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J Am Coll Cardiol, 2005; 46:5-70, doi:10.1016/j.jacc.2005.06.020 © 2005 by the American College of Cardiology Foundation |
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I. Choosing a research project/mentor |
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 Top I. Choosing a research... II. Funding opportunities for...III. Bridging funding...IV. Panel discussion:...V. Careers in clinical...VI. Careers in clinical...VII. Careers in outcomes...VIII. Careers in imaging...IX. Careers in electrophysiology...X. Careers in translational...XI. Panel discussion: Moving...XII. Careers in basic...XIII. Charting a course...XIV. Careers in...XV. Making the transition...XVI. Panel discussion: Moving...XVII. Cardiovascular genetics,...XVIII. Women and academic...XIX. Panel discussion: Greater...XX. Opportunities in training...XXI. Panel discussion: Junior...References |
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Choosing a mentor. The process of selecting a mentor is a reverse interview process. After a lifetime of being interviewed for jobs or academic programs, the tables are turned and now you orchestrate the interview. Remember that young investigators usually end up doing work in their mentor’s area of expertise first. Therefore, make sure you have real interest in the research being done by your prospective mentor’s laboratories or research program because you will be focusing on these.
What is a mentor? Mentor was a friend of Ulysses in the Odyssey. In fact, in the story the goddess Minerva assumes the form of Mentor when she accompanies Telemachos to search for his father because Mentor was so respected as a wise, faithful, and trustworthy counselor to Ulysses. This is a good starting list of important traits to look for in a mentor. When starting the process of choosing a mentor, I recommend that cardiology fellows meet with at least two and preferably three potential mentors. Do not make a snap decision. Begin to meet potential mentors no later than the first four months of your second year of fellowship if you are on the traditional fellowship trajectory. Set up meetings with potential mentors and sit down with them to talk about what they do in their research programs. Above all else, pay attention to the personal interaction as you begin to know potential mentors. Is this a person you can feel good about working with for an extended period of time? Does the "chemistry" between you feel right?
Go ahead and talk about the specific research question you are especially interested in, but remember: because of the way science is done today, it is often a team effort. As a result of the enormous sophistication being brought to bear on research questions in all areas, the mentors you interview are going to have established research efforts that are intricate and well developed. So, be sure you like a potential mentor’s area of interest as much as you like the person.
Obtain copies of papers that are representative of the mentor’s work. If a paper has been submitted and is under review, ask if you can have a copy of it to get a sense of what is currently happening in their program. Keep it confidential, but take it home, read it, and think about it. Is it boring? Is it the best thing you have read since The Godfather? Try to understand whether there is some intrinsic appeal to you in the scientific area being investigated by a potential mentor. Whether it is a study of brachial vasomotion and endothelial function in outpatients, culling an existing dataset using outcomes research methods, or cloning a protein and understanding how it works to regulate blood vessel cell function—does it match your interests? No matter how much you like a person, if they have nothing going on in your true field of interest, reconsider that person’s value to you as a mentor.
Ask potential mentors how often they meet with trainees. How often are their laboratory meetings? Ask how often you will personally meet with your mentor. I have a laboratory meeting once a week on Thursday mornings and spend the rest of Thursday meeting individually with trainees, and this schedule is something I try very hard to protect.
Have potential members describe the structure in their laboratory environment. Whether it is an outpatient clinical laboratory or a bench laboratory does not matter. Are you going to work side by side with the mentor? That is unusual unless it is someone who is more junior, but it may be preferable to you. Will you be assigned to someone who is several years more advanced than you who is spearheading a project, and will that person become your day-to-day mentor? If that is the case, you need to also meet that individual.
What is the lab like? Is it a big lab? Are there other fellows in the lab? Are there other fellows expected to join the lab soon or perhaps at the same time you will be joining? If there are people who have been through the lab, try to speak with them and ask them what the experience was like. Is it mostly a postdoctoral laboratory? Is it filled with international fellows or fellows from within the U.S.? Is it mostly undergraduate and graduate students? What is the mix? Where is the lab located? Is it in proximity to the clinical division, where you want to be able to attend seminars and conferences that are offered? Is it in proximity to where you will see patients in an outpatient clinic setting?
What is going to be expected of you by your prospective mentor? What will they want from you? That is often a very revealing question. If the answer to that question is, "I need you to be sure my coffee is here every morning and then we will talk," . . . well, enough said! If you know your prospective mentor is interested in you having an intense educational experience that will be fun, that is a good start. Be very frank about your own stage and interests by stating clearly, "I am not sure I want to do research," or "I am passionate about research." Bring into the mix what you are really thinking. This is about what you want, not what you think other people want from and for you.
In our research center, there is a mentoring or teaching relationship at every step, and they differ. The center director and co-director have a different form of mentoring relationship than the one that postdoctoral fellows have with individual principal investigators; the pre-doctoral students and college and high-school students receive an enormous amount of mentoring and teaching from everyone in the laboratory. So, the opportunity for you to practice being a mentor is also part of the process.
An important part of your experience should include training in the legal and ethical aspects of conducting research, including data management, as well as publication practices, and authorship, including the world of peer review and privileged information. You should learn about collaborations, human subjects’ research, and conflicts of interests. Mentors should review with you the handling of research data, including the collection and recording of primary data as well as what is required in terms of annotating and indexing laboratory data. Today, a lot of this may be computerized. Research data are legal documents. It is important to learn about these issues and their implications. Also, ask about the retention of your data and where it is stored when you are done working on the project. Can you have copies to take with you? If you spend three years of your life doing something and then join the faculty somewhere else, this will likely be important to you. Data management is important. It can be laborious, but investigators have to know how to take, record, and keep data. That includes an understanding of whom the data belong to, where data will be stored, how data will be processed, and what are considered good data-keeping practices. A mentor-to-be should be able to explain how these important matters will be learned.
