As senior neurology residents transition to fledgling researchers, they encounter numerous obstacles and unforeseen growing pains.
“As a senior resident you've acquired a lot of skills that allows you to work independently and with confidence in the hospital taking care of patients,” said Winston Chiong, MD, PhD, a neurology fellow in the department of neurology at the University of California-San Francisco. “It's then difficult to go into the lab. It's a bit like being an intern or a junior resident again because there are a lot of very basic skills that [you] have to pick up. In that way the experience has been humbling.”
Researchers must juggle their clinical responsibilities, prepare for board examinations, and maintain a semblance of a personal life, while cultivating their burgeoning research careers.
To help elucidate this career shift, Neurology Today spoke to investigators who are just beginning their research careers as well as seasoned experts about the obstacles physician-scientists must overcome and strategies to embark on their research careers.
“In medical school, instructors teach a lot about optimal patient care: taking a patient history, performing thorough physicals and examinations, and using new technologies,” said Allison Brashear, MD, professor and chair of the neurology department at Wake Forest University Baptist Medical Center in Winston-Salem, NC. “We don't necessarily teach people to think about things in a hypothesis driven model.”
This is only compounded by the fact that many researchers feel that they lack the time to compose an eloquent research proposal filled with a sufficient amount of preliminary data.
The hardest part of the process is learning how to budget the time to finish writing a proposal on time, said Brett M. Kissela, MD, professor and vice chair of education and clinical services at the University of Cincinnati Neuroscience Institute in Ohio. Investigators typically write their grant applications right up until their deadline. They should ideally finish early and have the opportunity to send the completed grant to several people, good reviewers who aren't necessarily in the same field, but smart, people who know a lot about research or who have reviewed NIH grants previously.
“I would much rather get some feedback and critiques from friends and colleagues before submitting [the grant application] than from the study section who hates it,” he said. “Allowing time for a pre-review process may be the single best thing a [researcher] can do, [particularly a new or young investigator].”
“When you're in the process of writing a grant you really hope for the best, but [should] always expect to get rejected,” said Khalid Hanafy, MD, PhD, instructor of neurology at Harvard Medical School and co-director of Neuro-ICU at Beth Israel Deaconess Medical Center. Dr. Hanafy, a recipient of the 2010 AAN Clinical Research Fellowship for his research on the role of microglia in subarachnoid hemorrhage and cerebral inflammation, said: “No one wants to see their grant application triaged, but it's a necessary part of peer review. I am always preparing my ego for rejection; you have to develop thick skin and never take anything personally.”
“It's important not to take rejections personally, but to learn from the review whenever possible,” said Michael Kruer, MD, a fellow in the departments of pediatrics and neurology at Oregon Health and Science University and a 2010 AAN Clinical Research Fellowship recipient. “Trying to consider things from the reviewers' point of view and to consider their funding priorities is important as well.”
Dr. Kruer's research focuses on understanding the pathogenesis of pediatric neurodegenerative disorders in order to develop rational therapies. He specifically investigates neurodegeneration with brain iron accumulation (NBIA).
To ensure his research received funding, he had to think of a way to readjust its focus to consider the broader context of his work.
“Studying a rare disease, it sometimes feels that there is a need to justify the value of the work being pursued, something not encountered with well-known disorders,” said Dr. Kruer. “I had to consider the wide-ranging implications of the work I was engaged in beyond the small group of disorders under study. It was important for me to recognize that NBIA can serve as a model disorder for insight into the mechanisms that contribute to neurodegeneration,” he said.
All of the investigators who spoke to Neurology Today unanimously agreed that establishing a supportive group of mentors is a critical component for success for young investigators.
“A mentor is probably the single most important aspect of your grant writing that an investigator has control over,” said Dr. Hanafy. “The mentors that I've had during every stage of my career were always more confident in my abilities than I was, and they made it fun for me to come into the lab and do my work.”
He suggested that fledgling investigators simply ask the many experienced physician-scientists at their institution out for a cup of coffee and take the opportunity to pick their brains about their own experiences.
That's how Dr. Chiong spent a lot of his time during the last year of his residency: He met with several established physician-scientists to discuss the kind of long-term career he's trying to develop, and also in the short-term, the right research question to begin his career.
“I really use my mentors as sounding boards,” said Dr. Chiong, who received the Robert Katzman, MD, Clinical Training Fellowship in 2010, cosponsored by the AAN Foundation and the Alzheimer's Association for his research on decision making in normal aging and neurodegenerative disease. “They're people who could advise me on the sort of pitfalls they saw in their experiences early in their career, or other people they had mentored.”
Dr. Chiong also has turned to junior faculty and other fellows — who had been his senior residents — for advice and asked to review their successfully funded grant applications. “The fact that there were local people around who were able to answer questions that I had about the process was very helpful. I would have been in a more difficult position if I were trying to do things without the benefit of their experience,” he said.
Investigators must also integrate another word into their vocabulary: No. “As a new investigator, people will try to help you in a well-intentioned way,” said Dr. Kissela. “Some will suggest that it would be really great for your career to be on certain committees [or take on other service tasks.] Although in my experience people offer these suggestions in your best interest, and the requested activity may produce some really useful downstream consequences, a young investigator needs to be judicious and pick and carefully choose which opportunities they would you want to accept. [Having said that, you shouldn't just say no to all of them either.]”
ADVICE TO OTHERS
“One good piece of advice I received is that a successful PI will nearly always be thinking of the next grant, actively writing most of the time,” said Dr. Kruer. “It's important to have a primary project that you are dedicated to, but things tend to move ahead erratically; sometimes more quickly, sometimes stalling. Having multiple projects increases your chances that one of them will come to fruition and provide you the jump-start you need to succeed.”
Dr. Brashear received similar advice when she first began her research career, which she said has worn her well may times. However, she recommended that researchers focus their projects and not be too diffuse in what they're trying to accomplish.
Dr. Kissela suggested investigators think about applying for grants to other sites besides the NIH. They should also apply to foundations, which are also great sources for funding, he said. Earlier in his career Dr. Kissela wanted a “K” grant but his research was also applicable for a foundation grant. He decided to apply for the foundation grant, which went through two cycles of review before he submitted his grant application to the NIH.
“The foundation had good feedback that came very quickly,” said Dr. Kissela. “Although the foundation didn't fund my research, the critiques [provided] were really useful and helped me shape a better application.”
Dr. Brashear stressed that novice investigators must focus their research, seek advice from experience researchers, and most importantly, persevere in their quests.
“You must be passionate about what you're doing, because you'll need to persevere and must be determined to not give up,” said Dr. Kissela. “Remember, every successful neurologist who's received funding has had many grants rejected.” •
FOR MORE INFORMATION ON DEVELOPING RESEARCH CAREERS:
At this year's AAN annual meeting in Hawaii, there will be a career forum and reception for neurology residents and fellows on Monday, April 11, from 6:30-9 pm. Among program events that evening, expert panelists will offer tips on how to start a career in academics/research and private practice; as well as discuss how to search for a fellowship, how program directors select fellows, and how a fellowship could benefit your career. For more information, visit AAN.com.