial for accurately referencing sources in a dissertation and avoiding plagiarism.

By mastering these structural elements, students learn to present their ideas in a clear and organised manner – a valuable skill that carries over into professional writing and research pursuits.

Coursework and dissertations are not isolated entities; they represent different stages along the path to academic success. Coursework provides the foundation of knowledge and hone the research and writing skills that are essential for crafting a compelling dissertation. 

The skills and knowledge gained through coursework empower students to tackle the challenges of in-depth research and critical analysis demanded by a dissertation.

Conclusively, coursework and dissertations share a symbiotic relationship. Coursework equips students with the tools they need to complete their dissertations. 

Frequently Asked Questions

How are coursework and dissertation similar.

Coursework and dissertations are both academic tasks requiring independent research and critical analysis. Both involve structured writing, referencing, and adhering to academic standards. They contribute significantly to a student’s final grade, assessing their understanding of a subject and ability to synthesise information. Both demand rigorous attention to detail and academic integrity.

What is the difference between coursework research and dissertation?

Coursework research typically involves shorter, structured assignments focusing on specific topics within a course. Dissertations, however, are in-depth, independent research projects undertaken at the culmination of a degree program, requiring original research, critical analysis, and contribution to existing knowledge in the field, often spanning many months.

What are the similarities between dissertation and thesis?

Dissertations and theses share similarities as scholarly research projects. Both involve in-depth investigation, critical analysis, and contribution to existing knowledge in a field. They require rigorous research methodology, extensive literature review, and adherence to academic standards. Additionally, both culminate in a formal written document defending the author’s findings.

Is dissertation part of coursework?

Typically, a dissertation is not considered part of coursework. Coursework generally refers to the structured assignments, projects, and assessments completed during a course. A dissertation is a separate, extensive research project undertaken at the end of a degree program, often representing a significant portion of the program’s requirements.

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Whats the different in coursework and research?

I heard there are coursework and research for taking Master but are there any different?

Isn't both of them are about making research papers?

• Masters degrees in what country? –  Nobody Commented Jun 4, 2018 at 7:36
• In Malaysia, although I don't think there are any different. –  Daniel Mana Commented Jun 4, 2018 at 7:51
• Hope this answer is helpful to you. –  Nobody Commented Jun 4, 2018 at 7:57

With a course there is a teacher that teaches you specific topics. You may need that to write a research paper, and the teacher may test your knowledge by letting you do or simulate a research project, but that is secondary. In a course there is a teacher that guides your learning process, and the learning goal is typically more limited.

A research project is more open ended, there is typically a faculty member that coaches you through the process, but now you are the primary actor.

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Postgraduate Study - What is the difference between coursework and research degrees?

What are the differences between postgraduate coursework and postgraduate research degrees.

Postgraduate degrees by coursework offer the opportunity for advanced study in a particular field or related fields through a combination of core and elective subjects. Students enrolled in postgraduate coursework degrees normally spend a majority of their time undertaking coursework and submitting related assignments but may also be required to write a minor thesis.

In most coursework subjects you will go to timetabled classes but some postgraduate courses and subjects are now available on line. In comparison, graduate research degrees require a candidate to spend a majority of their time undertaking research under the direction of a supervisor culminating in the submission of a thesis of up to 80,000 words for a PhD and 40,000 for a Master's by research. At Master's level the thesis will demonstrate competence in the design and conduct of a research project that includes the understanding of recent developments in the discipline. A PhD thesis will demonstrate a substantial body of knowledge at the frontier of a field of research or learning, including knowledge that constitutes an original contribution.

Candidates enrolled in professional doctorates normally undertake a year's coursework related to their profession before undertaking their research project. Some master's by research and PhD candidates will also undertake some coursework to support their research project.

Your progress during a graduate research degree is assessed through reports to research progress panels.

The Graduate Research School website has more information.

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Masters by Dissertation vs. Coursework Masters

If you’re studying psychology and looking to register as a psychologist in the future, it is likely that you’ve heard about the above-mentioned qualifications. To clear up any misconceptions about these types of masters programmes, Cognition & Co have put together the following article highlighting the differences between them;

Masters by Dissertation:

A Masters by Dissertation is a purely academic M degree whereby students are required to conduct research that culminates in a dissertation. Different universities call these qualifications by different names (Academic Masters / Masters by Research, etc), however they all follow a similar format.

Most of these programmes can be done part-time through distance learning institutions however students will need to be in contact with their allocated supervisor. A supervisors’ role is to help, support and guide students through their research, ensuring the quality of the dissertation.

While a Masters by Dissertation is heavily research orientated, these degrees are different to a Research Masters degree in South Africa. A Research Masters is a full-time (sometimes part-time) coursework programme offered by some universities ( Wits ) which can lead to an HPCSA registration as a Research Psychologist .

Unlike a Research Masters, a Masters by Dissertation does not lead to registration with the HPCSA. Even once a student has completed a Masters by Dissertation, they are still not allowed to call themselves a Psychologist, nor will they be able to counsel clients, regardless of their dissertation topic or title.

These degrees are highly valued in academic circles and would certainly put any graduate in good stead to work in some form of higher education. Completing a dissertation also opens doors in terms of publishing one’s dissertation and having that accolade added to one’s portfolio.

Coursework Masters:

In order to become an HPCSA registered Psychologist in South Africa, students will need to complete a Masters Degree that includes a coursework aspect, as well as a dissertation. These are typically all full-time programmes (except some Research Masters) where students will spend their time between classes and supervision on a university campus, as well as at practicals in hospitals, clinics, or schools.

Again, universities may call these coursework programmes by different names (sometimes called Professional Masters), but they are typically M degrees in a specialized area of psychology. These specialized areas are defined by the HPCSA and are broken into different registered categories; i.e. Clinical , Counselling , Educational , Industrial , Research , and more recently Neuropsychology .

The duration of a coursework degree is also specific to the different universities. Many universities offer these degrees over a period of two years, however there are a number of universities that allow students to complete both their coursework and dissertation in just one year. Once a student has completed their 1 or 2 years of coursework, they may then register with the HPCSA as an Intern Psychologist and begin their 1 year internship. Following the completion of a 1 year internship, graduates may write their respective board exam with the HPCSA and upon passing will receive the title; Psychologist.

It is also important to note that students following the route ending in registration as a Clinical Psychologist, will also need to complete one year of community service once they have successfully passed their board exams .

To find out more about the route to becoming a Psychologist in South Africa, click the link provided above. Students are also welcome to contact us with questions or queries by clicking here .

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What is the Difference Between Coursework and Research?

Why is this? Coursework is the units a student has to take in order to graduate from a college or university. It includes coursework in mathematics, English, humanities, and social science. In comparison, research is a single student’s project, or series of projects, which may take longer to complete, but does not necessarily contain coursework or reading.

Why is there such a difference? In large part, it is because of the different types of learning that take place in each. Coursework typically is a group activity, which is facilitated by a teacher, a professor, and other students in a classroom. In this type of learning, the focus is on obtaining knowledge for learning purposes. As such, it tends to produce more cognitive and communicative skills than doing much research, which tends to be more interest-based in nature.

However, the types of learning and teaching methods may differ depending on which type of course the teacher is using. In addition, some types of research are held outside of a classroom, although some professors still do hold courses in classrooms. Some types of coursework and research also require group participation, but not as much as doing independent studies. Because there are so many types of these activities, then, what is the difference between coursework and research can actually depend upon what type of activity is being undertaken.

One type of activity that is frequently considered what is the difference between coursework and research would be an essay. An essay, unlike a reading or a study, requires that the student compose and present an argument or a series of points that they will then support with evidence. Since most professors and classmates are usually involved in some way with the creation of the essay, students are encouraged to read and understand their assignments well before the start of the class. The process may entail the submission of essays to a thesis committee, the development of individual essays, or a combination of the two.

Another activity that is often what is the difference between coursework and research is the use of case studies. This is especially true for courses in the humanities, as most humanities courses tend to require a large amount of research in the form of anecdote, reflection, or personal anecdotes. Students may find themselves drawn to what is the difference between coursework and research because the latter involves the use of logic and evidence while the former often relies on more subjective and emotional factors. For instance, students may be required to draw a picture of their professor. In this case, what is the difference between coursework and research is that the assignment is for students to use this picture to further examine their instructor’s arguments or to argue a point of view on their own.

Of course, what is the difference between coursework and research is also determined by what is the difference between coursework and student projects. Most college students are required to read a variety of books and complete coursework in order to gain a specific degree. For some, this may seem like too much work but for others, it is simply the method that were used by their professors. With a project based course, students are required to do their coursework alone, submit their assignments to their professors, and do research related to their assignment. While this certainly isn’t as time consuming as a traditional class course, it still requires students to take the time to think and explore. Students also must often spend time in the library or elsewhere doing research in order to learn what is the difference between coursework and research.

Finally, what is the difference between coursework and research is also determined by what is the difference between what students are required to do and what they are given to do. Most students are required to read a variety of texts, complete a series of essays, write a paper, participate in a debate or group project, and read a final exam. What is the difference between coursework and research is that while students are expected to do all of these things, they are also often given a limited number of hours to do so. In many cases, students are only allowed to do the research on their own time.

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Course vs Coursework: Meaning And Differences

When it comes to education, the terms “course” and “coursework” are often used interchangeably. However, they have distinct meanings and it’s important to understand the difference between the two.

We should clarify that both words are proper and can be used appropriately depending on the context.

A course refers to a series of lessons or lectures on a particular subject, often leading to a qualification or certification. It can be taken in person or online and may include assignments, exams, or projects to assess learning.

On the other hand, coursework typically refers to the specific assignments, projects, or essays that are completed as part of a course. It is the practical work that students must complete in addition to attending lectures or lessons.

Understanding the difference between these two terms is essential for anyone pursuing education or looking to communicate effectively about their academic experiences.

In the following sections, we will explore the nuances between courses and coursework, including how they differ in terms of structure, purpose, and assessment.

Define Course

A course is a unit of study offered by an educational institution that typically lasts for a specific period of time and leads to the attainment of a degree, diploma, or certificate. It is a structured program of learning that covers a particular subject or topic and is designed to provide students with the knowledge, skills, and competencies required to succeed in their chosen field.

Courses can be offered in a variety of formats, including online, in-person, or hybrid models. They can range in length from a few weeks to several months or even years, depending on the level of study and the requirements of the program. Courses can also be categorized into different levels, such as introductory, intermediate, or advanced, depending on the complexity of the subject matter.

Define Coursework

Coursework refers to the assignments, projects, and assessments that students are required to complete as part of a course. It is the practical application of the knowledge and skills learned in the classroom and is designed to assess a student’s understanding of the subject matter.

Coursework can take many forms, including essays, reports, presentations, exams, and practical tasks. It is typically graded and contributes to a student’s overall grade or GPA. Coursework can also be used to develop a student’s research, critical thinking, and problem-solving skills, as well as their ability to work independently or as part of a team.

Coursework can be completed individually or in groups, and can be submitted in various formats, such as hard copy, online, or through a learning management system. It is an integral part of the learning process and is designed to help students apply what they have learned in a practical and meaningful way.

How To Properly Use The Words In A Sentence

Proper usage of words is essential in any form of writing, especially when it comes to academic writing. In this section, we will discuss how to use the words “course” and “coursework” correctly in a sentence.

How To Use “Course” In A Sentence

The word “course” has multiple meanings, but when used in the context of education, it refers to a series of lessons or lectures on a particular subject. Here are some examples of how to use “course” correctly:

• I am taking a course in biology this semester.
• The course on Shakespearean literature was very challenging.
• She completed her course on web design with flying colors.

As seen in the examples above, “course” is used to refer to a specific class or subject of study. It is important to note that “course” can also refer to a path or direction, such as in the following sentence:

• The hurricane changed course and headed towards the east coast.

How To Use “Coursework” In A Sentence

The word “coursework” refers to the assignments and tasks that students are required to complete as part of a course. Here are some examples of how to use “coursework” correctly:

• The professor assigned a lot of coursework for the semester.
• She spent all weekend working on her coursework for the marketing class.
• His coursework in physics included several lab reports and a research paper.

