Making It As a Clinical Researcher or Educator

Andrea E. Reid, MD, MPH

Massachusetts General Hospital

Harvard Medical School

Boston, MA

How do you define success?

– Publications– Promotion – Prestige– Payment– Parity– Peace

Franklin CoveyThe Seven Habits of Highly Effective People

1. Be Proactive

2. Begin with the End in Mind

3. Put First Things First

4. Think Win-Win

5. Seek First to Understand, Then to be Understood

6. Synergize

7. Sharpen the Saw

Definition of Clinical Research• Patient-oriented research. Research conducted with

human subjects or on material of human origin for which an investigator directly interacts with human subjects. This area of research includes: – Mechanisms of human disease – Therapeutic interventions – Clinical trials – Development of new technologies

• Epidemiologic and behavioral studies • Outcomes research and health services research.

JAMA 2003: 289; 1278-87

Translational Blocks in the Clinical Research Continuum

JAMA 2004: 291; 1120-6

Funding Roadblocks on the Way Toward Improved Public Health

NIH Director’s Panel on Clinical Research (CRP)

• Three questions:– Who is going to do clinical research and how

are these individuals to be properly trained?

– Where will clinical research be conducted?

– How will clinical research be funded?

The problems in clinical research

• Numbers down• Attrition up• Insufficiently nurturing environment in

AMC to sustain CI– Insufficient infrastructure– Insufficient mentoring– Increased pressure for more clinical activity– Shrinking revenues

Solutions to the crisis

• Funding– New investigators– Mid-level investigators

• Equitable grant review

• Formalized training

• Loan Repayment Programs

How to succeed as a clinical researcher

• Define your interests– Explore– Discuss– Commit

• Supportive environment is crucial • Find a good research mentor

– Experienced– Well-known– Funded– Interested in your success

• Obtain formal training in methology

Explore funding mechanisms

• NIH

• Veteran’s Administration

• Industry

• Foundations

• Private money

• Institutional grants

The Current State of Affairs

• NIH funds 212,000 researchers• ~ 30% extramural support devoted to clinical

research• NIDDK programs directed to clinical research:

– K01:Mentored Research Scientist Development Award

– K08: Mentored Clinical Scientist Development Award – K23: Mentored Patient-Oriented Research Career

Development Award – K24: Midcareer Investigator Award in Patient-

Oriented Research

Get someone else to pay your loans

National Institutes of Health Extramural Programs

• Loan Repayment Program for Minority Health Disparities Research

• Extramural Clinical Research Loan Repayment Program for Individuals from Disadvantaged Backgrounds

• Loan Repayment Program Regarding Clinical Researchers

• Pediatric Research Loan Repayment Program

LRP Eligibility

• Student debt > 20% of university compensation

• >50% time to research effort for > 2 yrs

• Applicant's support may be a grant from the NIH or any nonprofit organization

Success as a clinical researcher depends on your network

• Clinical research is collaborative

• Be creative about your collaborations

• Use your mentor’s network

• Be open to forming new, unexpected connections with people and projects

• Publish or perish

How are you evaluated as a clinician-educator?

• Objective criteria– Scholarly output

• Book chapters, reviews, clinical guidelines, curricula

– Grant support

– Recognition as an education leader by peers• Teaching awards

• National committees

– Administrative skills

– Revenue generated from clinical care

How are you evaluated as a clinician-educator?

• Subjective criteria: what are the measures of good teaching?– How well others learn– How much student grows as a learner because

of input– Practice methods– “Impact factor”

Components of evaluation

• Teaching skills

• Clinical skills

• Mentoring

• Academic administration

• Developing educational programs

• Non-research scholarship

• Clinical research

• Service coordination

• Education research

Methods of evaluation

• Peer evaluation• Awards• Trainee evaluation• Teaching portfolio• Clinical service time• Leadership qualities• Grant support• Publications

• The weight placed on each component varies by institution

Importance of specific aspects of a clinician-educator's performance when the promotion committee makes decisions

about promotion to associate professor

JAMA 1997: 278; 723-8

Know what your institution values

• Hospital: revenue, efficiency, quality, community involvement

• The medical school: publications, notoriety

• Know the promotions process

• Know your worth on the academic market

Make the most of every opportunity

• Teaching opportunities– Local: Medical students and residents– Regional: Medical societies– National: curriculum boards, national meetings,

educational symposia

• Service opportunities– Hospital and medical school committees

• Don’t overdo• Evaluate benefit to you

– Health organizations– GI Societies

Begin with the end in mind

• Document everything– When, where, why, how, to how many– Time keeping– Resume building

• Mentor and be mentored• Seek feedback from educators you respect• Training• Challenge yourself