From Clinician to Clinician Scientist: Strategies for Success

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From Clinician to Clinician Scientist Strategies
for Success

• Neil W. Kowall, M.D.
• VABHS Chief of Neurology
• BUSM Professor of Neurology

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The beginning of the journey

• Where are you now? Where do you want to be?
  Entering the highway at different time points
• You need a map and a plan to get to your
  destination
• Define your destination what is your personal
  vision, where do you want to be in 5 years or 10
  years--examples to be a clinical investigator
  working as part of a large team on large
  datasets? Do you want to work in a wet lab or
  with patients?

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Career Roadmap Why choose a career in academic
research?

• Issues a) the reality of publishing or
  perishing, b) the uncertainties of a salary
  based on grant funding, c) lower salaries
  compared to private practice or industry, d) the
  possibility of additional training , d) balancing
  time between work and personal/family.
• BUT potential to improve the lives of whole
  populations of people, the thrill of new
  discoveries, opportunities for networking with
  research colleagues, intellectual freedom and
  stimulation of a job that is never the same from
  one day to the next. Flexible work hours may help
  manage various personal/family commitments. In
  addition, the NIH Loan Repayment Program targets
  potential investigators that may be hesitant to
  enter academics due to mounting pressures to pay
  back educational debt.

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What other tools do you need?

• Go to meetings, take special courses, get to know
  peopledevelop personal contacts, talk to people
  regularly, cultivate and network, see what others
  think about your field, whats hot, seek opinion
  leaders, get diverse opinions, get a feel for
  what is being funded, like Traumatic Brain
  Injury-- often drive the field
• Know your skill set are you a cook? A musician? A
  philosopher? A talker? Detail oriented or big
  picture?

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First rule know yourself but then build yourself

• Excellence, hard work, attitude, passion,
  perseverance, talent, live your dream
• Surprising how open the top labs are and how rare
  motivated and committed people are
• If you have the desire you will succeed if you
  are flexible and hardworking
• Be dependable and ALWAYS follow through with your
  commitments
• Patience-- science is hard and the reward may be
  distant
• Be skeptical always check the facts yourself
• Dont do too muchlack of focus is the commonest
  problem followed by lack of perspective
• Use your current skills as a starting point-You
  have something unique to contribute

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Do you have what it takes?

• The top of the list of traits required for
  independent research are persistence,
  self-confidence, and flexibility.
• Persistence play a role in helping mentor review
  papers, write grants help recognize the
  importance of persistence and humility
• Confidence Mentors can help trainees become more
  self-confident by treating them as peers.
  Trainees gain confidence when they realize
  mentors dont have all the answers.
• Flexibility The ability to handle ambiguity and
  uncertainty with some equanimity, even to embrace
  it, is really critical. This requires a
  willingness to learn new roles, even or
  especially when it means moving beyond ones
  comfort level or skill set.
• Work smart One of the most universal keys to
  adapting to an independent position is learning
  to get more done in less time. Between teaching,
  research, grant writing, mentoring, and committee
  work, new faculty members have a lot more to do
  than they did when they were grad students and
  postdocs, so they can't afford to waste time--and
  that means working smart as well as hard.

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3 Keys to success (Sackett, 2001)

• 1 Mentoring
• Early on resources, opportunities and advice
  from a successful and secure person
• Later nominations to committees and symposia,
  protection from wasteful activities
• 2 Creating periodic priority listsdoing (like
  research, clinical practice, teaching, writing)
  not having (like space titles, rank or income).
• The priority list is trivially simple in format
  but dreadfully difficult in execution. It has 4
  elements
• List 1 Things Im doing that I want to quit.
• List 1a Things Ive just been asked to do that I
  dont want to do.
• List 2 Things Im not doing that I want to start
• List 3 Things I want to keep doing.
• List 4 How I plan to shorten List 1 and lengthen
  List 2 over the next 6 months
• 3 Time management
• The most important element of time management for
  academic success is setting aside and ruthlessly
  protecting time that is spent writing for
  publication.
• Never go to an annual meeting for the first time
  unless you have submitted an abstract that will
  get published in a journal (thus inaugurating
  your CV).
• Never go to that meeting a second time until you
  have a full paper based on that abstract in print
  or in press (thus making a major contribution to
  your CV and academic recognition).
• Thereafter, only go to that meeting if both Rule
  2 has been met and this years abstract has been
  selected for oral presentation (or you have been
  invited to give the keynote lecture).