As seen in the examples above, “coursework” is used to refer to the various assignments and tasks that are part of a course. It is important to note that “coursework” is a non-count noun, meaning that it cannot be pluralized.

More Examples Of Course & Coursework Used In Sentences

In order to fully understand the difference between course and coursework, it is important to see how they are used in context. Here are some examples of how both words can be used in a sentence:

Examples Of Using Course In A Sentence

• She is currently taking a course on digital marketing.
• The golf course was in pristine condition for the tournament.
• He had to drop out of the course due to scheduling conflicts.
• The university offers a wide range of courses in various subjects.
• After completing the course, she received a certificate of completion.
• The new employee had to go through a training course before starting work.
• The history course was taught by a renowned professor.
• The online course was accessible from anywhere with an internet connection.
• The course material was challenging but informative.
• He decided to audit the course instead of receiving a grade.

Examples Of Using Coursework In A Sentence

• Her coursework in college focused on environmental science.
• The final grade for the class was based on coursework and a final exam.
• He spent hours each night working on his coursework for the MBA program.
• The coursework included a research project and a group presentation.
• She struggled to keep up with the coursework in her advanced math class.
• The coursework for the online degree program was completed entirely online.
• He was able to transfer some of his previous coursework to the new university.
• The coursework was designed to be completed over a 12-week period.
• She received a high grade on her coursework for the architecture class.
• The coursework for the nursing program included both classroom and clinical components.

Common Mistakes To Avoid

When it comes to using the terms course and coursework, many people make the mistake of using them interchangeably. However, these two words have distinct meanings and should not be used in place of each other. Here are some common mistakes to avoid:

Mistake #1: Using “Course” To Refer To A Specific Assignment Or Project

One common mistake people make is using the word “course” to refer to a specific assignment or project. For example, saying “I have a course due tomorrow” instead of “I have coursework due tomorrow.” The word “course” refers to the entire class or program of study, while “coursework” refers to the individual assignments and projects within that class.

Mistake #2: Using “Course” As A Synonym For “Program”

Another mistake is using “course” as a synonym for “program.” For example, saying “I’m enrolled in a business course” instead of “I’m enrolled in a business coursework program.” The word “course” refers to a single class, while “coursework” refers to the entire program of study.

Mistake #3: Using “Coursework” To Refer To A Single Class

On the flip side, some people make the mistake of using “coursework” to refer to a single class. For example, saying “I have to study for my coursework” instead of “I have to study for my calculus course.” Coursework refers to the assignments and projects within a class, while “course” refers to the class itself.

Tips To Avoid These Mistakes

• Be mindful of the context in which you are using these words.
• Double-check your usage of “course” and “coursework” to ensure that you are using the correct term.
• If in doubt, consult a dictionary or style guide for clarification.

Context Matters

When it comes to choosing between the terms “course” and “coursework,” the context in which they are used can play a significant role. While both terms are related to education and learning, they have distinct differences that can affect how they are used in different situations.

A course is typically defined as a series of classes or lectures on a specific subject, usually taken by students in pursuit of a degree or certification. It can also refer to a specific subject or topic of study, such as a math course or a literature course. In this context, the term “course” is often used to refer to a structured program of study that has a clear beginning and end.

For example, a college student might enroll in a biology course as part of their degree program. The course would consist of a series of lectures, assignments, and exams that are designed to provide a comprehensive understanding of the subject matter. In this context, the term “course” is appropriate because it refers to a specific program of study that has a clear structure and purpose.

Coursework, on the other hand, refers to the assignments, projects, and other tasks that are assigned to students as part of a course. It can include everything from written essays to lab reports to group projects. In this context, the term “coursework” is often used to refer to the practical work that students are expected to complete as part of their studies.

For example, a student enrolled in a biology course might be assigned coursework that includes conducting experiments in a lab, writing research papers on specific topics, and giving presentations on their findings. In this context, the term “coursework” is appropriate because it refers to the practical work that is assigned to students as part of their studies.

Contextual Examples

The choice between course and coursework can depend on the context in which they are used. Here are some examples of different contexts and how the choice between course and coursework might change:

• Academic Setting: In an academic setting, the term “course” is often used to refer to a specific program of study, while “coursework” is used to refer to the practical work that is assigned to students as part of that program.
• Professional Setting: In a professional setting, the term “course” might be used to refer to a training program or workshop, while “coursework” might be used to refer to the specific assignments or projects that are assigned as part of that training.
• Online Learning: In an online learning environment, the term “course” might be used to refer to a self-paced program of study, while “coursework” might be used to refer to the specific assignments or projects that are assigned as part of that program.

Overall, the choice between course and coursework can depend on the context in which they are used. Understanding the differences between these terms can help you communicate more effectively in different educational and professional settings.

Exceptions To The Rules

While the rules for using course and coursework are generally straightforward, there are a few exceptions to keep in mind.

1. Colloquial Language

When speaking informally or using colloquial language, the rules for using course and coursework may not be as strict. In these cases, it is more important to convey your meaning clearly than to adhere to strict grammar rules.

For example, in casual conversation, it is acceptable to say “I’m taking a course in history” or “I have a lot of coursework to do this semester,” even if technically the word “coursework” should only be used to refer to the assignments and projects associated with a course.

2. Regional Differences

There may be regional differences in the use of course and coursework. In some areas or dialects, one word may be used more frequently or in a slightly different way than in others.

For example, in British English, the word “coursework” is more commonly used to refer to the assignments and projects associated with a course, while in American English, the word “coursework” may also be used to refer to the entire course itself.

3. Technical Jargon

In certain fields or industries, there may be technical jargon or specific terminology that uses the words course or coursework in a different way than the general rules dictate.

For example, in the field of education, the term “course of study” may be used to refer to the specific classes and requirements for a degree program, rather than to individual courses. In this context, the word “course” would not be interchangeable with “coursework.”

4. Idiomatic Expressions

There are also some idiomatic expressions that use the words course or coursework in a non-literal way. These expressions may not follow the usual rules for using the words.

For example, the phrase “stay the course” means to persevere or continue on a particular path, even in the face of obstacles or challenges. This usage of the word “course” is not related to a specific academic class or program.

While the rules for using course and coursework may seem simple, there are exceptions to keep in mind. In some cases, colloquial language, regional differences, technical jargon, or idiomatic expressions may cause the words to be used in a different way than the general rules dictate.

Practice Exercises

One of the best ways to improve your understanding and use of course and coursework is through practice exercises. These exercises will help you to apply the concepts you have learned and to identify any areas where you may need further clarification.

Exercise 1: Fill In The Blank

Complete the following sentences with either course or coursework:

• After completing the ______, students will receive a certificate of completion.
• He decided to change his major halfway through his ______.
• She is currently enrolled in a ______ on business writing.
• The ______ of study for this degree program is four years.
• The professor assigned a new ______ each week.

Answer Key:

Exercise 2: Multiple Choice

Choose the correct option to complete each sentence:

• ______ is the material that is covered in a class.
• b. coursework
• ______ refers to the specific assignments and projects that are completed in a class.
• Which of the following is an example of coursework?
• a. Attending lectures
• b. Taking quizzes
• c. Writing a research paper
• d. All of the above

By completing these practice exercises, you will be able to improve your understanding and use of course and coursework. Remember to always refer back to the definitions and examples provided to ensure that you are using these terms correctly in your writing and communication.

In conclusion, the difference between course and coursework is significant and should not be overlooked. While a course refers to a series of classes or lectures on a particular subject, coursework is the work assigned to students as part of the course. It is essential to understand this difference to avoid confusion and use the terms correctly.

Moreover, the proper use of grammar and language is crucial in any form of writing, whether academic or professional. It is essential to pay attention to the details and nuances of the language to convey the intended message effectively.

Therefore, readers are encouraged to continue learning about grammar and language use to improve their writing skills. There are numerous resources available online, such as grammar guides, style manuals, and writing courses, that can help individuals enhance their language skills.

Key Takeaways

• A course refers to a series of classes or lectures on a particular subject.
• Coursework is the work assigned to students as part of the course.
• The difference between course and coursework is significant and should not be overlooked.
• The proper use of grammar and language is crucial in any form of writing, whether academic or professional.
• Readers are encouraged to continue learning about grammar and language use to improve their writing skills.

Shawn Manaher is the founder and CEO of The Content Authority. He’s one part content manager, one part writing ninja organizer, and two parts leader of top content creators. You don’t even want to know what he calls pancakes.

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What Is Research? Types and Methods

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What Is Research? Types and Methods was originally published on Forage .

Research is the process of examining a hypothesis to make discoveries. Practically every career involves research in one form or another. Accountants research their client’s history and financial documents to understand their financial situation, and data scientists perform research to inform data-driven decisions. 

In this guide, we’ll go over: 

Research Definition

Types of research , research methods, careers in research, showing research skills on resumes.

Research is an investigation into a topic or idea to discover new information. There’s no all-encompassing definition for research because it’s an incredibly varied approach to finding discoveries. For example, research can be as simple as seeking to answer a question that already has a known answer, like reading an article to learn why the sky is blue. 

Research can also be much broader, seeking to answer questions that have never before been asked. For instance, a lot of research looks for ways to deepen our collective understanding of social, physical, and biological phenomena. Besides broadening humanity’s knowledge, research is a great tool for businesses and individuals to learn new things.

Why Does Research Matter?

While some research seeks to uncover ground-breaking information on its own, other research forms building blocks that allow for further development. For example, Tony Gilbert of the Masonic Medical Research Institute (MMRI) says that Dr. Gordon K. Moe, a co-founder and director of research at MMRI, led early studies of heart rhythms and arrhythmia.  

Gilbert notes that this research “allowed other scientists and innovators to develop inventions like the pacemaker and defibrillator (AED). So, while Dr. Moe did not invent the pacemaker or the AED, the basic research produced at the MMRI lab helped make these devices possible, and this potentially benefitted millions of people.”

Of course, not every researcher is hunting for medical innovations and cures for diseases. In fact, most companies, regardless of industry or purpose, use research every day.  

“Access to the latest information enables you to make informed decisions to help your business succeed,” says Andrew Pickett, trial attorney at Andrew Pickett Law, PLLC.

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Scientific Research

Scientific research utilizes a systematic approach to test hypotheses. Researchers plan their investigation ahead of time, and peers test findings to ensure the analysis was performed accurately. 

Foundational research in sciences, often referred to as “basic science,” involves much of the research done at medical research organizations. Research done by the MMRI falls into this category, seeking to uncover “new information and insights for scientists and medical researchers around the world.”

Scientific research is a broad term; studies can be lab-based, clinical, quantitative, or qualitative. Studies can also switch between different settings and methods, like translational research. 

“Translational research moves research from lab-settings to the settings in which they will provide direct impact (for example, moving bench science to clinical settings),” says Laren Narapareddy, faculty member and researcher at Emory University.

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Historical Research

Historical research involves studying past events to determine how they’ve affected the course of time, using historical data to explain or anticipate current and future events, and filling in gaps in history. Researchers can look at past socio-political events to hypothesize how similar events could pan out in the future.  

However, historical research can also focus on figuring out what actually happened at a moment in time, like reading diary entries to better understand life in England in the 14th century. 

In many ways, research by data, financial, and marketing analysts can be considered historical because these analysts look at past trends to predict future outcomes and make business decisions. 

User Research

User research is often applied in business and marketing to better understand a customer base. Researchers and analysts utilize surveys, interviews, and feedback channels to evaluate their clients’ and customers’ wants, needs, and motivations. Analysts may also apply user research techniques to see how customers respond to a product’s user experience (UX) design and test the efficacy of marketing campaigns. 

>>MORE: See how user and market research inform marketing decisions with Lululemon’s Omnichannel Marketing Job Simulation .

Market Research

Market research utilizes methods similar to user research but seeks to look at a customer base more broadly. Studies of markets take place at an intersection between economic trends and customer decision-making. 

Market research “allows you to stay up-to-date with industry trends and changes so that you can adjust your business strategies accordingly,” says Pickett. 