Other mentoring issues. Accessibility to your mentor is a critical issue. If a mentor says, like the old New Yorker cartoon, "No, Thursday is out. How about never? Is never good for you?" this is not the person you want for a mentor. You want to be able to call and say, "I just wrote my first grant and have incorporated your comments—could you look at it again?" The response should be: "Sure."
Is the potential mentor someone who will listen attentively? Is the person interested in your self-sufficiency? I like very much this quote from a professor of mine in undergraduate school. I went to Amherst College and my political science professor, George Kateb, who is quite a brilliant teacher and is now a professor at Princeton, said something I will never forget it. He paused one day in the middle of a lecture while talking about the process of teaching. He looked up at us and said, "You know, it’s the purpose of a good teacher to make himself obsolete." I have never forgotten that comment; it is a great definition to bear in mind when choosing a mentor.
Does the potential mentor have good interpersonal skills? This is key. Is the mentor unlikely to be ruffled by your success and become competitive with you? That is not an inconsequential issue; it is a sad issue, frankly, but it needs to be brought up because there are insecure people everywhere and they do not make good mentors very often. The last thing you want is to develop an area of expertise and then to have your mentor’s name appearing on your paper for the next decade when you finish training. Likewise, you do not want to be working in an area and have a mentor who continues publishing papers that are competing directly with what you want to do. That is a sensitive issue and conversation, but it is one you ought to have early on. Carve out an area of research as you mature and define your research and career goals. A good mentor, in the process of making him or herself "obsolete," ought to be able to look you in the eye and say, "I’m going to stay out of that area. In fact, when it comes to that one paper that’s really transitional, my bias is going to be to take my name off." That is the goal and the hope: a mentor who really helps launch your independent career.
Another good quote is from Bishop Stephen Neill (1): "The bad teacher imposes his ideas and his methods on his pupils and such originality as they may have is lost in the second-rate art of imitation." You have to be encouraged and emboldened to be creative. Granted, sometimes you are going to have research ideas that are a bit "whacky." In the beginning, such ideas are part of learning and being creative. A mentor’s job is to gently say, "That’s kind of peripheral. Let’s bring it closer to some of the issues you were talking to me about earlier." Having said that, do not be pigeonholed or discouraged from exploring that which excites you. You are certainly not there to become the mouthpiece of someone whose work is already well established; you are there to benefit from the process and environment. Of course, you will become a representative of the work you do together with your mentor, at least in regards to those issues that are germane to the science you are doing together, but that is very different. You need to be allowed to be original and creative and to differentiate.
When choosing a mentor, consideration also must be given to the financial support you will be provided. If you are learning at the bench, you need to know that at least two years of work will be supported if you are already experienced and three years of work will be supported if you are not already experienced. In other words, ideally support should be provided to you without your having to write a grant. You may want to write a grant, but you should not have to obtain a grant in order to receive a full training experience.
If you are learning clinical research, I strongly urge you to consider a didactic training course in statistics, epidemiology, outcomes, trial methods, and so forth. Summer courses in these areas are often offered by some of the better programs; if this is not available at your institution, will the prospective mentor support your going somewhere to take such a course? It is a wonderful investment in your future.
Conclusions. There are many research training websites and I encourage you to peruse them (Table 1). There are also a number of National Heart, Lung, and Blood Institute (NHLBI) research training programs for postdoctoral individuals, including programs for minorities and disabled researchers (Table 2).
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But, perhaps Albert Einstein (1879–1955) said it best: "It is the supreme art of the teacher to awaken joy and creative expression and knowledge" (3).
Question and Answer. Question: For fellows who are considering working with a preceptor who has a private interest or a financial interest in the work, what are some of the questions or concerns to be addressed before getting involved in a project?
Dr. Mendelsohn: That is a complicated question. I would begin by asking a trainee why he or she would want to get involved in something like that at this point in their training. Unless the trainee is seeking training in the business/industry side of research, I would caution against that. On the other hand, for example, if the trainee is one of the MD/MBA students we have at our institution, then this is exactly what they might want to pursue. In that case, there are specific questions relating to who owns the technology. What will happen if new technologies are discovered along the way? What rights, if any, will evolve for the mentor, the school/university, and so on?
Question: Should a mentor be someone involved in the field in which you want to do research? Sometimes you can not find such a person in your own university, especially in translational science research. Do you recommend we look all over the country and find somebody outside the institution you are working in and try making them a mentor? Or are we pretty much restricted to our own university?
Dr. Mendelsohn: That depends on the stage you are at in training. To make the analogy to graduate students, before doing a thesis, a graduate student often does rotations in different laboratories before selecting a mentor. So, there are two separate approaches to your question. One would be to visit a number of different centers for a short time and at least get a sense of what is going on. But if, as I think your question implies, you are ready and the best person in your mind to work with you is not at your campus, then what do you do? I feel very strongly that you should go to the best laboratory you can and work there. Many training programs support that: go off site as needed.
Question: What is more important when choosing a mentor: the mentor’s area of research or the tools that the mentor is going to provide? Sometimes a mentor is doing work in an area that may not be your first choice, but you know that this mentor will provide you the greatest number of tools you will need to succeed. Because we may change directions later in terms of our specific research interests, what is more important in the training period, the topic or the tools?
