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

PatientOrientedResearch

GENOME

PROTEOME

ENDOPHENOTYPEPHYSIOME

PHENOTYPE

OLD PARADIGM

ENVIRONOME

GENOME

PROTEOME

ENDOPHENOTYPEPHYSIOME

PHENOTYPE

NEW PARADIGM

ENVIRONOME

Clinical Research is not an easy roadway

Clinical research is impeded by escalating regulatory requirements to address the same oversight concerns.

Elias Zerhouni

Your careers will span an era of great change

“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

Bench Bedside Trench(Practice)

The Problem

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 or Investigator

• 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.

Is discovery central to your life?

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.”

Wassily Kandinsky: Old Town II

Practicing Clinical Research

• Creativity and innovation

• Be a clear thinker

• Hypothesis-testing is the liturgy of POR

• You must work very hard

Cultivation of Creativity

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

Cultivating Creativity

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

The Landscape on the Eve of Enlightenment

Stanley Cohen

• Vanderbilt Biochemist and Teacher

Arthur C. Guyton

• Medical Physiology Text

• So masterfully written, that the 95% of the undiscovered world was almost invisible

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

You have to take care of yourself

Quality Supersedes Quantity

You’ve got to be willing to fall flat on your face

Expect noise in the system

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.

Vanderbilt Clinical Research Center