A primary goal in market research is finding competitive advantages over other businesses. Analysts working in market research may conduct surveys, focus groups, or historical analysis to predict how a demographic will act (and spend) in the future. 

Other Types of Research

The world of research is constantly expanding. New technologies bring new ways to ask and answer unique questions, creating the need for different types of research. Additionally, certain studies or questions may not be easily answered by one kind of research alone, and researchers can approach hypotheses from a variety of directions. So, more niche types of research seek to solve some of the more complex questions. 

For instance, “multidisciplinary research brings experts in different disciplines together to ask and answer questions at the intersection of their fields,” says Narapareddy.

Research doesn’t happen in a bubble, though. To foster better communication between researchers and the public, types of research exist that bring together both scientists and non-scientists. 

“Community-based participatory research is a really important and equitable model of research that involves partnerships among researchers, communities and organizations at all stages of the research process,” says Narapareddy.

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Regardless of the type of research or the study’s primary goal, researchers usually use quantitative or qualitative methods. 

Qualitative Methods

Qualitative research focuses on descriptive information, such as people’s beliefs and emotional responses. Researchers often use focus groups, interviews, and surveys to gather qualitative data. 

This approach to research is popular in sociology, political science, psychology, anthropology, and software engineering . For instance, determining how a user feels about a website’s look isn’t easily put into numbers (quantitative data). So, when testing UX designs, software engineers rely on qualitative research. 

Quantitative Methods

Quantitative research methods focus on numerical data like statistics, units of time, or percentages. Researchers use quantitative methods to determine concrete things, like how many customers purchased a product. Analysts and researchers gather quantitative data using surveys, censuses, A/B tests, and random data sampling. 

Practically every industry or field uses quantitative methods. For example, a car manufacturer testing the effectiveness of new airbag technology looks for quantitative data on how often the airbags deploy properly. Additionally, marketing analysts look for increased sales numbers to see if a marketing campaign was successful. 

Mixed-Methods

Answering a question or testing a hypothesis may require a mixture of qualitative and quantitative methods. To see if your customers like your website, for instance, you’ll likely apply qualitative methods, like asking them how they feel about the site’s look and visual appeal, and quantitative methods, like seeing how many customers use the website daily. Research that involves qualitative and quantitative methods is called mixed-method research. 

Researching ideas and hypotheses is a common task in many different careers. For example, working in sales requires understanding quantitative research methods to determine if certain actions improve sales numbers. Some research-intensive career paths include:

• Data science
• Investment banking
• Product management
• Civil rights law
• Actuarial science  

Working in Research

Once you have the fundamentals of researching down, the subject matter may evolve or change over the course of your career. 

“My first research experience was assessing fall risk in firefighters — and I now use multi-omic methods [a type of molecular cell analysis] to understand fertility and reproductive health outcomes in women,” notes Narapareddy.

For those considering a career in research, it’s important to “take the time to explore different research methods and techniques to gain a better understanding of what works best for them,” says Pickett. 

Remember that research is exploratory by nature, so don’t be afraid to fail. 

“The work of scientists who came before us helps guide the path for future research, including both their hits and misses,” says Gilbert.

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You can show off your research skills on your resume by listing specific research methods in your skills section. You can also call out specific instances you used research skills, and the impact your research had, in the description of past job or internship experiences. For example, you could talk about a time you researched competitors’ marketing strategies and used your findings to suggest a new campaign. 

Your cover letter is another great place to discuss your experience with research. Here, you can talk about large-scale research projects you completed during school or at previous jobs and explain how your research skills would help you in the job you’re applying for. If you have experience collecting and collating data from research surveys during college, for instance, that can translate into data analysis and organizational skills. 

Grow your skills and get job-ready with Forage’s free job simulations . 

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The Link Between Climate and Health: We Chart a New Course

We now know that climate change is the biggest health threat we face. Climate risks are escalating faster than anticipated, causing the prevalence and severity of existing and emerging diseases to skyrocket ౼ ultimately, pushing healthcare systems around the world to the brink. While awareness of the environmental impact on human health is growing, a research gap hinders decision makers from designing effective strategies that will make a real difference.

The link between planet health and human health.

At Sanofi, we understand the power of data ౼ the way that objective, concrete numbers can reinforce a message that needs to be heard, a story that needs to be told. Which is why we conducted an extensive internal research project to generate data and bridge gaps in existing research. We began by evaluating thousands of published reports before focusing on 200 studies meeting extremely stringent criteria. These studies demonstrated a clear link between environmental outcomes and our specific disease areas of interest. Why? To generate data needed to guide our initiatives and inform our strategy, to drive maximum and sustainable impact and to send a message to our own Sanofians, stakeholders, partners and beyond.

The research clear underscores that health of people and the planet are intrinsically linked. As an industry, we must forge collaborative, multi-sectoral partnerships to develop sustainable solutions for climate change and to minimize its impact on human health – for the sake of our planet and its people.

As a longtime industry pioneer and leader, Sanofi has the expertise and credibility to drive real change. Which is why we focused this study not only on external influences, but also on our portfolio and our pipeline, in order to generate the data we need to drive internal action and impact the way we make decisions.

Sandrine Bouttier-Stref

Sanofi Head of Corporate Social Responsibility

Digging into the Details

Our review of published studies focused specifically on the relationship between climate change and health by analyzing the impact of environmental hazards on disease outcomes focusing on:

5 therapeutic areas

65 indications, 5 environmental hazards.

The results were unmistakable: 70% of existing Sanofi indications and 78% of the R&D pipeline indications are impacted by environmental hazards . This data is now helping to inform our R&D practices, pipeline discussions and overall strategy. In particular, we are integrating our learnings into our comprehensive, holistic strategy aimed at tackling climate change's health challenges and strengthening healthcare ecosystems.

Developing Innovative Medicines and Vaccines

We were encouraged by internal study findings revealing that 84% of our R&D pipeline products (from phase 2 to registration) target diseases impacted by climate change factors. “ This data solidifies our position at the forefront, actively tackling the health impacts of climate change. By integrating environmental considerations throughout our entire process, from research to patient care, we’ll continue to address these evolving health challenges ,” says Bouttier- Stref.

Driving Coordinated Action

The climate crisis is not directly attributable to one action, community, or industry. And it can’t be solved by a single initiative or entity. To create a truly sustainable change and to change the trajectory of the impact on human health, we must break down silos and work collectively. By harnessing the power of cross sector partnerships and engaging on a global, regional, and local level, we are able to leverage strengths and expertise to drive innovative solutions to combat this global threat.

Given our global presence and the expertise we have cultivated over the years, Sanofi is in a unique position to rally experts together and encourage these bright minds from all around the world to unite and address this crisis together.

Strengthening Healthcare Ecosystems for Sustainable Change

As the world grapples with climate change, its burden often falls heaviest on vulnerable communities least able to respond. Beyond the direct impacts, such as floods and droughts, indirect consequences can include access to healthy food, education and even basic healthcare. As a leading pharmaceutical company, we're working to ensure the entire global healthcare system is bracing for the impacts of climate change. 

We are convinced that new patient care pathways are necessary to ensure that everyone has access to healthcare services. Telemedicine is one opportunity to do so ౼ virtual medical appointments not only decarbonize the patient care pathway, but can also improve the care experience itself. Unfortunately, not all healthcare insurers reimburse telemedicine appointments. 

“ One of Sanofi’s key roles in strengthening healthcare ecosystems is our work with governments, ministers of health, and, in this instance, insurers ,” says Bouttier-Stref. “ In Cairo Egypt, for example, we're actively working with an entire ecosystem of players to make telemedicine appointments reimbursable – thereby transforming healthcare delivery for vulnerable populations .”

Mitigating Our Impact

Our fight against climate change starts with our Planet Care strategy, a multi-faceted approach to reducing CO2 emissions across our entire operation. This includes eco-design initiatives that minimize the environmental impact of our products throughout their lifecycle, from manufacturing to disposal. Additionally, Foundation S, Sanofi’s philanthropic organization, is focused on adaption initiatives to climate change for vulnerable communities.

As we look to the future, bolstered with the knowledge of the critical link between climate change and health, we will continue to reinforce our holistic approach to addressing future health impacts. At Sanofi, we are leaders in developing innovative treatments, driving collective action, strengthening healthcare ecosystems and mitigating our own impact. Paired with our global reach, disease expertise and the commitment of Sanofians around the world, we have the power and credibility to make a real difference in the future of our industry.

Comprehensive genomic profiling of ESR1 , PIK3CA , AKT1 , and PTEN in HR(+)HER2(−) metastatic breast cancer: prevalence along treatment course and predictive value for endocrine therapy resistance in real-world practice

• Open access
• Published: 14 June 2024

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• Manali A. Bhave 1   na1 ,
• Julia C. F. Quintanilha 2   na1 ,
• Hanna Tukachinsky 2 ,
• Gerald Li 2 ,
• Takara Scott 2 ,
• Jeffrey S. Ross 2 , 3 ,
• Lincoln Pasquina 2 ,
• Richard S. P. Huang 2 ,
• Heather McArthur 4 ,
• Mia A. Levy 2 , 5 ,
• Ryon P. Graf 2 &
• Kevin Kalinsky 1  

The treatment landscape for HR(+)HER2(−) metastatic breast cancer (MBC) is evolving for patients with ESR1 mutations (mut) and PI3K/AKT pathway genomic alterations (GA). We sought to inform clinical utility for comprehensive genomic profiling (CGP) using tissue (TBx) and liquid biopsies (LBx) in HR(+)HER2(−) MBC.

Records from a de-identified breast cancer clinicogenomic database for patients who underwent TBx/LBx testing at Foundation Medicine during routine clinical care at ~ 280 US cancer clinics between 01/2011 and 09/2023 were assessed. GA prevalence [ ESR1 mut, PIK3CA mut, AKT1 mut, PTEN mut, and PTEN homozygous copy loss ( PTEN loss)] were calculated in TBx and LBx [stratified by ctDNA tumor fraction (TF)] during the first three lines of therapy. Real-world progression-free survival (rwPFS) and overall survival (rwOS) were compared between groups by Cox models adjusted for prognostic factors.

 ~ 60% of cases harbored 1 + GA in 1st-line TBx (1266/2154) or LBx TF ≥ 1% (80/126) and 26.5% (43/162) in LBx TF < 1%. ESR1 mut was found in 8.1% TBx, 17.5% LBx TF ≥ 1%, and 4.9% LBx TF < 1% in 1st line, increasing to 59% in 3rd line (LBx TF ≥ 1%). PTEN loss was detected at higher rates in TBx (4.3%) than LBx (1% in TF ≥ 1%). Patients receiving 1st-line aromatase inhibitor + CDK4/6 inhibitor ( n  = 573) with ESR1 mut had less favorable rwPFS and rwOS versus ESR1 wild-type; no differences were observed for fulvestrant + CDK4/6 inhibitor ( n  = 348).

Our study suggests obtaining TBx for CGP at time of de novo/recurrent diagnosis, followed by LBx for detecting acquired GA in 2nd + lines. Reflex TBx should be considered when ctDNA TF < 1%.

Avoid common mistakes on your manuscript.

Introduction

The standard of care (SOC) for HR(+)HER2(−) metastatic breast cancer (MBC) is evolving with the introduction of new biomarker-guided drugs, including novel selective estrogen receptor degraders (SERDs) for patients with ESR1 mutations ( ESR1 mut) and PIK3CA and AKT inhibitors for patients with alterations in the PI3K/AKT pathway ( PIK3CA , AKT1 , and PTEN ), as well as next-generation PI3K inhibitors. Endocrine therapy (ET) with an aromatase inhibitor (AI) is typically the first option for patients with de novo and ET-naïve MBC or for MBC tumors that have recurred at least 12 months from their adjuvant ET. A SERD is usually the first option for MBC patients with early recurrence on adjuvant AI. More recently, capivasertib, an AKT inhibitor, was approved and is now recommended by the National Comprehensive Cancer Network (NCCN) guidelines to be added to ET for patients with PI3K/AKT pathway-driven tumors, including cases with activating mutations in AKT1 ( AKT1 mut), PIK3CA ( PIK3CA mut), or PTEN alterations, whose disease has progressed on one or more ET-based regimens in the metastatic setting or who have experienced recurrence during or within 12 months of completing adjuvant therapy [ 1 ].