Dr. Mendelsohn: I do not think it is the tools. It is the environment. You have to be drawn to the area you are going to work in. You would not want to go study clinical heart failure if really deep down what you want to do is outcomes research in electrophysiology. Certainly, once you have chosen an area, many state-of-the art tools are going to be available to you if it is a good laboratory or a good research program. Most young people who come to the laboratory can learn almost any methodology in a week. That is not the issue. The issue is asking the right research questions, and learning to do this comes with the right environment.
Dr. Fuster: It is very common to think that mentors come from the skies to you and, if they do not, you think there are no mentors. What Dr. Mendelsohn said is extremely important; you really have to go after mentors yourself. You interview them. If you do not, there are no mentors, because all of us are very busy and we are not likely to turn to you and say, "You look good to me. Let me mentor you." It is unfortunate because many people think there are no mentors in their institution. But did you ask? Did you go after them and read their papers? This is what Dr. Mendelsohn is talking about, and this is very important.
There is also the concept of the person who really advises you in your career, in general, not in specific projects. Such a general mentor is absolutely critical. Again, it is based on experience. One of the great problems is getting a mentor for specific research, but there is nobody around you who really guides your career in a more general sense. Maybe you do not belong there, you are really not in the right place, and you need someone who can look at your situation and help you see that. So, I am emphasizing the general individual who really knows you, whether that is someone in your own institute or somebody you had some attachment to before. It is very important that you have an individual or individuals who really guide your careers. They must be trustworthy. These are people who really would do anything for you.
Dr. Mendelsohn: I could not agree more. If you are going to be a cardiologist, there are leaders in cardiology at your institutions who are not involved in the specific area you are seeking to work in, but they still may be wonderful mentors in the general sense that Dr. Fuster is describing. These are the people you can bounce ideas off of and say, "You know, I have narrowed my mentor search down to Person X and Person Y. Can you help me think about it?" To have someone who you trust to be available to have that conversation with you is very important.
Dr. Fuster: Here is another issue: what happens after six months when you find that your mentor is not the person you wanted? That is a tough issue, but we see it commonly. In my experience, the first person you choose as a mentor fails 50% of the time. Then what do you do? First, go to the head of the department or division and present the situation. The department or division head should understand the situation, know the involved parties well, and know best how to approach it. Never try to take care of this yourself. Out of the blue, you may say a few words that can be damaging to you in the future. So you have to be very cautious, and this is why you need the advice of people who will give you an overall view of how to proceed. Again, this is a very common problem, and you should be at least ready with some idea of how to approach it.
Dr. Mendelsohn: It is another good reason to have a more general mentor helping "shepherd" you through the process.
Dr. Fuster: In regard to mentoring, classically, you look for mentors who are savvy, often 60 years of age or older, great professors, and people with a lot of experience. Dr. Mendelsohn, do you think these people are practical as mentors in the world we live in today? In general, are the younger generations of researchers, who are much more into what is happening right now in research, better able to be a mentor, although not the general mentor who assists you with the practical issues of a career?
Dr. Mendelsohn: I think that while it may be the purpose of mentors to make themselves obsolete, you do not want them to be already obsolete! Most of the time, the really good senior mentors of the type that you are describing as the "classic" image of a mentor have a cadre of superb, "fire in their belly," next-level investigators who are between the ages of 35 and 50 years, who run substantial programs with their own R01s, and who really are absolutely in the "sweet spot" to be superb mentors for persons at the start of their careers. You are absolutely right; those are the people you want to work for because they are at the center of the most current issues in the field.
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II. Funding opportunities for investigators in the early stages of their career development |
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TopI. Choosing a research...II. Funding opportunities for...III. Bridging funding...IV. Panel discussion:...V. Careers in clinical...VI. Careers in clinical...VII. Careers in outcomes...VIII. Careers in imaging...IX. Careers in electrophysiology...X. Careers in translational...XI. Panel discussion: Moving...XII. Careers in basic...XIII. Charting a course...XIV. Careers in...XV. Making the transition...XVI. Panel discussion: Moving...XVII. Cardiovascular genetics,...XVIII. Women and academic...XIX. Panel discussion: Greater...XX. Opportunities in training...XXI. Panel discussion: Junior...References |
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There are a number of sources of support (Table 3). One frequently known but underutilized area of support is going directly to the National Heart, Lung, and Blood Institute (NHLBI) or the National Institutes of Health (NIH). The NIH website has a link called the "K Kiosk," which is specifically for training information and awards. The websites for both the American College of Cardiology and the American Heart Association are very user-friendly and contain information for young investigators.
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Up until fiscal year 2003, there was approximately a 58% success rate in terms of approved applications for clinical research and 49% for pediatric research.
Training grants are available for individuals with or earning a health-professional doctorate (Fig. 1). Residents often are supported by institutional training grants (T32). Some individuals in the first couple of years of fellowship have the opportunity to be in a fellowship T32 training grant, which is quite an honor because these positions are limited and highly competitive.
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Some of the most important aspects of applying for the F32 award are the sponsor and training environment. Your sponsor or mentor is probably the single greatest determinant of your long-term success as an academic physician. Choosing a mentor wisely is probably the single most important thing you will do as a young investigator, and you should judge your sponsor on specific criteria. When you apply, your mentor will write a statement outlining his or her experience in training researchers. You need to know this information to see if it is worth spending your time with that individual. Clearly, anyone worthy of being your mentor has to be productive in terms of research grant support and publications. Also, you must be in an environment that has the staff, research support, and facilities for high quality research training.
The actual research proposal for the F32 award must be hypothesis-driven and include specific aims, which are testable predictions of your hypothesis. The research proposal should contain preliminary data, if available, although at this stage, most investigators will not have much preliminary data. If you are proposing a clinical project and you are paired with a mentor, you can use preliminary data from his or her studies, noting that this is what the group has done and that you will be adding your own work. The proposal should have a research design, and it should describe how the design relates to your career development plans.
