How Young Faculty Can Avoid Common Pitfalls in Academic Life David Robertson, MD CRC Director March 16, 2007
Limited Focus of this Presentation • Medical School • Clinical Department • Physician Investigators • Role of the physician • Role of the investigator
Outline • Clinical Research • Patient Oriented Research • An Era of Great Changes • Physician first or Investigator first? • Cultivating Creativity • Recognizing the Eve of Enlightenment • Miscellaneous Advice
Kinds of Clinical Researchand Level of Resolution KINDS RESOLUTION • Human gene function Cell • Human cell function Cell • Clinical pathophysiology Person • Clinical therapeutics Person • Clinical trials Person/Population • Outcomes Population • Epidemiology Population
Patient-Oriented Research • Occurs when the patient and the scientist are both in the room at the same time and both are alive.
Kinds of Clinical Research • Human gene function • Human cell function • Clinical pathophysiology • Clinical therapeutics • Clinical trials • Outcomes • Epidemiology Patient Oriented Research
OLD PARADIGM PHENOTYPE ENVIRONOME ENDOPHENOTYPE PHYSIOME PROTEOME GENOME
NEW PARADIGM PHENOTYPE ENVIRONOME ENDOPHENOTYPE PHYSIOME PROTEOME GENOME
Clinical Research is not an easy roadway • Clinical research is impeded by escalating regulatory requirements to address the same oversight concerns. Elias Zerhouni
“The End of Science” …John Horgan • Most disciplines … physics, chemistry, mathematics … are mature • The best and most exciting scientific discoveries are behind us • Pure Science evolving to Applied Science • Discovery to Application • Biomedical Science has a generation of discovery before it becomes Engineering + Business John Horgan
The Problem Bench Bedside Trench (Practice)
The new multidisciplinary paradigm • The multidisciplinary paradigm could be interpreted as NIH’s way of introducing what Horgan called “the end of science”
Your Career: Physician orInvestigator • Asking physicians to choose runs against the grain • Many never quite decide which is first in their life • Institutional leadership may foster this ambiguity • Some can be one sometimes and the other sometimes
Be a great physician • Study your patients • Study the literature • Study OMIM + links
Advice for Clinicians • Cathell DW. The physician himself. (Philadelphia: F. A. Davis) 1893 • Tumulty PA. The effective clinician. (New York: Saunders) 1973
Study your patients(for medical students and residents) • 2000 patients during residency • Listen to your patients’ observations • Master each H&P finding • Rationalize each lab abnormality • Maintain access (as HIPPA permits) to all 2000 H&Ps and summaries: they are your magnum opus • Reexamine them each decade to see what you have learned
Maintain a targeted practice • Focus on one lifetime clinical area • Choose that area with care • Limit your practice to that area * • Limit your practice to 10% effort * • Manage all aspects of their care • Look for heterogeneity • Think laterally about your patients * may be difficult to do in 2007
Investigator or Physician • Physicians are usually very intelligent, decisive, and hard-working. • These traits make great physicians, but not necessarily great scientists. • Does medical school stifle creativity? • Very few Nobel Prizes go to physicians.
The Search for Creativity • How can the physician-investigator cultivate creativity?
Flannery O’Connor(1925-1964) Reporter: “Ms O’Connor, do you believe we are stifling the creativity of too many young writers in our literature graduate programs?” O’Connor: “Actually, I don’t think we stifling enough of them.”
Practicing Clinical Research • Creativity and innovation • Be a clear thinker • Hypothesis-testing is the liturgy of POR • You must work very hard
Cultivating Creativity: Education at Vanderbilt in 1999-2006 • 163 new clinical investigators (MPH or MSCI) are produced (Nancy Brown) • These investigators have 185 CRC protocols (37% of all CRC activity) • Projects: 1/3 by MPHs and 2/3 by MSCIs • Average age of CRC users declines by ~7 years after two decades of increase • With this greening of the CRC has come creativity, innovation and productivity
Lateral Thinking • Alternatives: Use concepts to breed new ideas • Focus: Sharpen or change your focus to improve your creative efforts • Challenge: Break free from the limits of accepted ways of operating • Random Entry: Use unconnected input to open new lines of thinking • Provocation: Move from a provocative statement to useful ideas • Harvesting: Select the best of early ideas and shape them into useable approaches • Treatment of Ideas: How to develop ideas and shape them to fit an organization or situation Edward de Bono
Benefits of Lateral Thinking • Constructively challenge the status quo to enable new ideas to surface • Find and build on the concept behind an idea to create more ideas • Solve problems in ways that don’t initially come to mind • Use alternatives to liberate and harness your creative energy • Turn problems into opportunities • Select the best alternate ideas and implement them
Vanderbilt Biochemist and Teacher Stanley Cohen
Medical Physiology Text So masterfully written, that the 95% of the undiscovered world was almost invisible Arthur C. Guyton
Eve of Enlightenment • Aspirin and Prostaglandin • Aquaporin • Ulcer Disease
Miscellaneous Advice • Learn to enjoy writing grant proposals • Select a mentor who is successful and who fights for proteges • Help your mentor succeed; you may get his/her job • Never do something wrong: in research there may be no second chance; in clinical research there is no second chance
Develop Good Habits • Make your tasks educational • Be competent; know your methodology • Remember that a scientific career is a pleasure but also a business
What is the secret of working successfully with a difficult chair? • Learn to use different words in describing your goals Dean John E. Chapman
The Five Academic Deadly Sins • Failure of imagination • Superficiality • Lack of focus • Sloth • Majoring in the minors • Boundary Crossing
Writing Grants • Try to make the project compelling • Leave no doubt you will succeed • Prepare a fault-free application • Take plenty of time to write • Seek and use feedback from anyone • Can you explain it to Aunt Tilley? • Can you explain it to a Congressman?
Keeping on the Cutting Edge • 1. F1000, PubMed, OMIM • 2. Eskind Digital Browsing • 3. NEJM, JCI, et al. • 4. Nature, Science, Cell et al. • 5. The New York Times • 6. Maybe The National Enquirer
At any given moment, have … • 6 projects in planning • 4 projects in process • 2 projects in press ….Victor A. McKusick, Advice to Housemen, 1964
Career Advice • Boss JM, Eckert SH. Academic scientists at work: Navigating the biomedical research career (New York: Kluwer) 2003 ISBN 0-306-47493-X
Career Advice • Barker K. At the helm: A laboratory navigator. (New York: Cold Spring Harbor) 2002
Career Advice: The Far Side • C. J. Sindermann, Winning the Games Scientists Play (Cambridge: Perseus) 2nd edition. 2001 ISBN: 0-7382-0425-0
Career Advice: The Far Side II • Voltaire Cousteau, How to Swim with Sharks,http://www.apor.org/html/Articles.htm • Johns, RJ. Dinner address. How to swim with sharks: the advanced course. Trans Assoc Am Physicians. 1975; 88: 44-54.