Although most HR(+)HER2(−) MBC benefit from 1st-line ET, second-line ET monotherapy has shown limited efficacy likely due to acquired resistance mechanisms [ 2 ]. ESR1 mut has been identified as the main acquired resistance mechanism to ET [ 3 , 4 ] and have been reported in approximately 20–40% of AI-treated patients with MBC varying by sites of metastatic disease [ 5 ]. ESR1 is a transcription factor that codes for the estrogen receptor (ER) alpha protein, and ESR1 mut may result in constitutive activation of the ER pathway unaffected by AI depletion of estrogen [ 2 ]. Guidelines from both the American Society of Clinical Oncology (ASCO) and the NCCN now recommend ESR1 mut testing in either tissue or liquid samples at recurrence or progression on ET [ 1 , 6 ] based on the EMERALD trial results which showed improved clinical outcomes with elacestrant compared to SOC endocrine therapy for patients with ESR1 mut detected by ctDNA [ 7 ].

Several completed and ongoing clinical trials attempt to investigate the role of acquired ESR1 mut in patients with HR(+)HER2(−) MBC receiving ET treatment and its implications for optimizing first and subsequent lines of therapy. In the PADA-1 trial, patients receiving AI + CDK 4/6 inhibitor (CDK4/6i) were screened every two months for ESR1 mut [ 2 ]. Patients whose tumors had an ESR1 mut detected and subsequently switched to another ET backbone before clinical radiologic disease progression had better progression-free survival (PFS) than those who only shifted treatment upon clinical progression [ 2 ].

Previous studies have shown that ESR1 mut prevalence is only 1.5–7% in recurrent BC after prior adjuvant or neoadjuvant AI and less than 1% in ET-naïve MBC [ 5 ]. The clinical utility of ESR1 mut detection before 1st-line MBC treatment is not well defined. ESR1 mut prevalence is known to depend on prior duration of AI therapy, but additional data regarding the prevalence of ESR1 mut in real-world patient populations are needed. Moreover, the emergence of novel targeted therapies, such as capivasertib for PI3K/AKT pathway-altered tumors, raises questions about the co-prevalence of alterations in ESR1 and the PI3K/AKT pathway throughout the treatment course.

In an effort to aid optimal considerations for somatic genomic testing in HR(+)HER2(−) MBC, we sought to characterize the prevalence of ESR1 mut and alterations in the PI3K/AKT pathway [ PIK3CA mut, AKT1 mut, PTEN mut, and PTEN homozygous copy loss ( PTEN loss)] at the start of successive lines of therapy in a geographically and socioeconomically diverse real-world patient population and evaluate clinical outcomes of ET by ESR1mut status in 1st-line therapy in real-world practice. In addition, we report on detailed genomic alterations (GAs) in ESR1 , PIK3CA , AKT1 , and PTEN detected in both tissue and liquid biopsies (TBx, LBx) from MBC patients with HR(+)HER2(−).

Study population

This study included patients with HR(+)HER2(−) MBC who underwent genomic testing using tissue or liquid comprehensive genomic profiling (CGP) assays at Foundation Medicine during routine care. Clinical data were obtained from the nationwide (US-based) de-identified Flatiron Health and Foundation Medicine real-world clinicogenomic breast database (FH-FMI CGDB) between January 2011 and September 2023. Retrospective de-identified longitudinal clinical data were derived from electronic health records (EHR) from approximately 280 US cancer clinics (~ 800 sites of care) and comprise patient-level structured and unstructured data, curated via technology-enabled abstraction. Clinical data include demographics, clinical and laboratory features, time of therapy exposure, and survival. These were linked to genomic data derived from Foundation Medicine testing by de-identified, deterministic matching [ 8 ].

Comprehensive genomic profiling

Hybrid capture-based NGS assays (FoundationOne®, FoundationOne®CDx, or FoundationOne®Liquid CDx) were performed on patient tumor specimens in Clinical Laboratory Improvement Amendments (CLIA)-certified, College of American Pathologists (CAP)-accredited laboratory (Foundation Medicine, Inc.). The level of ctDNA shed in the FoundationOne®Liquid CDx assay for each specimen was quantified by calculating the ctDNA tumor fraction (TF). ctDNA TF was quantified by combining multiple methods described in the Supplement 1.

Real-world (rw)PFS and overall survival (rwOS) were the primary endpoints, and time to treatment discontinuation (rwTTD) was the secondary endpoint. Details of the outcome calculations are in Supplement 1.

Data analysis

The full spectrum of predicted pathogenic ESR1 mut, PIK3CA mut, AKT1 mut, and PTEN GAs (encompassing mutations and homozygous copy losses) detected in TBx and LBx of patients with HR(+)HER2(−) MBC in CGDB was assessed. ESR1 mut, PIK3CA mut, AKT1 mut, PTEN mut, and PTEN loss prevalence was calculated in TBx and LBx collected in the 1st, 2nd, and 3rd lines of metastatic therapy (up to 60 days before or after start of line of treatment, not longitudinally collected). The co-occurrence of ESR1 mut, PIK3CA mut, AKT1 mut, PTEN mut, and PTEN loss was assessed in TBx collected in 1st, 2nd, and 3rd lines of therapy.

rwPFS, rwOS, and rwTTD were compared between patients with TBx who received AI + CDK4/6i and between patients receiving fulvestrant + CDK4/6i 1st-line therapy by ESR1 mut status [ ESR1 mut versus ESR1 wild-type (wt)] by Cox models. Multivariable analyses adjusting for age, ECOG performance status, histology, menopausal status, adjuvant therapy, bone-only versus visceral metastasis, and number of metastatic sites were performed. Chi-squared and Wilcoxon rank sum tests were used to assess differences between groups of categorical and continuous variables, respectively. Z tests were performed for comparison of the prevalence of GAs between different lines of therapy, between TBx and LBx, and between LBx with ctDNA TF < 1% versus LBx with ctDNA TF ≥ 1%. The p -values reported are unadjusted for multiple comparisons. The cut-off of 1% for ctDNA TF was previously determined based on sensitivity for driver alterations found in > 2000 real-world tissue/liquid pairs across multiple tumor types across ctDNA TF cut-offs [ 9 ] as well as the prevalence of fusion alterations found in tissue and liquid samples, respectively, across a database of real-world genomic results by ctDNA TF cut-offs [ 9 , 10 , 11 ].

R version 4.1.3 software was used for analyses. All results are to be considered and interpreted in totality, in accordance with the Bradford Hill Criteria [ 12 ] wherever possible, with no one outcome measure standing on its own.

A total of 5,780 and 1,670 HR(+)HER2(−) MBC patients with TBx and LBx, respectively, were included in this study (Supplementary Figure S1 for detailed CONSORT chart). Out of those, 1002 (17.3%) TBx and 503 (30.1%) LBx had an ESR1 mut detected; 2,442 (42.2%) TBx and 564 (33.8%) LBx had a PIK3CA mut detected; 289 (5%) TBx and 70 (4.2%) LBx had an AKT1 mut detected; and 602 (10.4%) TBx and 41 (2.5%) LBx had a PTEN alteration (mut or loss) detected. The most common PTEN alteration detected in TBx was PTEN loss (4.1% of all TBx samples), while in LBx, copy loss was detected in only 4 (0.2%) of the samples. The full spectrum of presumed pathogenic GAs detected in TBx and LBx are described in Supplementary Figures S2 –S6.

Prevalence of ESR1 mut and PI3K/AKT pathway alterations ( PIK3CA mut, AKT1mut, PTEN mut, and PTEN loss) over treatment course

Evaluating specimens collected at or near the time of therapy initiation, the prevalence of ESR1 mut in TBx collected within 60 days before or after the initiation of 1st, 2nd, and 3rd lines of therapy was 8.1% ( n  = 175/2,154), 27.1% ( n  = 73/269), and 33.3% ( n  = 72/216), respectively. Patients with ESR1 mut detected at or near the initiation of 1st-line therapy were more likely to receive an alternative ET other than AI (TBx p  < 0.001/LBx p  = 0.006). Previous AI use was more common in patients with ESR1 mut detected in 2nd and 3rd lines compared to patients with ESR1 wt (Fig.  1 A). The prevalence of ESR1 mut in LBx collected proximal to initiation of 1st, 2nd, and 3rd lines of therapy was 10.4% ( n  = 30/288), 37.6% ( n  = 74/197), and 38.7% ( n  = 46/119), respectively (Fig.  1 B).

Prevalence of ESR1 mut detected in tissue and liquid specimens of HR(+)HER2(−) mBC in the first three metastatic lines of therapy. ESR1 mut detected in TBx ( A ) and LBx ( B ). AI aromatase inhibitors, chemo chemotherapy, CDK4/6i CDK 4/6 inhibitors, ET endocrine therapy, HR hormone receptor, LBx liquid biopsy, mBC metastatic breast cancer, mut mutations, SERD selective estrogen receptor degrader (fulvestrant), TBx tissue biopsy, TF ctDNA tumor fraction, Tx therapy

We observed that the prevalence of an alteration in the PI3K/AKT pathway in TBx collected in 1st, 2nd, and 3rd lines of therapy was 55.1% ( n  = 1,186/2,154), 48.3% ( n  = 130/269), and 54.6% ( n  = 118/216), respectively. In LBx, the prevalence was 38.2% ( n  = 110/2,154), 49.7% ( n  = 98/269), and 46.2% ( n  = 55/216), respectively. Figure  2 A shows the prevalence of each specific GA in TBx and LBx and the likelihood of detecting any of the actionable GAs ( ESR1 mut, PIK3CA mut, AKT1 mut, PTEN mut, and PTEN loss) in TBx and LBx in the first three lines of therapy. We observed that 58.8% and 42.7% of patients with TBx and LBx, respectively, have at least one GA detected in 1st line, with an increase in later lines of therapy to 62–71% mainly due to the acquisition of an ESR1 mut. We also observed that PTEN loss is detected at higher rates in TBx (3.3–5.6%) than LBx (0–1.0%). In an exploratory analysis to evaluate if exposure to CDK4/6 was potentially associated with some differences observed in GAs, we evaluated the prevalence of GAs in TBx samples collected prior to 2015 and in 2015 or later, and no significant differences were observed between the two groups of samples (Supplementary Figure S7). The cut-off year was chosen because the first use of a CDK4/6i was recorded in CGDB in 2015.

Prevalence of ESR1 mut and PI3K/AKT pathway alterations detected in tissue and liquid specimens of HR(+)HER2(−) mBC in the first three metastatic lines of therapy. Alterations detected in TBx and LBx ( A ) and in LBx stratified by ctDNA tumor fraction (TF) ( B ). p -values are unadjusted. loss homozygous copy loss, mut mutation

Given that GA detection in LBx is dependent on the tumor content of the sample, the prevalence of each GA was evaluated by the ctDNA TF status (≥ 1% versus < 1%). The prevalence of GA detected in LBx with ctDNA TF ≥ 1% was substantially higher than in LBx with ctDNA TF < 1% (Fig.  2 B). Additionally, we assessed the distribution of ctDNA TF content in LBx collected from patients with bone-only metastasis versus those with visceral metastasis (with or without bone), and no difference was observed (Supplementary Figure S8).

Co-occurrence of ESR1 mut and PI3K/AKT pathway alterations ( PIK3CA mut, AKT1 mut, PTEN mut, and PTEN loss)

Among patients with TBx in 1st ( n  = 2154), 2nd ( n  = 269), and 3rd ( n  = 216) lines, both ESR1 mut and a PI3K/AKT pathway GA were detected in 4.4% (95), 8.2% (22), and 17.1% (37), respectively (Fig.  3 A).