The last element of the F32 application process is training potential: what is the value of this experience over the time period being requested? How will it help you prepare for a career as an independent investigator? It may give you skills. It may give you exposure. It may give you a number of things that will enable you to take the next step. It does not have to be long, but you need to think about the training potential of what you are proposing to do.
K awards. Let us assume you are at the end of your fellowship and you have determined you do not want to go into clinical practice; instead you want to do research. What do you need to make that career goal happen? First, you need the tools and education for clinical or basic science research and you may need some sophisticated training depending on your area of interest. You can use a K award to assist you in designing a program with didactic studies to help you with the clinical or basic science research aspects of your study and then have a mentored clinical research program with your mentor. The NIH offers a variety of K awards that are institute-specific (Table 6, Fig. 2).
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Again, picking a mentor is very important. The K08 and K23 applications are judged on all the aforementioned criteria, but the mentor may be the most important. The mentor has to state his or her willingness to protect your commitment of 75% of your time to your research program.
The K23 is identical to the K08, except that the K23 is for doctorate-prepared individuals who are going to do patient-oriented research. This is the kind of research that requires you as the principal investigator to interact with living, breathing, conscious patients. What kind of research would this entail? If you are interested in outcomes research on heart failure patients and you will be interacting with patients in your heart failure clinic, this is for you. If you are mining an existing database for new and unique markers for cardiovascular disease, then a K23 award is not appropriate. A misconception is that the K23 award cannot have hardcore basic science components. If you have three or four aims, one of which has to be achieved working with patients, then you can be translating observations that you are making in your first three aims on mice or zebra fish; it qualifies for a K23 as long as there is a human study component.
The success rate on K23 award application acceptance is very close to the K08 awards at the NHLBI and several other institutes. Once again, the application requires exactly the same information as the K08. And remember, if you are not successful the first time, the success rate on resubmissions for many of these is even better.
Question and Answer. Question: How mobile are awards like a K08 or K23? If they are mentor-dependent, how do you travel with them?
Dr. Balke: These awards are very mobile. All you have to do is demonstrate to the National Institutes of Health (NIH) administrative staff that you’re going to a mentor and an environment at least as good as you were in your original institution. This happens all the time. It does not have to get re-reviewed or go back to a study section. Obviously you can’t move one of these awards into a private practice situation and have it continue to support your salary, but otherwise they are very mobile awards.
Question: Many of the awards you mentioned are more to give you support for your salary. Are there other grants or awards that pay for your research, for example, to enroll patients or to do a statistical analysis or other direct research purposes?
Dr. Balke: Let me explain how the actual dollar amount works. You are absolutely correct that the majority of the monies are for salary protection. Depending on the institute and the award, you may request as much as $50,000 per year for supplies and research support. Because these are mentored awards, the NIH expects, actually demands, that the mentor have enough resources to help you get your work done. If you have a clinical trial as part of your project, obviously $50,000 is not going to fund a clinical trial of any worthiness. But it is your mentor’s resources and the institutional resources that will provide that. That is why the mentor is so important and the criteria of having a mentor being funded in a peer-reviewed setting and being productive is so essential. If you have a mentor who does not have a grant, you will not get a K23 or a K08.
Question: Can the NIH loan repayment program be combined with some of these other grants, or are they mutually exclusive?
Dr. Balke: They are absolutely independent of one another and you can have both, so you should apply for both. Also, you can qualify for the loan repayment program without any of these other awards, too.
Question: What do they mean when the requirements talk about covering 75% of your time? Is that based on a 40-h work week, or does it mean three-quarters of the time that you spend working in research?
Dr. Balke: The answer from the NIH is a little murky on that, but generally, when institutions with K awards have been investigated by the Office of the Inspector General, the interpretation of that rule is based on 75% of your total effort. So, if you are working 80 h a week, it is 75% of 80 h. If you are working 40 h a week, it is 75% of 40 h. The NIH is not going to play games with these time percentages. For example, you cannot claim 75% of a 40-h work week for research and then have your department chairman make you work every weekend in the clinic to make up for this protected time. It does not work that way, which is a good thing for you as you are trying to establish your career.
Question: If you are in the second half of your training, doing research, and thinking about applying for an award, would you recommend going for the National Research Service Award (NRSA) or for a K08 or K23?
Dr. Balke: I would apply for an NRSA, even if it is only for a year. You are a principal investigator on an NRSA. Then when you go in for your K23 or K08 you have already started to develop a reputation and a track record for being a funded investigator, and that looks great on your application. You will use a lot of the things that you learn in the NRSA for the K08 and the K23. I would suggest you not waste an opportunity to get a score on the board, even if it is only a field goal, which the NRSA might be.
Question: Some mentors say just go directly for the K08 or K23; do not waste time with an NRSA.
Dr. Balke: It depends on your institute and what your discipline is, but you cannot have a K08 or K23 activated unless you are a junior faculty member. So, if you are in your third of four years of fellowship, I would apply for an NRSA for my fourth year of fellowship. This time next year I would be preparing my K08 or K23.
Dr. Fuster: Say I am finishing the training program and I heard all this talk about productivity, productivity, productivity, and I have two choices. One is to write the proposal for an NIH grant; the other option is to begin working on a research project because I am convinced I can write a paper faster than going through all that. I think getting funded at that stage is the most important goal. Would you interpret what productivity means at different stages of careers?
Dr. Balke: For an example, let us assume you are in your third year of fellowship and you have got only X amount of hours in the day. Do you apply for an NRSA or do you finish a paper? I do not see them as mutually exclusive. An NRSA is not that difficult of a grant. It is shorter, and much of what you do to produce a paper will go into your NRSA anyway. If you are doing a paper, those are your preliminary data. When you write a paper, if you do it well, the paper is addressing a hypothesis; that hypothesis is going to be part of your grant. I do not necessarily see it as an either/or situation.
