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 Covey The Seven Habits of Highly Effective People Be Proactive Begin with the End in Mind Put First Things First Think Win-Win Seek First to Understand, Then to be Understood Synergize 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.

Translational Blocks in the Clinical Research Continuum JAMA 2003: 289; 1278-87

Funding Roadblocks on the Way Toward Improved Public Health JAMA 2004: 291; 1120-6

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