Lessons Learned in Radiology Research and Academia:

A Radiologist's Odyssey in Making the Future of Radiology"

Michael P. D'Alessandro, M.D."University of Iowa College of Medicine / The University of Iowa Children's Hospital"

michael-dalessandro@uiowa.edu"www.educationalinformatics.org"

Goals"•  To inspire you to become a maker and help make the future of

radiology"•  Entered residency not knowing what research or academics was +

therefore not intending to do them"•  Was lucky enough to be exposed to both + given a choice"

•  Give case study of a (junior) radiology researcher's career"•  From medical student to professor with tenure"•  In understandable subject area"

•  Lessons Learned"•  Research Questions"•  Mentorship"•  Funding "•  Publishing"•  Politics"•  Academics"•  Work / Life Balance"

The View From 30,000 Feet…So What?"

• Why do radiology research?"• To make the world a slightly better place"

Who And What Is A Maker?"

"…itʼs someone who is a builder, a creator, a producer, a developer, someone who has an active sense of taking an idea and developing it into something thatʼs real and tangible and can be shared with other people.""" "- Dale Dougherty, editor + publisher Make magazine"

•  Academicians are Makers"•  They are making the future of radiology"

The Maker Mindset""Life can be much broader

once you discover one simple fact: Everything around you that you call life was made up by people that were no smarter than you and you can change it, you can influence it, you can build your own things that other people can use."

Once you learn that, you'll never be the same again.""" " " "- Steve Jobs"

Why It Is A Good Thing To Be A Maker"

"Technological innovation is the source of all progress, so you should be in the technological innovation business, at the core of which is science and engineering. The highest calling is to be in technological innovation. Democracy, freedom, prosperity - they all stem from technological innovation, and the world needs more of us.""

- Bob Metcalfe"

My Background"•  1977 - A geek - punch cards + paper tape"•  1985 - B.S. Biology+B.S. Computer Science"•  1989 - M.D. "•  1993 - Radiology Residency"•  1995 - Pediatric Radiology Fellowship"•  1995 - Assistant Professor"•  1999 - Associate Professor with tenure"•  2004 - Full Professor with tenure"•  2020 (estimated) - Retirement to…"

Subject Area - Medical Informatics / Educational Informatics"•  Specifically - digital libraries"

•  Organized collections of information that can be used to seek answers to questions or solve problems"

•  Current research focused on empowering learners through learning tools that"•  Enhance learning at point-of-care and document + preserve this learning to create a

personalized learning environment / knowledge management / e-memory system for every physician"

•  This is the best way to change physicians' knowledge, attitudes + behaviors and thereby improve patient's care, outcomes + lives"

It All Starts With A Question"•  …but to find the answer you need the holy trinity:"

•  Persistence"•  Mentors"•  Funding"

•  Reason to do research"•  You feel that if you can answer the question you will change the

world in some small way and you feel this is how you can make a contribution "

•  You must be passionate about the question"•  Pursuing the question will cost you (and others) a lot, in many ways"

•  You must believe in the importance of the question"•  Over time, the question becomes equated with you professionally"

Choosing a Question""When seeking tenure, one should select a seemingly

insurmountable medical problem and then proceed to tackle it. If you solve it, you will easily obtain tenure. If you fail to solve it, you may still obtain tenure for sheer persistence and dedication!" "

- Judah Folkman, M.D."

"Aim for the stars so that you reach the treetops and at any rate you'll get off the ground." "" - Shirley Ann Jackson, Ph.D., President RPI"

•  As long as research goes well, stay focused on the question"

•  …and if you are doing your work right, the question evolves over time…"

My Question"•  Philosophy"

• Learning is an apprenticeship"• Goal of my research"

• Gain a deeper understanding of thinking and learning and to develop new computational tools to think with that help people learn new things in new ways"

• How to build tools that support apprenticeship?"•  Initially interested in building tools for

individuals, now interested in building tools for communities"

Evolution of the QuestionPre Web -> Browsable Web -> Searchable Web - > Social Web"