When applying for the K08s, K23s, or the R01 awards, your ability to compete increases with manuscript productivity. That is when you really want to start getting some traction with those applications. However, you can get a K08 and a K23 without a lot of publications. If you finish your fellowship with one really solid publication in a good journal, you have more than enough to launch a K08 or a K23. I am chairman of the National Heart, Lung, and Blood Institute K23 study section. I have seen applications come in with one or two papers that are superb, from JAMA, New England Journal of Medicine, Nature, Science, Journal of Clinical Investigation, Cell, and so forth. One or two papers, four years worth of work, two years in the lab, and two years in the clinic, that is great. You see applications come in with 14 papers in cardiovascular niche journals, and they do not succeed. You have to try to strike the right balance.
Dr. Fuster: When you are ready for publication, before you do anything else, should you discuss with your mentor about the order of authorship?
Dr. Balke: Absolutely. This is hard for all of us. One of the sort of silent genes that select us for being in medicine is the fact that we do not really address issues, we kind of settle them as we go along. This is your career. This is your life. Grab it by the horns and do not be passive about it. Be polite, but do not be passive. Sit down with your mentor and say, "I really am interested in this project you are doing with T-wave alternans, for example. I know this is your project, but I am going to meet these patients, I am going to analyze the wave forms, I am going to do the statistics. Where is my name going to be listed on this paper?" And if you agree with wherever he or she puts you, that is great, but it is also all right if you want to be in a different position. Recognize that your mentor may say, "I started this project, there is this other more senior fellow who has been doing a lot of the work, so he or she will be first author, you will be second, and I will be last. But let us see how the project concludes. If, for some reason, the percent contribution changes, then we can always revisit this."
I have accepted and actually administered that kind of a position a number of times. It often ends up exactly the way it was originally described, but it can change later. The last thing you want to do is set up a situation where you put a very acrimonious wedge between you and your mentor because you had one idea in your mind, he or she had another, you did not talk about it, and then when the paper goes out the door, you have big disagreements. Life is too short and you do not need that kind of aggravation. So ask up front. Nobody is going to be offended if you do. Just be polite about it.
Dr. Fuster: Can you give a sense as to whether authorship order is important, or is it more important that you can transmit how you contributed to a paper?
Dr. Balke: At this stage in your career, it is paramount to contribute at a level that gets you author attribution anywhere in the author list. Once you are on the author list, then order has some importance. First author is the best, and if you can get that position, please try. Being first author means you are the person who really made the project happen. It is not necessarily your idea but you understood the idea, you did a lot of the work, you contributed intellectually and substantially to the completion of a project, and you are sort of the fulcrum that all the different pieces went through. The last author is usually the person whose laboratory or research program conceived the whole direction. If you cannot be first, be second. If you cannot be second, be third. Get as close as you can to the front of the line.
If you are a second- or third-year fellow and you are in the middle of a pack of 20 authors, it is still okay. It is a publication. But no matter where you are on the list, when you go for an interview or when you write your description of your grants, talk about it like it is your project. You have got to know it. You just cannot be along for the ride. If I am interviewing someone for a junior faculty position and I have a fourth-year fellow who has got a couple publications, maybe first author in a small journal article but fifth author in Journal of Clinical Investigation, if he can tell me the hypothesis and he gets excited about the work and tell me what he and the team did, I do not care if he is fifth or first author; at that point, it is all the same. He contributed; it is his or her work.
Dr. Fuster: Do you think it is right or wrong for a senior research member, the one who runs the area and has a lot of experience, to give someone else the opportunity to be last author?
Dr. Balke: I do not know that I would say it is right or wrong. It is a matter of personal style. At this stage in my career—I finished my training in 1991—I do what I can within the honest scope of the work to give the last spot and corresponding spot to junior faculty when I can. Here is a very specific example. We have a program looking at some of the molecular determinates of contractile dysfunction in heart failure and we are doing a number of animal models. This has been a long-standing research program that I developed when I was a post-doc and have continued ever since. But for the latest paper, the clinical fellow is actually the first author, the new junior faculty member is the last author, and I am the next to last as corresponding author. The next paper that we put out on this model in this group, new junior faculty members will be the last end-corresponding author, and I will be buried somewhere in the middle. It is fine by me. And it is not dishonest. One thing you cannot do is put people on the list or in positions if they have not contributed to the work. That dilutes the quality of the science and the whole process that we are all so completely vested in.
Dr. Fuster: I agree every contributor should be there and someone who is not a contributor should not be. I feel very positive about giving people the opportunity to be the last author. When we talk about the importance of altruism, this is how it makes things go. It is to create incentive, and I feel very strongly about what you said.
Dr. Balke: Let me add that if you can find mentors who say they will use their seniority and clout to help get the first several papers that result from the work you do together into the best journals and then will voluntarily remove their names from later publications to help you develop your own reputation as an emerging independent scientist, that is the kind of mentor you want to wrap your arms around and never let go. That is a generosity you rarely see, but it is what you need.
In our study section, I occasionally see situations where mentors are secure enough that they actually make explicit in their support statements for the candidate these kinds of generous offers. If you can pair yourself with someone like that, it will be one of the best opportunities in your entire career. Even if you do not find a mentor like this, put this in the back of your mind and when you mentor, which will not be many years from now, you should do the same thing. It is not a question of whether you have 2 or 300 publications in your curriculum vitae, it is a question of the quality of the work.