Co-occurrence of ESR1 mut and PI3K/AKT pathway alterations detected in tissue specimens of HR(+)HER2(−) mBC in the first three metastatic lines of therapy. loss copy loss, mut mutation, PI3K/AKT alterations include AKT1 mut, PIK3CA mut, PTEN mut, and PTEN loss

Regarding co-alterations in the PI3K/AKT pathway, PIK3CA mut and PTEN alterations (either mut or loss) co-occurred in 4.0% (85) patients in 1st line, 1.8% (5) in 2nd line, and 4.6% (10) in 3rd line. PTEN loss was the only GA detected in 3.2% (68) patients in 1st line, 2.2% (6) in 2nd line, and 3.2% (7) in 3rd line. PIK3CA mut and AKT1 mut co-occurred in 0.4% in 1st and 2nd lines of therapy in 0% in 3rd line. AKT1 mut and PTEN alterations were mutually exclusive (Fig.  3 B and Supplementary Figure S9).

Clinical characteristic of patients with HR(+)HER2(−) MBC receiving AI + CDK4/6i or Fulvestrant + CDK4/6i in 1st-line therapy

Out of the 2,154 HR(+)HER2(−) MBC patients with TBx collected at 1st line of therapy, a total of 921 patients were included in the outcome analyses. Patients were excluded from the outcome analysis if they received therapies other than AI + CDK4/6i or fulvestrant + CDK4/6i or had CGP ordered after the start of the 2nd line of therapy (Supplementary Figure S1 for detailed CONSORT chart).

Out of the 921 patients included, 62.2% received 1st-line AI + CDK4/6i and 37.8% received Fulvestrant + CDK4/6i. Baseline ESR1 mut was detected in 81 patients (8.8%), and of these patients, 27.2% received 1st-line AI + CDK4/6i and 72.8% received fulvestrant + CDK4/6i. The median age observed for patients with ESR1 wt and ESR1 mut was 63 [interquartile range (IQR) 55–70] and 65 (IQR 58–73), respectively. Most patients had an ECOG performance status of 0 (51.5%) and bone-only metastasis was observed in 32.0% of patients. Most of the cases that featured an ESR1 mut had received adjuvant ET with AI or tamoxifen (61.7%), while only 34.4% had received adjuvant therapy with ET among those with ESR1 wt. Finally, menopausal status and histology data were unknown in many cases, but for those cases with data available, the majority were postmenopausal and had invasive ductal histology (Table  1 ). See Supplementary Tables 1 and 2 for breakdown statistical comparison of baseline characteristic in patients with ESR1 wt versus ESR1 mut among those receiving AI + CDK4/6i and among those receiving fulvestrant + CDK4/6i in the 1st setting.

Baseline ESR1 mut is associated with less favorable outcomes in patients receiving 1st-line AI + CDK4/6i, but not in patients receiving fulvestrant + CDK4/6i

Among patients receiving AI + CDK4/6i 1st-line therapy ( n  = 573), those with ESR1 mut versus ESR1 wt had less favorable rwTTD [7.2 versus 18.8 months, hazard ratio (HR) 2.84, 95% confidence interval (CI) 1.76–4.58, p  < 0.0001], rwPFS (median 8.1 versus 21.4 months, HR 1.93, 95% CI 1.16–3.19, p  = 0.011), and tended to have less favorable rwOS (median 33.9 versus 53.5 months, HR 1.35, 95% CI 0.63–2.89, p  = 0.436), (Fig.  4 A–C). Among patients receiving fulvestrant + CDK4/6i 1st-line therapy ( n  = 348), no difference was observed for those patients with ESR1 mut versus ESR1 wt (rwTTD p  = 0.748, rwPFS p  = 0.16, and rwOS p  = 0.278) (Fig.  5 A–C). The specific ESR1 mut identified did not appear to impact patient outcomes with the AI + CDK4/6i regimen (Fig.  4 D); however, notably shorter rwTTD and rwPFS were observed for the three patients with ESR1 Y537S receiving fulvestrant + CDK4/6i (Fig.  5 D).

Clinical outcomes of HR(+)HER2(−) metastatic breast cancer patients receiving 1st-line AI + CDK4/6i by ESR1 mut detected by TBx. Kaplan–Meier plots show rwTTD ( A ), rwPFS ( B ), and rwOS ( C ) for ESR1 mut ( n  = 22) vs ESR1 wt ( n  = 551). Swimmer plot shows rwTTD (each bar represents therapy duration on 1st line of therapy) and rwPFS (dots represent progression) for patients with ESR1 mut ordered by specific ERS1 mut ( D ). AI aromatase inhibitors, ESR1mut ESR1 mutations, ESR1WT ESR1 wild-type, HR hazard ratio, OS overall survival, PFS progression-free survival, rw real-world, TBx tissue biopsy, TTD time to treatment discontinuation

Clinical outcomes of HR(+)HER2(−) metastatic breast cancer patients receiving 1st-line Fulvestrant + CDK4/6i by ESR1 mut detected by TBx. Kaplan–Meier plots show rwTTD ( A ), rwPFS ( B ), and rwOS ( C ) for ESR1 mut ( n  = 59) vs ESR1 wt ( n  = 289). Swimmer plot shows rwTTD (each bar represents therapy duration on 1st line of therapy) and rwPFS (dots represent progression) for patients with ESR1 mut ordered by specific ERS1 mut ( D ). ESR1 mut ESR1 mutations, ESR1 WT ESR1 wild-type, HR hazard ratio, OS overall survival, PFS progression-free survival, rw real-world, TBx tissue biopsy, TTD time to treatment discontinuation

We further performed multivariable analyses to control for confounding variables and found the independent association of baseline ESR1 mut and less favorable rwTTD (HR 2.42, 95% CI 1.47–4.00, p  < 0.001), rwPFS (HR 1.79, 95% CI 1.05–3.06, p  = 0.033), and rwOS (HR 2.07, 95% CI 0.93–4.58, p  = 0.074) in patients receiving 1st-line AI + CDK4/6i, but not in patients receiving Fulvestrant + CDK4/6i (Supplemental Figure S10).

In this study, CGP was used to characterize the prevalence of ESR1 mut and alterations in the PI3K/AKT pathway detected by TBx and LBx at the start of successive lines of therapy in geographically and diverse patients with HR(+)HER2(−) MBC. ESR1 mut were detected in approximately 8–10% of TBx and LBx collected at 1st-line therapy, while alterations in the PI3K/AKT pathway were detected in 38–55%. The prevalence of ESR1 mut clearly increased across the lines of therapy, most likely due to exposure to ET, with up to 33% harboring an ESR1 mut detected by TBx and 39% detected by LBx at time of 3rd-line therapy (59% in LBx with TF ≥ 1% and 17.2% in LBx with TF < 1%). Prior AI use was seen in the majority of patients with ESR1 mut detected in 2nd and 3rd lines. Baseline ESR1 mut were associated with less favorable outcomes, with worse rwTTD and rwPFS seen in patients with ESR1 mut receiving 1st line AI + CDK4/6i versus ESR1 wt. rwOS was also worse in patients with a baseline ESR1 mut who received 1st-line AI + CDK4/6i, although not statistically significant.

The frequencies of ESR1 mut found in 1st-line samples in our cohort are slightly higher than reported in the literature (4–5% in recurrent MBC and 1% in de ET-naïve MBC) [ 13 ]. This may be due to the large sample size of this study compared to prior studies with over 7,000 TBx and LBx samples included and perhaps an increase in baseline TBx collected proximal to 1st line therapy and LBx collected in different lines of therapy with newer targeted therapies for HR(+)HER2(−) MBC including SERDs and PI3K/AKT inhibitors. These findings are also clinically relevant given the less favorable outcomes including worse rwPFS for patients with baseline ESR1 mut who were started on an AI + CDK4/6i compared to ESR1 wt, and supports ASCO and NCCN guidelines to test for acquired ESR1 mut in patients with recurrent disease. These data also support further investigation of the clinical utility of ESR1 testing in patients MBC overall and serial ESR1 testing prior to radiographic progression, given the positive results of the PADA-1 clinical trial [ 2 ]. The SERENA-6 trial will help determine whether this approach achieves clinical utility [ 14 ].

While ESR1 mut account for approximately 50% of ET resistance cases, they alone are not the sole mechanism of ET resistance. Other mechanisms of ET resistance include alterations in PI3K-AKT-mTOR, RAS-MAPK and CDK 4/6-RB-E2F pathways, as well as ESR1 loss, amplification and translocation [ 3 ]. Combination strategies with novel ET partnered with targeted inhibitors including CDK4/6i, PI3K/AKT inhibitors, or mTOR inhibitors have therefore shown more favorable results compared to SOC endocrine monotherapy, although further investigation is ongoing, particularly with the newer, more potent ER-targeting agents.

Our understanding of acquired resistance mechanisms and treatment of patients with MBC has improved with CGP. Specifically, CGP detects a wide spectrum of activating GAs including different mutations, insertion/deletions, copy number alterations, and rearrangements. Published literature has shown that ESR1 Y537S-mutated tumors when compared to D538G-mutated tumors have greater resistance to fulvestrant. We did observe short rwTTD and rwPFS in the three patients with ESR1 Y537S receiving fulvestrant + CDK4/6i and a better understanding of specific ESR1 mut and response to newer ER-targeting agents is therefore imperative not only with the development of these agents, but also when considering sequencing in patients with continued estrogen sensitivity.

The recent approval of capivasertib for patients with PIK3CA mut, AKT1 mut, PTEN mut, and PTEN loss has motivated our investigation of the prevalence of these GA in different lines of therapy in addition to ESR1 mut. We observed a slight increase in the prevalence of AKT1 mut and PTEN mut across the therapy lines, especially in LBx. LBx is usually more suitable for the detection of acquired and subclonal alterations, which would be consistent with the higher prevalence of ESR1 mut detected in LBx compared to TBx. However, the mechanism underlying potential acquired AKT1 mut or PTEN mut remains relatively unexplored, warranting further investigation to understand the observed variations in prevalence. Furthermore, we found that PTEN loss was detected in only three LBx collected at 1st line and it was not observed in LBx collected at 2nd and 3rd lines of therapy, while TBx exhibited a prevalence ranging from 3.3 to 5.6%. Detecting copy number alterations through CGP in LBx is inherently challenging, requiring significantly higher tumor content than what is required for short variant mutation detection [ 15 , 16 ], making TBx the preferred choice for PTEN loss detection. It is noteworthy that PTEN loss is the only observed targetable alteration in 3.1% of TBx patients; consequently, patients with PTEN loss may be erroneously precluded from accessing targeted therapy if LBx alone is utilized without TBx evaluation with validated assays.

In this study, we also assessed the prevalence of GAs detected in LBx based on ctDNA TF content. LBx with ctDNA TF ≥ 1% showed a markedly higher prevalence of any of the GAs assessed, with 63.5% detecting at least one of the GAs, compared to only 26.5% in LBx with ctDNA TF < 1% in the 1st line of therapy. The prevalence of any GA detected in 1st-line TBx was 58.5%, implying that more than half of these alterations might be overlooked in LBx with ctDNA TF < 1%. Therefore, the evaluation of ctDNA TF is essential for accurately interpreting negative LBx results, as it informs consideration for use of a tissue specimen for CGP testing in the setting of low tumor shed of ctDNA.

While we believe this study to be one of the largest CGP studies for patients with HR(+)HER2(−) MBC, there are several limitations. Due to the retrospective nature of this study, there were fewer LBx available compared to TBx, particularly at 1st-line assessment. Additionally, no patients with serial CGP were included. We were therefore unable to draw any conclusions related to variations in acquired ESR1 mut by specimen collected (tissue versus plasma), though there was a numerically higher prevalence of ESR1 mut detected in LBx with ctDNA TF ≥ 1% compared to those with ctDNA TF < 1%, suggesting that tissue testing particularly for patients with ctDNA TF < 1% may be indicated. The results from our study are not automatically applicable to other CGP tests. Detection of copy number loss requires robust and specialized bioinformatics analyses than detection of other alteration classes, such as mutations and rearrangements, and existing commercially available assays do not uniformly support this capability [ 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 ]. A strength of our study is the use of the TBx assay that was used as the companion diagnostic test (CDx) to enable the FDA approval of capivasertib, which has gone through additional analytical and clinical validations that are not necessarily required of non-FDA-approved diagnostic tests. Finally, tumor fraction algorithms vary from platform to platform and assay to assay, and the results observed here are not automatically applicable to other tumor fraction estimations.