Year Question Funding/Source"1985 Use PCs to teach medicine? (ETNet) $0 / Dad / NLM"1988 Use PCs to teach radiology? $1,000 / NLM"1991 Educational effectiveness / efficiency of PCs? $100K /Startup"1994 Use Internet to teach medicine? (VH) $1.1 mil / NLM"1995 Help med students use Internet? (MS.C) " $0 / Me"1996 Internet to promote health / improve care? (VNH) $1.7 mil / USN"1997 Organize pediatric radiology Internet? (PR.C) $120K / RSNA"1998 How to sustain digital press? (VH) " " $350K / yr / UI"2001 Organize chaos of radiology Internet? (RE.C) $0 / Me"2003 Are digital libraries cost effective? (VNH renew) $1.5 mil / USN"2003 How to build biodefense collaboratory? (BE.O) $70K / NIH"2004 How to build pediatric collaboratory? (PE.O) $0 / Me"2006 How to situate learning at point-of-care? (SR.C) $0 / Me"2007 How to build radiology community of practice? (RC.O) $20K / RSNA"2008 How to build research community of practice? $250K / NIH"2009 How to build pediatric community of practice? (PC.O) $0K / Me"

Evolution Insights"•  Keep your eye on the prize"

•  Keep big picture in view, don't bog down in details "•  Mentors helped me every step of the way"•  Every question answered generates at least 2 new

questions"•  When we started we thought we'd be done in 3 years"•  We now know we'll be done in 30 years!"

•  You can do a lot with a lot of resources"•  You can do a lot with a few resources"

•  Pilot data can be generated with bottle return money"•  Can be most interesting work because you need to be so

creative to get things done on a tight budget"

Evolution Insights - On Love + Trust"

"You've got to find what you love…Your work is going to fill a large part of your life, and the only way to be truly satisfied is to do what you believe is great work. And the only way to do great work is to love what you do."

- Steve Jobs http://news.stanford.edu/news/2005/june15/jobs-061505.html"

"Connecting the dots…You can't connect the dots looking forward; you can only connect them looking backwards. So you have to trust that the dots will somehow connect in your future. You have to trust in something — your gut, destiny, life, karma, whatever."

- Steve Jobs http://news.stanford.edu/news/2005/june15/jobs-061505.html"

•  From Heron Island to Pediatric Commons"

Evolution Insights - On Failure""Can learn more from failure than you can from success""

- Richard Saul Wurman"

"I didn't see it then, but it turned out that getting fired from Apple was the best thing that could have ever happened to me. The heaviness of being successful was replaced by the lightness of being a beginner again, less sure about everything. It freed me to enter one of the most creative periods of my life.""

- Steve Jobs http://news.stanford.edu/news/2005/june15/jobs-061505.html"

•  Research laboratory de-funded in 2005 "•  From panic to liberation to exhilaration"•  Virtualized our laboratory for $2,000 / year"•  Moved from Web 1.0 to Web 2.0"

•  Personal metric of success: What do I do / At what cost"•  Before - 22 million learners helped / year for $700,000 / year"•  After - 2.2 million learners helped / year for $2,000 / year"

Evolution Insights - Regrets"•  In fall 1998 NASA approached us to build Virtual

Space Hospital based upon Virtual Naval Hospital"•  I was a child of Apollo so I jumped at it"•  I soon hit a wall and could not do it"

•  Heavy clinical schedule"•  Running two large research programs"•  In middle of contentious application for tenure"•  Having (pre) family issues"

•  Didn't have time or energy to regret it then, regret it more now that I could have been a rocket scientist"

Mentors"

• How to find them?"• You find them in the most unlikely places…"•  I found my first two by roping them into

supporting my resident research project"

Mentors - Alan Gruskin, M.D."•  Medical background"•  Expertise was teaching"

"I love what I do""•  Influenced the direction of my clinical career"

"So what did you read last night?""•  Stressed situating learning in practice"•  Influenced the direction of my research career + life's work in

educational informatics"

•  Mentee turned mentor"•  Planned to come work with and learn from us"

Mentors - Jeffrey R. Galvin, M.D."