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III. Bridging funding opportunities for young investigators |
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TopI. Choosing a research...II. Funding opportunities for...III. Bridging funding...IV. Panel discussion:...V. Careers in clinical...VI. Careers in clinical...VII. Careers in outcomes...VIII. Careers in imaging...IX. Careers in electrophysiology...X. Careers in translational...XI. Panel discussion: Moving...XII. Careers in basic...XIII. Charting a course...XIV. Careers in...XV. Making the transition...XVI. Panel discussion: Moving...XVII. Cardiovascular genetics,...XVIII. Women and academic...XIX. Panel discussion: Greater...XX. Opportunities in training...XXI. Panel discussion: Junior...References |
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This is especially a concern, given that during the period from 1990 to 2000 many more PhDs than MDs applied for NIH grant funding, although the overall level of funding stayed somewhat the same during this period (Fig. 3). Importantly, MDs and PhDs have a similar chance of successfully getting funded. We need to get young MDs enthused about getting funded and see to it that they get the job done.
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Part of this is related to the fact that the transition from fellow to faculty is one of the most difficult hurdles on the path to a career as a clinical investigator. What can be done to make this transition a little easier? At the NIH, there are important transition awards for junior faculty members as well as those in the last stages of fellowship, as discussed by Dr. Balke.
There are other institutions offering support as well, including the American College of Cardiology (ACC), the American Heart Association (AHA), and the Department of Veterans Affairs (VA). Take these opportunities seriously. If you go to the AHA Scientific Sessions, for example, there is a Saturday afternoon session in which you can get survival skills necessary for early career development. You can have one-on-one discussions with successful scientists as well.
Transition awards—AHA. While funding from the AHA is only about 5% of the total funding of the NHLBI, the AHA focuses most of its research funding on young investigators. The AHA strategic goal for research is to identify opportunities and implement programs to increase the number of beginning investigators; specifically, those with no more than four years since their first full-time faculty or staff appointment.
There is a portfolio of possible grants from the AHA that differ among the AHA affiliates and the organization’s national level of programs. This discussion will focus on the Scientist Development Grant and the Fellow-to-Faculty Transition Award. The Scientist Development Grant supports highly promising beginning scientists in their progress towards independence (Table 8). For this grant, applicants should be a faculty/staff member or a fellow who is about to become a faculty member. Applicants must be initiating independent research careers at the early faculty level, usually at the rank of instructor or assistant professor (or equivalents). Applicants can be writing this grant and getting the award while making the transition.
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The intent of the AHA Fellow-to-Faculty Transition Award is to provide a supportive mentored experience during this transition period (Table 9). This is not funded heavily at the local affiliate level, but has a high success rate if you apply for this at the national level. Applications can be made to either the affiliate or national grant sections, and sometimes it may be appropriate to apply to both. With this award, one may obtain research support during one’s fellowship and carry the remainder into the early faculty years.
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Fellows can receive the award for work at one institution and then carry it to another institution where they join the faculty.
Other AHA programs for beginning investigators include the Beginning Grant-in-Aid and the Established Investigator Grant. The Beginning Grant-in-Aid program is designed to promote independent status to promising beginning scientists up to and including the faculty level of assistant professor or equivalent. This award is less frequently funded within the AHA portfolio because there is more support going to the Scientist Development Grant. However, in some of the AHA affiliates there may still be available funding for Grant-in-Aid. When looking for the programs offered by AHA affiliates, see what is being funded in any given cycle or in previous cycles to determine those awards that may be applicable to your situation, but understand that the Scientist Development Grants are going to be much more attractive, and that is where the AHA wants to put the money.
The Established Investigator Grant is for someone at the next career level beyond fellowships. This award is for individuals who have already established themselves as independent investigators and is meant to support the career development by funding innovative projects not funded elsewhere. The grants usually are given to investigators four to nine years after their first faculty or staff appointment. This is the kind of prestigious grant that should be a goal for serious young investigators.
Beginning investigators should be applying for grants at the NIH K award level as well as for the Scientist Development Grants. It is not possible to get funded from both arms, but it’s wise to apply for both; if an applicant gets rejected by one program, they may get accepted for the other. The same thing is true for the Established Investigator Grant, as investigators move up the NHLBI grant program ladder as their career advances.
For the year 2004, exactly 60% of AHA research funding went to applicants at the level of assistant professors, fellows, and instructors. Other career guidance information is available from the AHA, including mentoring information and the AHA Mentoring Handbook (5), at the organization’s web site, www.americanheart.org/research. Becoming a member of the AHA gives you access to myamericanheart.org, which provides even more specific career information as well as more specific ways to obtain grant support from the AHA.
Transition awards—ACCF. The American College of Cardiology Foundation (ACCF) is a very attractive source of information and funding for fellows. There are fewer grants available, but they are quite prestigious. The ACCF/Merck Research Fellowship awards are for one-year research fellowships with preference given to individuals with no more than two years of full-time research experience (Table 10). The new focus of this award this year is cardiovascular disease and the metabolic syndrome.
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This K22 award requires an intramural phase at the NIH, which includes direct costs of up to $150,000 per year including salary, followed by an extramural phase during which the award continues, provided there is an extramural faculty appointment that is on a tenure track. The extramural phase requires at least 75% research time for two years and provides up to $150,000 per year in direct costs including salary plus fringe benefits.
The VA also has Clinical Research Career Development Awards (www.va.gov/resdev), but they are only applicable for investigators on staff with salary support at a VA hospital on site. The intent is to foster research careers of clinical scientists who are not yet fully independent but will soon become independent clinical investigators. The VA awards share similarities with the NIH K awards and the AHA Scientist Development Grants; specifically, applicants are not yet fully independent, and they must have a strong mentor relationship. The VA awards provide three years of support, including salary and supplemental research support for a fully trained clinician scientist who is entering or has recently entered a career in clinical research.