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Making the Leap to Independence

• One prerequisite to independence is an academic
  position that provides the space, freedom, and
  employment stability necessary to engage in
  independent research and to build a research
  team. This is becoming harder to come by
• But this is only the beginning. Although academic
  positions generally come with start-up packages,
  setting up a lab from scratch is expensive and
  it's soon necessary to go hunting for more
  funding.

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Challenges for the next generation

• The scientific community has long considered
  single-investigator research grants, such as the
  RO1 or VA Merit, the Holy Grail of science
  funding--but that goal often remains elusive,
  particularly for young investigators.
• The success rate for RO1s, remains
  disappointingly low. Of 22,148 applications
  reviewed in 2006, only 3610 (or 16.3) were
  funded.
• Over the 25-year period between 1978 and 2002,
  the median age of doctoral biomedical researchers
  receiving their first independent research grants
  from the NIH rose from 37 to 42
• Times are likely to get worse before they get
  better..

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Challenges for the next generation

• Recognizing this as a threat to the development
  of the next generation of researchers, in 2006,
  NIH announced the K99/R00 Pathway to Independence
  (PI) award, designed to increase the share of
  federally-funded awards received by younger
  investigators and to create institutional
  incentives to help postdocs become independent
  investigators.
• After 2 years of funding at 90,000 per year,
  grantees can apply for an additional 3 years of
  funding for up to 250,000 per year. And since
  the grants cover full overhead costs, they
  provide a strong incentive for universities to
  create positions for these grantees

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The spectrum of funding opportunities
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Challenges for the next generation

• To become successful as independent
  investigators, young scientists must possess--or
  acquire--a battery of nonscientific skills.
  Traditionally, individuals were left to pick
  these up on their own, but they may now take
  advantage of many excellent programs that focus
  on teaching them the skills of successful grant
  applications and scientific management.
• One of the most ambitious and comprehensive of
  these efforts is a program in lab management
  supported by the Howard Hughes Medical Institute
  (HHMI) and the Burroughs Wellcome Fund.

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Other pathways

• A seminal report from the National Research
  Council (NRC) published in 2005, called Bridges
  to Independence Fostering the Independence of
  New Investigators in Biomedical Research ,
  suggests that the traditional definition of an
  independent researcher--as an individual, usually
  in a tenure-track position, who has received his
  or her first RO1 research project grant (or
  equivalent) as a principal investigator--is too
  narrow.
• Researchers need not be tenured or even
  self-sustaining to be independent. They can
  achieve independence by making distinct
  contributions to the research enterprise even if
  they're not in charge of the lab.

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Other pathways

• The problem is that there aren't many
  alternatives to PI-ship for established academic
  scientists. Although some non-PI jobs may be
  found within universities--running core
  facilities, for example--these kinds of jobs are
  relatively few.
• Far more common is that older scientists stuck in
  postdocs with little job security, even a decade
  or more past their Ph.D.s. But these are not jobs
  that anyone aspires to.
• So early-career scientists who aren't eager to
  head up their own research enterprise perhaps
  should consider opportunities to teach or to find
  work outside academia--at government labs or in
  private industry--where they can do good work
  without having to build and support a laboratory
  and a team.

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Resources

• http//www.rheumatology.org/fellowsfunding_roadmap
  .asp
• http//www.hhmi.org/resources/labmanagement/
• http//sciencecareers.sciencemag.org/
• R01 toolkit http//sciencecareers.sciencemag.org/
  career_development/previous_issues/articles/2007_0
  7_27/caredit_a0700106
• http//www.med.uiuc.edu/msp/students/ASIP_clinicia
  n_scientist.pdf
• Academic mentoringhttp//jama.ama-assn.org/cgi/con
  tent/full/297/19/2134
• http//www.saem.org/facdev/Mainpages/fdguide.html