•  Medical background"•  Expertise was educational vision"

"Learning is an apprenticeship"""Family comes first"""How much money do you really need?""

•  An analysis of 150 studies of wealth and happiness shows happiness is a product less of wealth and more of:"•  Personal relationships"•  Satisfying work"•  Community involvement"•  A sense that life has meaning"

-  Professors Ed Diener of U of Illinois and Martin E.P. Seligman of U of Pennsylvania"

•  Private practice gets 10 weeks off / year = vacation"•  Metric of success = happiness"

•  Academic gets 10 weeks off / year = academic time"•  Metric of success = pride in scholarship"

Mentors - William E. Erkonen, M.D."

•  Medical background"•  Expertise was educational evaluation"

"Better a good job today than a perfect job tomorrow""

"Never do anything you wonʼt publish"""The secret to life is to just keep showing up""" " " " " "- Woody Allen"

"Take risks""""For of all sad words of tongue or pen,""The saddest are these: it might have been!""" " " " "- John Greenleaf Whittier"

Mentors - William T.C. Yuh, M.D."

•  Medical background"•  Expertise was process of doing research"

"Think of project, submit abstract, if accepted, do research"""Ride the wave"""Two ways for a lesion to stand out in MRI ~ Two ways to

stand out in academics:""Fat suppression ~ Make everyone around you less bright""Give contrast ~ Make everyone around you shine""

Mentors - Mary J.C. Hendrix, Ph.D."

•  Medical background"•  Expertise was political"

"Excellence without arrogance"""From whom much is given, much is expected"""Networking is everything"""Accentuate the positive side of a situation"""Learn the value of a good attitude"

Mentors - Donna M. D'Alessandro, M.D."

• Medical background"•  Expertise was personal - no one knows me

better"

"Enjoy the journey - have fun""

Mentors - Mom and Dad"

• Medical background"•  Expertise was spiritual"

"What do you care what other people think?"""If you can accept the worst possible

outcome of a situation, you have nothing to fear""

"Live by the Golden Rule""

Mentors - Family Members"

• Medical background"•  Expertise was practical"

"Academic radiology has a crazy and dark side everywhere - Deal with it!""

The unacademic - "Ten-year professor""

Mentors - Assistants"

•  Teresa A. Choi, B.A."• Nola Riley, B.A."• William E. Carlson, B.S.M.E."• David L. Lacey, M.D."

Mentors - In Summary"•  You wonʼt answer your

question by yourself - itʼs a team effort"

•  Multiple generations of mentors give greater insights"

•  Mentors should come from all over, not just your field"

•  Probably the most rewarding part of all of my research are the unique souls I have met, and the relationships I have forged with them"

Funding - Think Different!""Luck is where opportunity meets preparation""

•  NIH RO1s are very tough to get and keep, especially for M.D. radiologists"

•  Politics is key"•  What topics are hot politically (medical informatics,

errors in medicine, quality, radiation reduction, obesity)"•  Can you be part of a bigger institutional grant on a hot

topic? (biodefense, Institutional Clinical and Translational Science Award [CTSA])"

•  Can you work with Ph.D.s or M.D. clinicians lending radiological expertise to their grants?"•  Demand appropriate salary support for your effort"

•  Think of non-traditional sources of funding like military (prostate + breast cancer)"

Where Should You Publish"•  Impact factors are important but…"

• The higher the impact factor the fewer the people that read it"

• We weren't well known + respected until we were in Readerʼs Digest"

•  Publishing is a form of marketing"• Appear in multiple publications in multiple

disciplines to reach multiple audiences"

Politics - Change is Hard""Academic politics are so vicious precisely because the

stakes are so small"" - Henry Kissinger"

"There is nothing more difficult to take in hand, more perilous to conduct, or more uncertain in success, than to take the lead in the introduction of a new order of things…Innovation makes enemies of all those who prospered under the old regime, and only lukewarm support is forthcoming from those who would prosper under the new" "

- Niccolo Machiavelli""The pioneer is the guy with the arrows in his back""

•  Build network of friends locally / nationally / globally"•  "Keep your powder dry" / Route around obstructions"

Political Personal Hygiene"• Get everything in writing"

• Ensures people keep their word "•  Learn how to protect your research time"

• Learn to say "no" politely""That's an interesting opportunity. I'll get back to you in 2 - 3 days""

• Don't become a dumping ground for senior faculty"

•  Learn the art of negotiation"• Getting to Yes by R. Fisher and W. Ury"

• Don't let them scare you"• What's the worse thing that can happen? They

could fire you…and would that be all so bad?"