Finally, there are many foundations interested in supporting young careers. These foundation transition awards come from foundations such as the Schweppe Foundation, Doris Duke Foundation, Robert Wood Johnson Foundation, and the GlaxoSmithKline Research and Education Foundation for Cardiovascular Disease. There are many additional local awards, and they can be found in the cities where your institutions reside. This is where a mentor can be quite helpful, because many mentors know about these awards and have used them successfully.
A successful transition requires dedication, focus, and mentorship. Importantly, you should have fun and enjoy this part of your career. Many of us are overachievers—we like instant gratification and do not take bad news easily. On the other hand, a successful research career is like a rollercoaster ride. Every young investigator will face times of rejection. You have to have a thick skin. You have to have persistence. Yet, it is a very invigorating career, and it can be enjoyable. You get to meet interesting people, and you are given the opportunity to teach the next generation of interesting people. It is a very rewarding experience.
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IV. Panel discussion: Opportunities for young investigators |
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TopI. Choosing a research...II. Funding opportunities for...III. Bridging funding...IV. Panel discussion:...V. Careers in clinical...VI. Careers in clinical...VII. Careers in outcomes...VIII. Careers in imaging...IX. Careers in electrophysiology...X. Careers in translational...XI. Panel discussion: Moving...XII. Careers in basic...XIII. Charting a course...XIV. Careers in...XV. Making the transition...XVI. Panel discussion: Moving...XVII. Cardiovascular genetics,...XVIII. Women and academic...XIX. Panel discussion: Greater...XX. Opportunities in training...XXI. Panel discussion: Junior...References |
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Dr. Bonow: I am not sure I have the answer. You could argue that the 4% figure for funding is a little misleading. Maybe the grant is going to an older investigator, and younger people are being supported through that grant.
However, I do not completely buy that explanation because if you look at that intermediate group of researchers 35 to 45 years of age, that group’s funding is not expanding either. I am concerned that we are kind of an endangered species with fewer and fewer people going into research. By the way, that graph I showed was not just cardiovascular disease research funding; that was funding across the board. It may be worse in cardiovascular disease research, possibly because clinical cardiology is so exciting. When you start saving lives at 3:00 in the morning with a balloon catheter, that can be habit-forming; who has time for research?
Training programs are supposed to be training clinicians as well as scientists and future academic leaders. In any cardiology training program, we accept the fact that a number of participants will ultimately go into clinical practice. As a profession, however, we must provide not only the tools but also an environment that encourages young people and attracts them to research.
The reason we have this meeting is to give you the opportunity to discuss with all of us your aspirations and the difficulties or hurdles you face. I do not have the answer. All I know is that the data tend to speak for themselves and, of course, many others have been raising alarms regarding funding for a number of years. As a result of those alarms, many of the National Institutes of Health (NIH) career development awards came to fruition, and the K awards have been very successful. So, we may see a turnaround in this as we update that graph over the next 10 years.
Right now, the K award applicants get funded at a very high level. If you apply for a K award with a good mentor and a good project, you have got almost a 40% chance of getting funded, which is great. From my perspective, the problem is going to come in the success of moving K award recipients into R01 grants, which is the original and historically oldest grant mechanism used by NIH. Going from a K to an R01 grant moves you from the mentored experience to the independent experience. That is an important step because they are not funded at the same level.
Also, there is the NIH budget itself, which is going up each year, but the budget has gone from increasing 15% per year in the last five years to just 3% this year, with a lot of that increase going to bioterrorism, not cardiovascular disease. So, the ability to take all those K award recipients and advance them into R01s is going to be tricky.
I have a question for Dr. Fuster: while the team approach is a great concept, how do you reward the team player in the current academic environment? The person with a grant tends to get all the credit at the university, in terms of promotion and so forth, so how does the dean recognize a good team player? Certainly you contributed to this grant, but you are not the recipient or principal investigator (PI) on it. A lot of medical institutions are struggling with that issue. We all agree there is a need for team-based research and building new research teams.
Dr. Fuster: In my view, the NIH is stuck in the PI concept, and this is a mistake. As we move towards the future, we must identify young people and provide the resources and incentives necessary for these people to be recognized. Unless this is done, it is going to be a huge problem.
Question: My question relates to clinical work versus research. Many of us love clinical work but are also drawn by research. As fellows, we are trying to find a way to combine them and be happy with both worlds. Is that truly possible?
Dr. Grant: I would say, it is. If I have conveyed the idea of a dichotomy, I would like to correct that. On the one side, there is someone like Dr. Vatner who spoke with you earlier about dedicating yourself to basic cardiovascular research. As for myself, I have been on the Duke faculty for 25 years, and I continue to see patients while I run an NIH R01-funded laboratory. So it is possible to do both.
The question is: how do you divide your time? I commit a majority of my time to basic research, but it is certainly possible to still maintain my clinical contact. After all, that is why we became physicians in the first place. If you are trying to decide your commitment in terms of effort and time, then my message is this: if your maximum commitment is to basic research or to clinical patient care, there are differences in lifestyle involved. But both are rewarding.
Dr. Bonow: Also, it depends on the kind of research you are talking about pursuing. If it is a highly competitive area of basic investigation, that can be difficult, which is why we talked about focus. That scenario would require an 80% minimum commitment by you in order to be competitive with the PhDs who do this 100% of the time.