In summary, our cohort reveals that approximately 60% of HR(+)HER2(−) MBC cases exhibit at least one GA ( ESR1 mut and/or PIK3CA mut, AKT1 mut, PTEN mut, and PTEN loss) detected by TBx or LBx with ctDNA TF ≥ 1% in the 1st-line setting, while in LBx with ctDNA TF < 1% the prevalence is 26.5%. ESR1mut detection in 1st-line decisions may aid treatment decisions for AI versus SERD in particular for endocrine-resistant disease. ESR1 mut prevalence increases across treatment lines, especially in LBx, with 59% in LBx with ctDNA TF ≥ 1% in 3rd line. Ongoing studies into serial monitoring for emergent ESR1 mut during ET treatment can potentially refine the paradigm to guide treatment strategies. Additionally, PTEN loss is detected at much higher rates in TBx than LBx, consistent with the known inherent limitations of ctDNA testing. Our study suggests obtaining TBx testing at time of de novo or recurrent diagnosis of HR(+)HER2(−) MBC with subsequent LBx for acquired GA in 2nd + line (especially ESR1 mut). Reflex TBx should be considered when ctDNA TF is < 1% and no actionable GA is detected with LBx.

Data availability

The data that support the findings of this study originated by Flatiron Health, Inc. and Foundation Medicine, Inc. Requests for data sharing by license or by permission for the specific purpose of replicating results in this manuscript can be submitted to [email protected] and [email protected].

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Foundation Medicine, a wholly owned subsidiary of Roche, is a for-profit company and producer of FDA-regulated molecular diagnostics. Flatiron Health, Inc., is an independent member of the Roche group. Authors employed by Foundation Medicine and Flatiron Health were involved in the design and conduct of the study, analysis, interpretation of the data, preparation, review, and approval of the manuscript.

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Manali A. Bhave and Julia C. F. Quintanilha have contributed equally to this work.

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Winship Cancer Institute, Emory University, 1365 Clifton Rd NE, Building B, Suite 4000, Atlanta, GA, 30322, USA

Manali A. Bhave & Kevin Kalinsky

Foundation Medicine, Inc, 400 Summer Street, Boston, MA, 02210, USA

Julia C. F. Quintanilha, Hanna Tukachinsky, Gerald Li, Takara Scott, Jeffrey S. Ross, Lincoln Pasquina, Richard S. P. Huang, Mia A. Levy & Ryon P. Graf

Upstate Medical University, Syracuse, NY, USA

Jeffrey S. Ross

University of Texas Southwestern, Dallas, TX, USA

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M.B. contributed to data analysis and interpretation, manuscript writing, and final approval of manuscript. J.C.F.Q. contributed to data analysis and interpretation, preparation of figures, manuscript writing, and final approval of manuscript. H.T. contributed to data analysis and interpretation, manuscript revision, and final approval of manuscript. G.L. contributed to manuscript revision and final approval of manuscript. T.S. contributed to manuscript revision and final approval of manuscript. J.S.R. contributed to manuscript revision and final approval of manuscript. L.P. contributed to manuscript revision and final approval of manuscript. R.S.P.H contributed to manuscript revision and final approval of manuscript. H.M.A contributed to manuscript revision and final approval of manuscript. M.A.L contributed to Conception/Design, data analysis and interpretation, manuscript revision, and final approval of manuscript. R.P.G. contributed to Conception/Design, data analysis and interpretation, manuscript revision, and final approval of manuscript. K.K. contributed to Data analysis and interpretation, manuscript revision, and final approval of manuscript.

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Financial disclosures: JCFQ, HT, GL, TS, JSR, LP, RSPH, MAL, and RPG are employees of Foundation Medicine, a wholly owned subsidiary of Roche and have equity interest in Roche. MB has consulted for Merck, Gilead, DSI, AstraZeneca, Pfizer, and Eli Lilly. JSR has consulted and owns equity in Celsius Therapeutics and Tango Therapeutics. HMC has consulted for Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Genentech/Roche, Immunomedics, Merck, OBI Pharma, Pfizer, Puma, Spectrum Pharmaceuticals, Syndax Pharmaceuticals, Peregrine, Calithera, Daiichi-Sankyo, Seattle Genetics, AstraZeneca, Gilead, Crown Bioscience, and TapImmune and has research supported by Bristol-Myers Squibb; MedImmune, LLC/AstraZeneca; BTG; and Merck. KK has consulting or advisory role for Merck, Lilly, Novartis, AstraZeneca, Genentech/Roche, Immunomedics, Seattle Genetics, Oncosec, 4D pharma, Daiichi-Sankyo, Puma Biotechnology, Mersana, Menarini Silicon Biosystems, Myovant Sciences, and Takeda. Research funding (institution) from Novartis, Ascentage, Genentech/Roche, Lilly, Seattle Genetics, AstraZeneca, and Daiichi-Sankyo.

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Bhave, M.A., Quintanilha, J.C.F., Tukachinsky, H. et al. Comprehensive genomic profiling of ESR1 , PIK3CA , AKT1 , and PTEN in HR(+)HER2(−) metastatic breast cancer: prevalence along treatment course and predictive value for endocrine therapy resistance in real-world practice. Breast Cancer Res Treat (2024). https://doi.org/10.1007/s10549-024-07376-w

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Disparities in Health and Health Care: 5 Key Questions and Answers

Nambi Ndugga and Samantha Artiga Published: Apr 21, 2023

Introduction

The COVID-19 pandemic and nationwide racial justice movement over the past several years have heightened the focus on health disparities and their underlying causes and contributed to the increased prioritization of health equity. These disparities are not new and reflect longstanding structural and systemic inequities rooted in racism and discrimination. Although growing efforts have focused recently on addressing disparities, the ending of some policies implemented during the COVID-19 pandemic, including continuous enrollment for Medicaid and the Children’s Health Insurance Program (CHIP), may reverse progress and widen disparities. Addressing health disparities is not only important from an equity standpoint, but also for improving the nation’s overall health and economic prosperity. This brief provides an introduction to what health and health care disparities are, why it is important to address disparities, what the status of disparities is today, recent federal actions to address disparities, and key issues related to addressing disparities looking ahead.

What are health and health care disparities?

Health and health care disparities refer to differences in health and health care between groups that stem from broader inequities . There are multiple definitions of health disparities. Healthy People 2030 defines a health disparity, as “a particular type of health difference that is linked with social, economic, and/or environmental disadvantage,” and that adversely affects groups of people who have systematically experienced greater obstacles to health. The Centers for Disease Control and Prevention (CDC) defines health disparities as, “preventable differences in the burden, disease, injury, violence, or in opportunities to achieve optimal health experienced by socially disadvantaged racial, ethnic, and other population groups and communities.” A health care disparity typically refers to differences between groups in health insurance coverage, affordability, access to and use of care, and quality of care. The terms “health inequality” and “inequity” are also sometimes used to describe unjust differences. Racism, which the CDC defines as the structures, policies, practices, and norms that assign value and determine opportunities based on the way people look or the color of their skin, results in conditions that unfairly advantage some and disadvantage others, placing people of color at greater risk for poor health outcomes.

Health equity generally refers to individuals achieving their highest level of health through the elimination of disparities in health and health care. Healthy People 2030 defines health equity as the attainment of the highest level of health for all people and notes that it requires valuing everyone equally with focused and ongoing societal efforts to address avoidable inequalities, historical and contemporary injustices, and health and health care disparities. The CDC describes health equity as when everyone has the opportunity to be as healthy as possible.

A broad array of factors within and beyond the health care system drive disparities in health and health care (Figure 1) .  Though health care is essential to health, research shows that health outcomes are driven by multiple factors, including underlying genetics, health behaviors, social and environmental factors, and access to health care. While there is currently no consensus in the research on the magnitude of the relative contributions of each of these factors to health, studies suggest that health behaviors and social and economic factors, often referred to as  social determinants of health , are the primary drivers of health outcomes and that social and economic factors shape individuals’ health behaviors. Moreover,  racism  negatively affects mental and physical health both directly and by creating inequities across the social determinants of health.

Health and health care disparities are often viewed through the lens of race and ethnicity, but they occur across a broad range of dimensions.  For example, disparities occur across socioeconomic status, age, geography, language, gender, disability status, citizenship status, and sexual identity and orientation. Research also suggests that disparities occur across the life course, from birth, through mid-life, and among older adults. Federal efforts to reduce disparities focus on  designated priority populations , including, “members of underserved communities: Black, Latino, and Indigenous and Native American persons, Asian Americans and Pacific Islanders and other persons of color; members of religious minorities; lesbian, gay, bisexual, transgender, and queer (LGBT+) persons; persons with disabilities; persons who live in rural areas; and persons otherwise adversely affected by persistent poverty or inequality.” These groups are not mutually exclusive and often intersect in meaningful ways. Disparities also occur within subgroups of populations. For example, there are differences among Hispanic people in health and health care based on length of time in the country, primary language, and immigration status . Data often also mask underlying disparities among subgroups within the Asian population.

Why is it important to address disparities?

Addressing disparities in health and health care is important not only from an equity standpoint but also for improving the nation’s overall health and economic prosperity . People of color and other underserved groups experience higher rates of illness and death across a wide range of health conditions, limiting the overall health of the nation. Research further finds that health disparities are costly, resulting in excess medical care costs and lost productivity as well as additional economic losses due to premature deaths each year.

What is the status of disparities today?

Disparities in health and health care are persistent and prevalent. Major recognition of health disparities began more than three decades ago with the Report of the Secretary’s Task Force on Black and Minority Health (Heckler Report) in 1985, which documented persistent health disparities that accounted for 60,000 excess deaths each year and synthesized ways to advance health equity. The Heckler Report led to the creation of the U.S. Department of Health and Human Services Office of Minority Health and influenced federal recognition of and investment in many aspects of health equity. In 2003, the Institute of Medicine’s Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care released the report, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care , which identified systemic racism as a major cause of health disparities in the United States. Despite the recognition and documentation of disparities for decades and overall improvements in population health over time, many disparities have persisted, and, in some cases, widened over time.

Beyond coverage, people of color and other marginalized and underserved groups continue to experience many disparities in accessing and receiving care . For example, people in rural areas face barriers to accessing care due to low density of providers and longer travel times to care, as well as more limited access to health coverage. There also are inequities in experiences receiving health care across groups. For example, the KFF/The Undefeated 2020 Survey on Race and Health , found that one in five Black adults and one in five Hispanic adults report being treated unfairly treatment due to their race or ethnicity while getting health care for themselves or a family member in the past year. Nearly one-quarter (24%) of Hispanic adults and over one in three (34%) potentially undocumented Hispanic adults reported that it was very or somewhat difficult to find a doctor who explains this in a way that is easy to understand in a 2021 KFF survey.  Other KFF survey data from 2022 found that nearly one in ten (9%) of nonelderly adult women who visited a health care provider in the past two years said they experienced discrimination because of their age, gender, race, sexual orientation, religion, or some other personal characteristic during a health care visit. KFF data also showed that LGBT+ people were more likely than their non-LGBT+ counterparts to report certain negative experiences while getting health care, including a doctor not believing they were telling the truth, suggesting they are personally to blame for a health problem, assuming something about them without asking, and/or dismissing their concerns. The 2023 KFF/The Washington Post Trans Survey found that trans adults were more likely to report having difficulty finding affordable health care or a provider who treated them with dignity and respect compared to cisgender adults.

The COVID-19 pandemic has taken a disproportionate toll on the health and well-being of people of color and other underserved groups. Cumulative age-adjusted data showed that AIAN and Hispanic people have had a higher risk for COVID-19 infection and AIAN, Hispanic, and Black people have had a higher risk for hospitalization and death due to COVID-19. Beyond these direct health impacts, the pandemic has negatively impacted the mental health, well-being, and social and economic factors that drive health for people of color and other underserved groups, including LGBT+ people . As such, the pandemic may contribute to worsening health disparities going forward.