Academic Personal Hygiene - Choosing a Job"

•  How to choose a Chair - look for:"•  Clinical competence ~ Leadership ~ Honesty ~ Fairness ~ Loyalty ~

Mentorship"•  No longer working to make themselves successful, but working to make

individuals in department successful "•  Bad Chairs often chosen for their research skills ~ Are selfish rather than

selfless ~ Are perpetually disappointed with your underachievement"

•  Family friendly"•  Day care ~ Sick child care ~ Co-worker cross coverage in emergencies"•  School quality"•  Proximity to relatives"

•  Start off with the resources you need to succeed"•  Time / money / space"•  Failure can only be blamed on you"

•  For salary"•  Obtain Report on Medical School Faculty Salaries 2009 - 2010 by the

AAMC, use to negotiate fair salary ~ 50th percentile"

Academic Personal Hygiene - Day to Day"

•  Loyalty"•  Place your loyalty with your patients, colleagues, family, yourself"•  Don't place your loyalty with your institution - you will only be

disappointed"

•  Goal is to get promoted and or tenured"•  Understand what is required / "Self marketing""•  Document your scholarship!"•  Keep your own CV / medical educator's portfolio"•  Clinical track versus tenure track"

•  To resolve ownership disputes"•  Keep a laboratory notebook / save e-mail"

•  To keep momentum going"•  Set deadlines and keep to them ~ Submit abstracts to meetings

regularly"

Career Plan / Reflection"• Revise each year - Use 5 year

timeline "• Career Goals in Patient Care"

•  Training being undertaken to realize goals"•  Current Patient Care responsibilities"

• Career Goals in Education "•  Training being undertaken to realize goals"•  Current Education responsibilities"

• Career Goals in Research"•  Training being undertaken to realize goals"•  For each research project "

•  What it is"•  Why you are interested in it and why it is important"•  Who you are working with"•  What funding sources are you pursuing for it"•  Recent publications"

Promotion Lessons Learned"•  Understand the criteria for promotion"

•  Get on promotions committee to see criteria applied and to see how others are viewed"

•  The arc of progress is crucial"•  Your work should not be all over the place; Dr. X = Y"

•  It is a personality contest, it is about who you are"•  A nice personality is given much more leeway than a malignant one"

•  Writing the essay"•  Tell me a story"•  You are writing a legal document"

•  You are making your case for promotion"•  Don't be shy about your accomplishments"•  Back up your claimed accomplishments with facts"

•  There are evil forces out there"•  The only way to fight evil is with facts and data that is well

organized and presented"

The Essay"•  Teaching"

•  Local - formal - lectures: undergraduate, graduate, continuing"•  Local - informal: at conferences, in labs, in clinics / on wards"•  National / International: lectures - continuing, visiting professor"

•  Service"•  Clinical"

•  Responsibilities, % time, RVUs compared to others, clinical revenue"•  Administrative"

•  Local - committees: departmental, hospital, college"•  Local - courses, curricula"•  National / International - committees, editorial boards"

•  Scholarship (only place to describe your scholarship)"•  Papers"•  Grants"•  For each medical education web site"

•  Traditional and evolving metrics"•  Have someone read it"•  Make sure contents meet all requirements"•  Have supplementary materials organized logically"

Balancing Work / Life"• On women in academic medicine"

• Comprise 50% of medical school classes"• Usually the primary caregiver to children +

parents"• Often work part-time "• Are they truly committed to their work?"

•  Should full-time faculty be committed for their commitment to their work?"

• There is rampant discrimination towards women in medicine"•  There is a glass ceiling in medicine for women!"

