how young faculty can avoid common pitfalls in academic life david robertson, md crc director march...
TRANSCRIPT
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How Young Faculty Can Avoid Common Pitfalls in Academic
Life
David Robertson, MD
CRC Director
March 16, 2007
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Limited Focus of this Presentation
• Medical School
• Clinical Department
• Physician Investigators– Role of the physician– Role of the investigator
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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
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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
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Patient-Oriented Research
• Occurs when the patient and the scientist are both in the room at the same time and both are alive.
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Kinds of Clinical Research
• Human gene function
• Human cell function
• Clinical pathophysiology
• Clinical therapeutics
• Clinical trials
• Outcomes
• Epidemiology
PatientOrientedResearch
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GENOME
PROTEOME
ENDOPHENOTYPEPHYSIOME
PHENOTYPE
OLD PARADIGM
ENVIRONOME
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GENOME
PROTEOME
ENDOPHENOTYPEPHYSIOME
PHENOTYPE
NEW PARADIGM
ENVIRONOME
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Clinical Research is not an easy roadway
Clinical research is impeded by escalating regulatory requirements to address the same oversight concerns.
Elias Zerhouni
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Your careers will span an era of great change
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“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
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Bench Bedside Trench(Practice)
The Problem
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The new multidisciplinary paradigm
• The multidisciplinary paradigm could be interpreted as NIH’s way of introducing what Horgan called “the end of science”
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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
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Be a great physician
• Study your patients
• Study the literature
• Study OMIM + links
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Advice for Clinicians
• Cathell DW. The physician himself. (Philadelphia: F. A. Davis) 1893
• Tumulty PA. The effective clinician. (New York: Saunders) 1973
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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
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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
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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.
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Is discovery central to your life?
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The Search for Creativity
• How can the physician-investigator cultivate creativity?
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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.”
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Wassily Kandinsky: Old Town II
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Practicing Clinical Research
• Creativity and innovation
• Be a clear thinker
• Hypothesis-testing is the liturgy of POR
• You must work very hard
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Cultivation of Creativity
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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
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Cultivating Creativity
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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
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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
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The Landscape on the Eve of Enlightenment
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Stanley Cohen
• Vanderbilt Biochemist and Teacher
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Arthur C. Guyton
• Medical Physiology Text
• So masterfully written, that the 95% of the undiscovered world was almost invisible
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Eve of Enlightenment
• Aspirin and Prostaglandin
• Aquaporin
• Ulcer Disease
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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
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Develop Good Habits
• Make your tasks educational
• Be competent; know your methodology
• Remember that a scientific career is a pleasure but also a business
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You have to take care of yourself
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Quality Supersedes Quantity
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You’ve got to be willing to fall flat on your face
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Expect noise in the system
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What is the secret of working successfully with a difficult chair?
• Learn to use different words in describing your goals
Dean John E. Chapman
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The Five Academic Deadly Sins
• Failure of imagination
• Superficiality
• Lack of focus
• Sloth
• Majoring in the minors
• Boundary Crossing
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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?
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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
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At any given moment, have …
• 6 projects in planning
• 4 projects in process
• 2 projects in press
….Victor A. McKusick, Advice to Housemen, 1964
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Career Advice
• Boss JM, Eckert SH. Academic scientists at work: Navigating the biomedical research career (New York: Kluwer) 2003
ISBN 0-306-47493-X
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Career Advice
• Barker K. At the helm: A laboratory navigator. (New York: Cold Spring Harbor) 2002
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Career Advice: The Far Side
• C. J. Sindermann, Winning the Games Scientists Play (Cambridge: Perseus) 2nd edition. 2001
ISBN: 0-7382-0425-0
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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.
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Vanderbilt Clinical Research Center