Concerns about mental health and substance use have increased since the onset of the pandemic, particularly among some groups. According to a 2022 KFF/CNN survey , 90% of the public think there is a mental health crisis in the U.S. today. Over the course of the pandemic, many adults reported symptoms consistent with anxiety and depression. Additionally, drug overdose deaths have sharply increased – largely due to fentanyl – and after a brief period of decline, suicide deaths are once again on the rise. These negative mental health and substance use outcomes have disproportionately affected some populations, particularly communities of color and youth. Drug overdose death rates were highest among AIAN and Black people as of 2021. Alcohol-induced death rates increased substantially during the pandemic, with rates increasing the fastest among people of color and people living in rural areas. From 2019 to 2021, many people of color experienced a larger growth in suicide death rates compared to their White counterparts. Additionally, self-harm and suicidal ideation has increased faster among adolescent females compared to their male peers. Findings from a 2023 KFF/The Washington Post survey found that more trans adults reported struggling with serious mental health issues compared to cisgender adults and were six times as likely as cisgender adults to have engaged in self-harm in the previous year (17% vs. 3%). There are also substantial disparities in mental health, including suicidality, among LGBT+ youth compared to their non-LGBT+ peers.

What are recent federal actions to address disparities?

In the wake of the COVID-19 pandemic, there has been a heightened awareness of and focus on addressing health disparities. The disparate impacts of COVID-19 and coinciding racial reckoning following the police killing of George Floyd contributed to a growing awareness of racial disparities in health and their underlying causes, including racism. Early in his presidency, President Biden issued a series of executive orders focused on advancing health equity, including orders that outlined equity as a priority for the federal government broadly and as part of the pandemic response and recovery efforts . Federal agencies were directed with developing Equity Action Plans that outlined concrete strategies and commitments to addressing systemic barriers across the federal government. In its Health Equity Plan, the Department of Health and Human Services (HHS) outlined a series of new strategies, including addressing increased pregnancy and postpartum morbidity and mortality among Black and AIAN women; addressing barriers that individuals with limited English proficiency face in obtaining information, services, and benefits from HHS programs; leveraging grants to incorporate equity consideration into funding opportunities, implementing equity assessments across its major policies and programs; investing in resources to advance civil rights; and expanding contracting opportunities for small, disadvantaged businesses. The plan builds on earlier efforts that included increasing stakeholder engagement, establishing the Office of Climate Change and Health Equity , and establishing the National Institutes of Health UNITE Initiative to address structural racism and racial inequities in biomedical research. Since the release of its Equity Action Plan, HHS has taken actions to extend postpartum coverage through Medicaid and CHIP; issued rules to strengthen patient protections, including nondiscrimination protections; and issued nondiscrimination guidance to ensure that telehealth services are accessible to people with disabilities and those with limited English proficiency.

The Centers for Medicare and Medicaid Services (CMS) released an updated framework to advance health equity, expand health coverage, and improve health outcomes for people covered by Medicare, Medicaid, CHIP, and the Health Insurance Marketplaces. The framework outlined five priorities including expanding the collecting, reporting, and analysis of standardized data on demographics and social determinants of health; assessing the causes of disparities within CMS programs and addressing inequities in policies and operations; building capacity of health care organizations and the workforce to reduce disparities; advancing language access, health literacy, and the provision of culturally tailored services; and increasing all forms of accessibility to health services and coverage. The Administration has also identified advancing health equity and addressing social determinants of health as key priorities within Medicaid and has encouraged states to propose Section 1115 Medicaid waivers that expand coverage, reduce health disparities, and/or advance “whole-person care.” States have increasingly requested and/or received approval for waivers that aim to advance equity . Further, a growing number of states have approved or pending waivers with provisions related to addressing health-related social needs , such as food and housing, often focused on specific populations with high needs or risks.

The Administration and Congress have taken a range of actions to stabilize and increase access to health coverage amid the pandemic. Early in the pandemic, Congress passed the Families First Coronavirus Response Act (FFCRA), which included a temporary requirement that Medicaid programs keep people continuously enrolled during the COVID-19 Public Health Emergency in exchange for enhanced federal funds. Primarily due to the continuous enrollment provision, Medicaid enrollment has grown substantially compared to before the pandemic, and the  uninsured rate  has dropped with differences in uninsured rates between people of color and White people narrowing. Coverage gains also likely reflected enhanced ACA Marketplace subsidies made available by the American Rescue Plan Act (ARPA) of 2021 and renewed for another three years in the Inflation Reduction Act of 2022, boosted outreach and enrollment efforts, a Special Enrollment Period for the Marketplaces provided in response to the pandemic, and low Marketplace attrition . Additionally, in 2019, the Biden Administration reversed changes the Trump Administration had previously made to public charge immigration policies that increased reluctance among some immigrant families to enroll in public programs, including health coverage. Most recently, the Consolidated Appropriations Act of 2023 included a requirement for all states to implement 12 months of continuous coverage for children, supporting their coverage stability. However, it also set the end of the broader Medicaid continuous enrollment provision for March 31, 2023, which could lead to coverage losses for millions of people, reversing recent coverage gains.

There have been growing federal efforts to address disparities in maternal health. Over the past few years, the Administration launched several initiatives focused on addressing inequities in maternal health. In April 2021, President Biden issued a proclamation to recognize the importance of addressing the high rates of maternal mortality and morbidity among Black people. At the end of 2021, the White House hosted its inaugural White House Maternal Health Day of Action during which areas of concern in maternal health outcomes were identified and the Administration announced actions aimed at solving the maternal health crisis. In June 2022, the Biden Administration released the Blueprint for Addressing the Maternal Health Crisis . The Blueprint outlines priorities and actions across federal agencies to improve access to coverage and care, expand and enhance data collection and research, grow and diversify the perinatal workforce, strengthen social and economic support, and increase trainings and incentives to support women being active participants in their care before, during and after pregnancy. In July 2022, CMS announced a Maternity Care Action Plan to support the implementation of the Biden-Harris Administration’s Blueprint for Addressing the Maternal Health Crisis. The action plan takes a holistic and coordinated approach across CMS to improve health outcomes and reduce inequities for people during pregnancy, childbirth, and the postpartum period. ARPA included an option, made permanent in the  Consolidated Appropriations Act , to allow states  to extend Medicaid postpartum coverage  from 60 days to 12 months. As of April 2023, the majority of states  have taken steps to extend postpartum coverage. The Human Resources and Services Administration also announced $12 million in awards for the Rural Maternal and Obstetrics Management Strategies Program (RMOMS), which is designed to develop models and implement strategies to improve maternal health in rural communities.

The Administration has also taken steps to address health disparities and discrimination experienced among LGBT+ people. On his first day in office, President Biden signed an Executive Order on “Preventing and Combating Discrimination on the Basis of Gender Identity or Sexual Orientation.” Since then, the Administration has taken multiple actions to address discrimination within health care specifically. In May 2021, the Biden Administration announced that the HHS Office for Civil Rights (OCR) would include gender identity and sexual orientation as it interprets and enforces the ACA’s prohibition against sex discrimination (Section 1557), reversing the approach taken by the Trump Administration. Additionally, the Administration has spoken out against state actions aimed at curtailing access to gender affirming care for transgender and gender nonconforming people, particularly policies targeting youth. In January 2023, the Administration released its Federal Evidence Agenda on LGBTQI+ Equity , a “roadmap for federal agencies as they work to create their own data-driven and measurable SOGI Data,” which the Administration views as central to understanding disparities and discrimination facing this community.

What are key issues related to health disparities looking ahead?

The end of the Medicaid continuous enrollment provision may lead to coverage losses and widening disparities. Following the ending of the Medicaid continuous enrollment provision on March 31, 2023, states resumed Medicaid redeterminations. KFF estimates that between 5 and 14 million people could lose Medicaid coverage, including many who newly gained coverage during the pandemic. Other research shows that Hispanic and Black people are likely to be disproportionately impacted by the expiration of the continuous enrollment provision. Moreover, some groups, such as individuals with limited English proficiency and people with disabilities may face increased challenges in completing the Medicaid renewal process increasing their risk of coverage loss even if they remain eligible for coverage. OCR has reminded states of their obligations under federal civil rights laws to take reasonable steps to provide meaningful language access for individuals with limited English proficiency and ensure effective communication with individuals with disabilities to prevent lapses in coverage amid the unwinding of the continuous enrollment provision. CMS issued guidance that provides a roadmap for states to streamline processes and implement strategies to reduce the number of people who lose coverage even though they remain eligible. The extent to which states simplify processes to renew or transition to other coverage and provide outreach and assistance to individuals more likely to face challenges completing renewal processes will impact coverage losses and potential impacts on coverage disparities.

The end of the COVID-19 Public Health Emergency (PHE) and the potential depletion of the federally purchased supply of COVID-19 vaccines, treatments, and tests may curtail access to these supplies for some individuals, particularly those who are uninsured. In response to the COVID-19 pandemic, the federal government spent billions of dollars in emergency funds to purchase COVID-19 vaccines, including boosters, treatments, and tests to provide free of charge to the public. In addition, Congress enacted legislation that included special requirements for their coverage by both public and private insurers, and the Administration issued guidance and regulations to protect patient access and promote equitable distribution. The upcoming end to the PHE on May 11, 2023, as well as the potential depletion of federally purchased supplies in the absence of any additional funding, could result in new or higher cost-sharing and/or reduced access to these products although these impacts may vary by product and the type of health coverage an individual has. People who are uninsured or underinsured face the greatest risk of access challenges, including limited access to free vaccines and no coverage for treatment or tests. Since people of color and people with lower incomes are more likely to be uninsured, they may be at a disproportionate risk of facing barriers to accessing COVID-19 vaccines, tests, and treatments once the PHE ends and the federal supply is depleted.

The  overturning of  Roe v. Wade may exacerbate the already large racial disparities in maternal and infant health. The decision to overturn the longstanding Constitutional right to abortion and elimination of federal standards on abortion access has resulted in growing variation across states in laws protecting or restricting abortion. These changes may disproportionately impact women of color, as they are more likely to obtain abortions, have more limited access to health care, and face underlying inequities that would make it more difficult to travel out of state for an abortion compared to their White counterparts. Restricted access to abortions may widen the already stark racial disparities in maternal and infant health, as some groups of color are at higher risk of dying from pregnancy-related reasons and during infancy and are more likely to experience birth risks and adverse birth outcomes compared to White people. It may also have negative economic consequences associated with the direct costs of raising children and impacts on educational and employment opportunities. Further, women from underserved communities may be at increased risk for criminalization in a post-Roe environment, as prior to the ruling, there were already cases of women being criminalized for their miscarriages, stillbirths, or infant death, many of whom were low-income or women of color.

Many states have implemented policies banning or limiting access to gender affirming care, especially for youth, as well as other legal actions that threaten access to care for LGBT+ people . Policies aimed at limiting access to gender affirming care may have significant negative implications for the health of trans and nonconforming people, particularly young people, including negative mental health impacts, and an increased risk of suicidality . Additionally, the recent Braidwood case on preventive care access directly affects LGBT+ people in its treatment of Pre-Exposure Prophylaxis (PrEP). It relies, in part, on religious protections arguments to limit access to the drug based on the plaintiff’s claim that it “facilitate[s] and encourage[s] homosexual behavior, prostitution, sexual promiscuity, and intravenous drug use.” If PrEP use declines as a result of the Braidwood decision, HIV incidence could increase , likely disproportionally impacting people of color and LGBT+ people. Efforts to curtail access to gender affirming care and the Braidwood decision are at odds with the Administration’s stated approach to health equity for LGBT+ people. How such policies play out in the longer term will be determined largely by the courts.