Yet even if you are doing basic investigation, it is great to have a clinical presence. It makes you more aware of where your research should be going, the real world it is going to be applied in, and why the research is important. Also, having that clinical presence helps you keep from getting off track into some irrelevant area, and it allows younger trainees to see you as a real doctor, and perhaps it will help you draw them into your laboratory. And there is another bonus, too: reserving some time for clinical work maintains the reason why you went to medical school in the first place, and that is the patient experience.
All of that applies to basic laboratory research. If your research is more clinically based, it may be quite easy for you to be in a cath lab involved in research of vascular function, for example, or myocardial infarction or medical devices. In the cath lab, you are dealing with those cases every day, and half of what you do clinically may be adding to your research database.
So, I agree with Augustus: certainly you can combine both clinical and research work, but when you do that your focus becomes really critical, and you have to watch your time on the clinical side.
Dr. Fuster: I would like to add to what Bob said. I have combined clinical research and clinical practice all my life. It is hard, although it can be very enjoyable. What you must remember is that you are competing when you apply for grants. It is impossible to do basic science today and be a great clinician because the competition is so much greater. But it is possible to take the clinical investigation track and be a translational researcher working with basic investigators and enjoying what you are doing while still getting grants. However, to make it work you have to be methodical with an organized pattern in your life; it has to be very strict.
Dr. Grant: This comes back to the issue of focus again. If you are interested in vascular biology or some other particular area, an ideal research career would be to select a group of patients who have a related problem and then work towards gaining focused clinical experience directly related to your research. With a career built around that sort of paradigm, you can be extraordinarily successful.
Question: Dr. Bonow, you were speaking of the American Heart Association (AHA) Fellow-to-Faculty Transition Award, and there are the K08 and the K23 Transition Awards as well. It seems as though it would be difficult to be part of a mentored program if you are going to leave the institution where you are doing fellowship and go to another institution. To me—unless I am not understanding the award—that seems like a limitation. How do you identify a mentor at an institution where you have not been hired yet in order to obtain one of these awards?
Dr. Bonow: It is tricky, but it is possible. It requires homework and long-distance mentoring, just like we talked before about the ability to reach out and identify potential mentors. As part of the recruitment process, you could be doing that. As you are selecting one place over another, due diligence is your responsibility to identify those individuals who will mentor you.
I should add that, compared to the NIH awards you mentioned, the AHA award is a little easier to transfer. You can pick that up and move with it if you need to. In doing so, however, you have got to be certain that there is a mentor on the other end of your move because there will be required review of your progress. If your progress was great as a fellow but it starts to slip as a faculty member because you moved, that is not good. So, if you are considering a move, you have got to look very carefully at the mentorship on the other side.
Question: I hear that sometimes, even though you are working with a good mentor, it is better to move to a different institution as faculty to get a better opportunity and more experience. Can you keep the same mentor and do this long distance, or is it better to just stay in the institution where you are a fellow, finish your work, and then move?
Dr. Bonow: It depends on your work. It may work if you are dealing with a database and outcomes research. If it is bench research, it will be virtually impossible unless you are just finishing up some data analysis and writing it up in the transition period.
There is no problem in staying. This comes up all the time as we are talking with fellows about getting faculty positions: is it better to go someplace else where you might get a better deal? Also, if you move, you are coming in to your new position as an accepted senior person as opposed to somebody who has been a fellow and is now just moving into faculty. It is very individual and based upon you, the institution, and your track record there. Independent of that personal feeling of whether you should stay or go, the key issue is what will a move do to your research career? Is it going to suffer because you are moving?
The question often comes up: when is the right time to leave and move? Frankly, it comes up not only as a fellow but throughout the rest of your life. All of us have had opportunities almost every year to change our stripes and go someplace else. I bet Augustus has had offers this year and Valentin has, and I have too. At some stage, you decide this might be the right thing to do. But if you are productive and successful, the offers only get better. Therefore, if you are doing well where you are, you might join the faculty at that institution for a couple more years, get a few more grants, become independent, and then when you have the R01 you might want to leave.
Dr. Grant: In a lot of ways, this is truly a personal decision. And the decision should turn around specific arguments, for example: am I really at the stage of my career where I can truly be independent? Do I have the skills that I need to stand on my own feet? Am I prepared to write—or better still, have been successful at writing—my first grant? Can I comfortably sit down with my data and prepare a completed manuscript? If you feel that all the pieces are in place and you are truly comfortable with where you are in your career, then I say the decision can go either way.
If you can identify deficiencies in your skills at any level, and you are in an environment in which those deficiencies can be corrected, then surely the answer is to stay longer and not move. It is a very personal decision, and you must reevaluate it from time to time. There is no timetable or any rules to tell you exactly when that transition is appropriate.
Question: I have a question about the Fellow-to-Faculty Transition Award. Do you have to be actively engaged as a fellow at the time of the award?
Dr. Bonow: Yes, and because of the award you may decide to extend your fellowship. There is nothing wrong with getting a couple of extra years of fellowship training if you are in an environment where you are really protected. As soon as you join the faculty, your protection becomes a real issue; even when you have 75% protected time, you will have people biting at your heels to spend a little more time seeing patients, doing other things. That is where you need a mentor to protect your time and stand behind your grant. If your fellowship is ending, then you would be eligible for the Career Development Awards, which are specifically for junior faculty.
Question: Do you think medical schools or universities could do more to assist in this transition into research, which seems to be the hard part? I am talking about making it easier in terms of support, because a lot of grants require the institution to make a commitment that could cost them $40,000 a year. That might be a problem in some institutions that do not have a lot of resources.
Dr. Bonow: It is true for NIH K awards, too, because they do not really support your salary. From the institution’s point of view, K awards are great and yet every time we get one, we swallow hard because now we have got to find a way to support this person when 80% of their time is protected for