Balancing Work / Life"•  Average number of hours worked per year by academic radiologist =

2,400 ~ by private practice radiologist = 2,200" - Radiology 2005; 236:932-938"

"The working week excluding call (average 52 hours) and including call (average 61 hours) was not regarded as too long…However 63% said they had too little time to spend at home, with family, or in hobbies…53% said that their work regularly causes conflicts at home…" "! ! ! ! !- Acad Radiol 2007; 14-445-454"

•  More men are becoming like women and working part time…"•  In 2006 I worked 2,700 hours = 58 hours / 47 weeks"•  In 2007 I went 90% time ~ 2,455 hours / year = 52 hours / 47 weeks"•  In 2008 at 80% time ~ 2,557 hours / year = 54 hours / 47 weeks"•  In 2009 at 80% time ~ 2,290 hours / year = 49 hours / 47 weeks"•  In 2010 at 80% time ~ 2,158 hours / year = 46 hours / 47 weeks"•  In 2011 at 80% time ~ 2,074 hours / year = 44 hours / 47 weeks"

Achieving a Work / Life Balance"•  Keep your clinical skills"

•  Insurance of decent income if you leave academics"

•  Learn to savor the small thanks"

•  Learn to pace yourself to avoid burnout"•  Take vacations regularly to recharge"

•  Get - and keep - a personal life!"•  Your family are the only ones who will

remember you when you are dead"

When Should You Change Jobs?"•  You should be in an environment where you can Thrive rather than just Survive"

•  When you feel you are accomplishing things in spite of, rather than because of the institution"

•  When you are exposed to (Tor) Mentors"•  Supervisor who is not honest or capable or an advocate for their faculty -- and their

supervisor allows them to keep their job"•  Leads to the realization that institution is not interested in your success"•  Erodes your self-worth ~ Has a corrosive effect on you that diminishes you"•  Results in learned helplessness"

•  When you want to move to a leadership position (most likely)""No prophet is accepted in his own country""

"Work only with people you like" " - Warren Buffet""Change jobs every 10 years so you don't stagnate"" - Vartan Gregorian, Ph.D."

It's A Long, Hard Slog…"

•  Do I think of quitting? Almost every day, but…"•  I can't get excited by exclusively clinical work"•  No one has my unique skill set and can do what I do"

•  I think academic medicine is a noble calling"•  I don't feel bad labeling myself an inventor. There's

something romantic about coming up with (or making) something new that can change people's lives"

•  So I stick with it..."

Friend Me?"

•  In private practice I could have been monetarily wealthy"•  Academics made me intellectually wealthy "

•  I have been able to learn radiology, teach radiology, make friends and have fun all over the world"•  …and my family and I are better for it"

In Conclusion"

"Be an optimist. Be curious. Read every night. "Donʼt meet the same people all the time. Sooner or

later they become lazy, boring, and repeat themselves. "

Don't be a cynic. Don't envy or be jealous. These sentiments are corrosive and they diminish you. "

Spend some time in solitude to reflect. "Meet different people, young people, travel, and if

you are rich, adhere to the gospel of, 'the joy of giving'.""

- Brooke Astor"

Remember!"

"Life is a banquet -"

- and most poor suckers are starving to death!""

- Auntie Mame"

One More Thing…"

"Hereʼs to the crazy ones. The rebels. The troublemakers. The ones who see things differently. While some may see them as the crazy ones, we see genius. Because the people who are crazy enough to think they can change the world, are the ones who do.""

For More Information…"•  About academics"

•  Levine MS. Primer for Clinician Scholars in Academic Radiology. Radiology 2004; 231: 622-627""

http://radiology.rsnajnls.org/cgi/content/full/231/3/622"•  Zerazn JT et.al. Making the Most of Mentors: A Guide for Mentees.

Academic Medicine 2009; 84(1):140-144."•  Academic Medicine: A Guide for Clinicians by Robert B Taylor"

•  About what we do and why we do it…"

http://www.educationalinformatics.org"

•  About this talk"•  http://www.slideshare.net/michaeldalessandro"