1. Care and feeding of Physician Neuroscientists Training, career development, and independent research AUPN, ANA and NINDS Dennis M. D. Landis, M.D. Professor and Chairman, Department of Neurology, Case Western Reserve University.

2. Clinical training and research experience Recognition of basic science advances which could be pertinent to human disorders. Assisting basic scientists in the design of studies related to human illness. Communication with patients and patient advocacy groups about conduct and results of research. Educating physicians in the biological basis of clinical disorders. Opportunity to apply your ideas in a clinical context, involving patients. Personal satisfaction of caring for people and advancing the science and art of medicine

3. This timeline summarizes the most common career path for individuals who undertake MD/PhD training, and then clinical training prior to independent research At first glance, it looks like an incredibly long process. Keep in mind that each phase has intrinsic awards and satisfaction. You should view this timeline diagram as an aid to planning. Anticipate what will be required at each phase, and things will go much more easily

4. The mission of the National Institute of Neurological Disorders and Stroke is to reduce the burden of neurological disease. The principal strategy is to support research. A supporting strategy is to guarantee the supply of future researchers by supporting the training of especially promising individuals Help From NINDS

5. Understanding science and physician scientists

6. In general terms, the way in which your research is supported changes with your level of training and with evidence of your successful work. During research training, your work initially is directed by others. During career development, you develop your ideas and strategy with a mentor, and work with suggestions. An independent researcher devises his/her own plans, and figures out how to accomplish them. Sequence of Support

7. Most combined degree students are supported by a training grant to the institution, such as MSTP. It is also possible to obtain individual funding for MD/PhD training Usually, those who have done research training during medical school will later elect to obtain further research training prior to applying for a career development award, or independent funding

8. –One approach is to break away from clinical training, obtain definitive research training, apply for independent investigator awards or career development awards during the third year of residency, and then go right to work. –Restructuring of residency training is underway. The premises are that it is desirable to continue research, and that are certain classes of clinical education can be tailored to the individual needs of the resident. Research Training During Residency

13. The interval between completion of residency training and obtaining definitive research support is fun and confusing. You’ll have to decide whether you want more specialized clinical training. You’ll learn to balance clinical activity and performing the research necessary to earn your own independent funding. You now have to give serious thought to the directions of your future work. After Initial Clinical Training

14. It may be necessary to re-enter research training for 1 or 2 years, even if one has not changed interests or techniques. Review for K08 and K23 awards seeks substantial preliminary evidence. The support mechanism during the gathering of preliminary evidence is usually a NRSA. The stipend is now comparable to a similar year of clinical training. Research Training After Initial Clinical Training

15. In addition to federal support of post-residency research training, you should be aware of grants from: –Professional organizations, such as the American Academy of Neurology –Private Foundations –Health advocacy organizations, such as American Heart Assoc., Muscular Dystrophy Assoc., Multiple Sclerosis Society, etc. Research Training After Initial Clinical Training

16. The K08 and K23 career development awards provide salary support for a junior faculty member (not a postdoctoral fellow), money for research (but someone else will have to supplement this), and requires “institutional commitment”. The K08 mechanism supports any sort of research. The K23 mechanism is designed to support clinical research. A variety of Foundations provide awards similar to the K08 and K23 mechanisms. These, too, can bridge the interval until R01 funding. Career Development Awards

17. The K99/R00 mechanism is an alternative to the career development awards. One does 2 years of mentored research, and then has 3 years of funding for independent research in your own institution. This diagram does not include PhD training

18. The R01 mechanism supports investigator-initiated research. Funds may be used for salary support, technicians, equipment, travel, and supplies. The duration of the award is 2 to 5 years, which means regular and rigorous peer review of your progress and ideas. Usually, you can take the grant with you if you choose to move. Independent Research Support

19. Foundation support. Participation in program project grants as a project director. Participation in multi-site NIH-supported clinical trials. Participation in clinical trials supported by pharmaceutical companies. Employment in pharmaceutical or biotechnology companies Alternatives and Adjuncts to the RO1 Grant Mechanism

20. You will succeed In recent years, more than half of the R01 grants awarded to individuals with a MD degree have been awarded to MD/PhDs. Whole realms of research inquiry are open to you that your PhD colleagues cannot attempt. The number of physicians who choose to conduct basic and/or clinical investigation is inadequate. The number of elderly persons and the number of patients with disorders affecting the nervous system are increasing

21. Clinical Loan Repayment Program The NIH has addressed the pressing problem of academic debt. A program is in place to pay approximately $100,000 of academic debt, tax free. To qualify, an individual must have succeeded in obtaining grant support—federal (NRSA, K08, K23, R01, project on P50) or Foundation. The work must include clinical research.

22. What is clinical research? “clinical research means patient-oriented clinical research conducted with human subjects, or research on the causes and consequences of disease… involving material of human origin, … for which an investigator or colleague directly interacts with human subjects, …epidemiological, …outcomes, …developing new technologies, …therapeutic interventions, or …clinical trials”

23. Guiding principles Stay informed and plan ahead. The AUPN and ANA will help with more ideas during your K awards. Intramural and Extramural branches of NINDS are there to help at every phase, and want to work with you. There are funding mechanisms for virtually every research path. Choose your research on the basis of its importance and the satisfaction it provides you.

25. The path is long, but each step has its interest and rewards. Because ideas and interests change, and because fields progress, many of you will seek additional research training after completing clinical preparation and before beginning the mentored career development interval. Combining Research and Clinical Training