Evolving immigration policies may impact the health and well-being of immigrant families. When the PHE ends on May 11, 2023, Title 42 restrictions that suspended the entry of individuals at the U.S. border to protect public health during the COVID-19 emergency are expected to terminate. It is anticipated that when the authority ends, there will be an increase in immigrant activity at the U.S. border. The Biden Administration has announced  plans  to increase security and enforcement at the border to reduce unlawful crossings, expand “legal pathways for orderly migration”, invest additional resources in the border region, and partner with Mexico to implement the aforementioned plans. However, it remains to be seen how shifting policies will impact trends at the border and health and health care in that region. The future of the Deferred Action for Childhood Arrivals (DACA) program remains uncertain, and its implementation is currently limited subject to court orders . If the DACA program is found to be unlawful in pending court rulings, individuals would lose their DACA status and subsequently their work authorizations. The loss of status and work authorization may result in loss of employer-based health coverage, leaving people uninsured and unable to qualify for Medicaid, CHIP, or to purchase coverage through the Marketplaces. Additionally, although the Biden Administration reversed public charge regulations implemented by the Trump Administration as part of an effort to address immigration-related fears that limited immigrant families’ participation in government assistance programs, including Medicaid and CHIP, many families continue to have fears and concerns about enrolling in these programs, contributing to ongoing gaps in coverage for immigrants and children of immigrants.

Growing mental health and substance use concerns and ongoing racism, discrimination, and violence may contribute to health disparities. As previously noted, mental health and substance use concerns have increased since the onset of the pandemic, with some groups particularly affected. These trends may lead to new and widening disparities. For example, people of color have experienced larger increases in drug overdose death rates than White people, resulting in the death rate for Black people newly surpassing that of White people by 2020. Further, Black and Asian people have reported negative mental health impacts due to heightened anti-Black and anti-Asian racism and violence in recent years. Research has documented the negative health impacts, including negative impacts on mental health and well-being, of exposure to violence, including police and violence. Research shows African American and AIAN men and women, and Latino men are at increased risk of being killed by police compared to their White peers. Black and Hispanic adults also are more likely than White adults to worry about gun violence according to 2023 KFF survey data . Other KFF analysis shows that firearm death rates increased sharply among Black and Hispanic youth during the pandemic driven primarily by gun assaults and suicide by firearm. Research further shows that repeated and chronic exposure to racism and discrimination is associated with negative physical and mental health outcomes , including premature aging and associated health risks, referred to as “ weathering ,” as well as higher mortality .

Despite growing mental health concerns, people of color continue to face disproportionate barriers to accessing mental health care. Research suggests that  structural inequities  may contribute to disparities in use of mental health care, including lack of health insurance coverage and financial and logistical barriers to accessing care, stemming from broader inequities in  social and economic factors . Lack  of a diverse mental health care workforce, the  absence of culturally informed treatment options, and stereotypes  and  discrimination  associated with poor mental health may also contribute to limited mental health treatment among people of color.   Amid the pandemic, many states implemented telehealth behavioral health services to expand access to behavioral health care, and most states intend to keep these services. States are also adopting strategies to address workforce shortages in behavioral health. As states seek to expand access to behavioral health care, it will be important to ensure that services address the cultural and linguistic needs of diverse populations. Further, in 2022, the federal government mandated the suicide and crisis lifeline number that provides a single three-digit number (988) to access a network of over 200 local and state-funded crisis centers. The 988 number is expected to improve the delivery of mental health crisis care; however, it is unknown how well it will address the needs of people of color and other underserved populations.

In sum, disparities in health and health care for people of color and other underserved groups are longstanding challenges, many of which are driven by underlying structural and economic disparities rooted in racism. Addressing disparities is key not only from an equity standpoint but for improving the nation’s overall health and economic prosperity. Amid the COVID-19 pandemic, the federal government identified health equity as a priority and has since launched initiatives to address disparities wrought by the COVID-19 pandemic and more broadly. Alongside the federal government, states, local communities, private organizations, and providers have engaged in efforts to reduce health disparities. Moving forward, a broad range of efforts both within and beyond the health care system will be instrumental in reducing disparities and advancing equity.

• Racial Equity and Health Policy
• Coronavirus (COVID-19)
• Women's Health Policy
• Access to Care
• American Indian/Alaska Native
• Race/Ethnicity

Also of Interest

• How History Has Shaped Racial and Ethnic Health Disparities: A Timeline of Policies and Events
• Key Data on Health and Health Care by Race and Ethnicity
• Health Coverage by Race and Ethnicity, 2010-2022

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Understanding How COVID-19 Vaccines Work

What you need to know.

COVID-19 vaccines help our bodies develop immunity to the virus that causes COVID-19 without us having to get the illness.

• Different COVID-19 vaccines may work in our bodies differently but all provide protection against the virus that causes COVID-19.
• None of the COVID-19 vaccines can give you COVID-19.
• Bringing new vaccines to the public involves various steps, all which must be followed to ensure they are safe and effective before they are made available for use.

How COVID-19 Vaccines Work

Different types of vaccines work in different ways to offer protection. But with all types of vaccines, the body is left with a supply of “memory” T-lymphocytes as well as B-lymphocytes that will remember how to fight that virus in the future.

It typically takes a few weeks after vaccination for the body to produce T-lymphocytes and B-lymphocytes.

Sometimes after vaccination, the process of building immunity can cause symptoms, such as fever. These symptoms are normal signs the body is building immunity.

Types of Vaccines: mRNA, and Protein Subunit

There are different types of vaccines.

• All COVID-19 vaccines prompt our bodies to recognize and help protect us from the virus that causes COVID-19.
• Currently, there are two types of COVID-19 vaccines for use in the United States: mRNA , and protein subunit vaccines.

None of these vaccines can give you COVID-19.

• Vaccines do  not  use any live virus.
• Vaccines  cannot  cause infection with the virus that causes COVID-19 or other viruses.

They do not affect or interact with our DNA.

• These vaccines do  not  enter the nucleus of the cell where our DNA (genetic material) is located, so it cannot change or influence our genes.

mRNA vaccines (Pfizer-BioNTech or Moderna)

To trigger an immune response, many vaccines put a weakened or inactivated germ into our bodies. Not mRNA vaccines. Instead, mRNA vaccines use mRNA created in a laboratory to teach our cells how to make a protein—or even just a piece of a protein—that triggers an immune response inside our bodies. This immune response, which produces antibodies, is what helps protect us from getting sick from that germ in the future.

Research for mRNA technology

Researchers have been studying and working with mRNA vaccines for decades .

• In fact, mRNA vaccines have been studied before for flu, Zika, rabies, and cytomegalovirus (CMV).
• Beyond vaccines, cancer research has also used mRNA to trigger the immune system to target specific cancer cells.
• First, mRNA COVID-19 vaccines are given in the upper arm muscle or upper thigh, depending on the age of who is getting vaccinated.
• After vaccination, the mRNA will enter the muscle cells. Once inside, they use the cells’ machinery to produce a harmless piece of what is called the spike protein. The spike protein is found on the surface of the virus that causes COVID-19. After the protein piece is made, our cells break down the mRNA and remove it, leaving the body as waste.
• Next, our cells display the spike protein piece on their surface. Our immune system recognizes that the protein does not belong there. This triggers our immune system to produce antibodies and activate other immune cells to fight off what it thinks is an infection. This is what your body might do if you got sick with COVID-19.
• At the end of the process, our bodies have learned how to help protect against future infection with the virus that causes COVID-19. The benefit is that people get this protection from a vaccine, without ever having to risk the potentially serious consequences of getting sick with COVID-19. Any side effects  from getting the vaccine are normal signs the body is building protection.

How mRNA COVID-19 Vaccines Work

PDF infographic explaining how mRNA COVID-19 vaccines work.

• English [128 KB, 1 page]
• Other Languages

Protein subunit vaccines (Novavax)

Protein subunit vaccines contain pieces (proteins) of the virus that causes COVID-19. These virus pieces are the spike protein. The vaccine also contains another ingredient called an adjuvant that helps the immune system respond to that spike protein in the future. Once the immune system knows how to respond to the spike protein, the immune system will be able to respond quickly to the actual virus spike protein and protect you against COVID-19.

Research for protein subunit technology

Protein subunit vaccines have been used for years.

• More than 30 years ago, a hepatitis B vaccine became the first protein subunit vaccine to be approved for use in people in the United States.
• Another example of other protein subunit vaccines used today include whooping cough vaccines.
• Protein subunit COVID-19 vaccines are given in the upper arm muscle. After vaccination, nearby cells pick up these proteins.
• Next, our immune system recognizes that these proteins do not belong there. Another ingredient in the vaccine, the adjuvant, helps our immune system to produce antibodies and activate other immune cells to fight off what it thinks is an infection. This is what your body might do if you got sick with COVID-19.
• At the end of the process, our bodies have learned how to help protect against future infection with the virus that causes COVID-19. The benefit is that people get this protection from a vaccine, without ever having to risk the potentially serious consequences of getting sick with COVID-19. Many side effects  from getting the vaccine are normal signs the body is building protection.

How Protein Subunit COVID-19 Vaccines Work

PDF infographic explaining how Protein Subunit COVID-19 vaccines work.

• English [953 KB, 1 page]

Developing COVID-19 Vaccines

While COVID-19 vaccines were developed rapidly, all steps have been taken to ensure their safety and effectiveness. Bringing a new vaccine to the public involves many steps including:

• vaccine development,
• clinical trials,
• U.S. Food and Drug Administration (FDA) authorization or approval,
• and development and approval of vaccine recommendations through the Advisory Committee on Immunization Practices (ACIP) and CDC.

As vaccines are distributed outside of clinical trials, monitoring systems are used to make sure that COVID-19 vaccines are safe.

New vaccines are first developed in laboratories. Scientists have been working for many years to develop vaccines against coronaviruses, such as those that cause severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS). SARS-CoV-2, the virus that causes COVID-19, is related to these other coronaviruses. The knowledge that was gained through past research on coronavirus vaccines helped speed up the initial development of the current COVID-19 vaccines.

After initial laboratory development, vaccines go through three phases of clinical trials  to make sure they are safe and effective. No trial phases have been skipped.

The clinical trials for COVID-19 vaccines have involved tens of thousands of volunteers of different ages, races, and ethnicities.

Clinical trials for vaccines compare outcomes (such as how many people get sick) between people who are vaccinated and people who are not. Results from these trials have shown that COVID-19 vaccines are safe and effective , especially against severe illness, hospitalization, and death.

Before vaccines are made available to people in real-world settings, FDA assesses the findings from clinical trials. Initially, they determined that COVID-19 vaccines  met FDA’s safety and effectiveness standards and granted those vaccines  Emergency Use Authorizations (EUAs) . The EUAs allowed the vaccines to be quickly distributed for use while maintaining the same high safety standards required for all vaccines. Learn more in this  video about EUAs .

FDA has granted full approval for some COVID-19 vaccines. Before granting approval, FDA reviewed evidence that built on the data and information submitted to support the EUA. This included:

• preclinical and clinical trial data and information,
• as well as details of the manufacturing process,
• vaccine testing results to ensure vaccine quality, and
• inspections of the sites where the vaccine is made.

These vaccines were found to meet the high standards for safety, effectiveness, and manufacturing quality FDA requires of an approved product. Learn more about the process for FDA approval .

When FDA authorizes or approves a COVID-19 vaccine, ACIP reviews all available data about that vaccine to determine whether to recommend it and who should receive it. These vaccine recommendations then go through an approval process that involves both ACIP and CDC.

  Watch Video: Understanding ACIP and How Vaccine Recommendations are Made [00:05:02]

Hundreds of millions of people in the United States have received COVID-19 vaccines under the most intense safety monitoring in U.S. history.

Several monitoring systems continue to track outcomes from COVID-19 vaccines to ensure their safety. Some people have no side effects. Many people have reported common side effects after COVID-19 vaccination , like pain or swelling at the injection site, a headache, chills, or fever. These reactions are common and are normal signs that your body is building protection.

Reports of serious adverse events after vaccination are rare .

• How can you prepare for vaccination?
• What can you expect during and after your vaccination?
• Uninsured? You can still get a free COVID-19 vaccine. Learn more about CDC’s Bridge Access program .

COVID-19 Clinical and Professional Resources

• Coronaviruses
• Vaccine Development Process: How Was Time Saved [779 KB, 1 Page]

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