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During medical school orientations just a few decades ago, it was common for the Dean or another senior speaker to say to the assembled freshman class: "Look to the right of you...look to the left of you... [and in solemn tones]...in four years one of you three will not be here." Happily for today's medical students, dire threats and gloomy predictions have long since become unacceptable, and medical schools strive for their students' success. However, in many ways the transition from undergraduate to medical student is more challenging today than ever. Medical schools have a complex selection process that carefully vets applicants and admits only students it judges to have the intellect and ability to succeed. Still, in each class some medical students struggle, particularly in the first 2 years. Why do some students do poorly or even fail and what should new or prospective medical students do to raise their odds of success?

A major reason medical school is challenging is that students are exposed to a new way of learning, which differs from the methods of most undergraduate programs in two ways:

  1. Case-based learning largely replaces the conventional didactic lectures.
  2. Learning is centered on groups of medical students working as teams.  
This is a radical departure from the "Lone Ranger" method of individual learning that undergraduates are used to. In the team system, medical students work together to tackle problem sets. They teach and learn from each other with faculty input and supervision. The team approach, combined with case-based learning, has proven pedagogically superior; working in teams stimulates learning and increases retention (see references 1 and 2 below). Another advantage is that while individual accountability and responsibility remain essential, medical care increasingly depends upon teams of caregivers; if you don't learn to work in teams in medical school, where will you learn this skill?
 
Another reason students struggle is that in medical school the pace of learning is much faster than what they're used to. There's more material to master in less time. Medical knowledge increases very quickly, so each new class has more to learn. The knowledge needed to be a physician is voluminous and complex, often requiring intensive concentration and study to be fully understood.  Effective teamwork and case-based learning facilitates the learning process--but also calls for flexibility, adaptability, and maturity beyond what is needed to excel as an undergraduate. Sub-par performance results in remedial work; weak students may even need to repeat the school year.
 
So how does one assure success in making this transition? There is no single answer, no magic rule. However, here are 10 suggestions that address the major obstacles to success:
 
  1. Make the necessary emotional and psychological adjustment to deal with 4 extremely tough academic years. Yes, this is within your control. Get used to having less time for family and friends, recreation and social life.
  2. The summer before you start medical school, obtain a reading list and possibly a textbook or two. Get a head start on your work and adjust your frame of mind towards serious study.
  3. Once medical school has started, take an engaged and active role in your teams and study group. When working in a group, there's a tendency to focus on your own contributions more than those of your teammates. Avoid it; you need to know all the material, so focus on the contributions of others at least as much as you focus on your own. 
  4. Limit distractions. There is no end of attractive opportunities for committees on class affairs, participation in clinics for indigent patients, community teaching, and other laudable efforts--but school work comes first.
  5. Think realistically about ways of incorporating research into your medical school experience. If you affiliate with a laboratory, make a commitment that does not encroach too much on your medical class work. If you have a passion for research, consider taking a year off to work in a lab. In addition, many schools with M.D.-Ph.D. programs will consider allowing interested and qualified students to transfer to the program through their second year. This is an attractive opportunity for some.
  6. Although exam scores and grades are usually not entered on your official transcript until the 2nd or even 3rd years, pay close attention to how you are doing on quizzes and exams and respond when there are indications that you may need to study more or get help.
  7.  Familiarize yourself with and take advantage of mentoring and other academic support services. These are extensive, accessible, and well-organized at most institutions. Periodically review your progress and review any concerns with your assigned mentor.
  8. Medical Schools are not monasteries or cloisters. Close friendships and relationships develop and can be rewarding--but maintain stability in your personal life.
  9. Don't spend time and mental energy worrying about future decisions such as what specialty to select or where you will do your postgraduate training. The curriculum is designed to give you the experience and information you need to make a carefully considered decision regarding specialty choice, residency, and fellowship--at the appropriate time.
  10. Eat well, sleep sufficiently, and exercise regularly. The ancient Greek philosopher was right--a sound mind in a sound body is what it takes.
It cannot be stressed enough that the first two years of medical school provide the foundation for the knowledge you need in your medical career.  Not only your success as a medical student, but the health and well-being of your future patients depend on the preparedness, commitment, and hard work you bring to bear those first two years. Make them count!
 
References
1.    Michaelsen L, and B Richards. 2005. "Drawing conclusions from the team-learning literature in health-sciences education: a commentary". Teaching and Learning in Medicine. 17 (1): 85-8.
2.    Williams, B. 2005. Case based learning--a review of the literature: is there scope for this educational paradigm in prehospital education? Emerg Med J. 22:577-581 doi:10.1136/emj.2004.022707.

So new is the field of Environmental Science (ES) that, according to the U.S. Bureau of Labor Statistics (BLS), the first generation of scientists in the field are beginning to reach retirement age -- one reason that some people anticipate growth in the number of available jobs in the field.

ES came into being as a real branch of science in the 1960s and 1970s, answering a need to understand complex environmental problems and deal with a flood of new environmental laws that required specific environmental investigation protocols. The ultimate cause was public awareness and concern about the environment raised by the 1962 publication of Rachel Carson's exposé Silent Spring, and later reinforced by the energy crisis, global warming, Hurricane Katrina, and the Gulf oil spill, among other changes and events. (1)

"The aging process is not fun, but when it begins decades ahead of schedule, it's tragic" (See Editor's Choice: Splicing Therapy Comes of Age, Science 11 Nov 2011, Vol. 334, p. 739). Substitute the word "retirement" for "aging" and you have the problem facing many career scientists today. While scientific journals and the science establishment bemoan the macroeconomics of "U.S. Science and Austerity" (See News Focus: U.S. Science and Austerity, Science 11 Nov 2011, Vol. 334, pp. 750-759), those working in university laboratories, research institutes, and hospitals see the tragic results among themselves and their colleagues as grant funding dries up. This "professional progeria" unexpectedly and increasingly strikes talented researchers with track records of success and accomplishment. As John Lennon noted: "Life is what happens to you while you're busy making other plans." Still, for individuals entering science careers, it's wise to make those plans now to prepare for when the grants stop coming. If that never happens, so much the better.

There is increasing awareness that for optimum intellectual function, a balanced relationship must exist between the use of our electronic linkages and our brains. Excessive use and over-dependence on the Internet, e-mail, smartphones, and Web-enabled tablets can hinder instead of helping progress toward a successful science career.

This is a complex and contentious issue. It was addressed by Nicholas Carr, a respected technology writer, with a 2008 article in The Atlantic titled "Is Google making us stupid?" and  expanded upon in his recent book, The Shallows:  What the Internet is Doing to Our Brains (W. W. Norton, 2010). Carr believes that "we are trading away the seriousness of sustained attention for the web's frantic superficiality." As a researcher, advisor, and student mentor, I see this happening in many struggling students and young scientists.

The striking characteristics of the nutritional sciences are its long and colorful history, its broad scope and complexity, its ability to integrate with other scientific disciplines, and the excellent opportunities it offers for a scientific career.

Its long history includes the first written nutritional research study -- reported in the Book of the Prophet Daniel, in the Bible. In Chapter 1, Daniel and his companions, captives of King Nebuchadnezzar, disdain the food and wine they are offered from the royal table and request a diet of vegetables and water. After a 10-day "clinical trial," they look healthier and better fed than the "control" group eating from the royal table. As a reward, the King admits the group into his service.

The broad scope of the nutritional sciences is well documented by the information provided by the more than 160 graduate programs offering advanced degrees in the field. Nutritional sciences encompass all aspects of an organism's interaction with food, and can be investigated at levels ranging from molecules to populations.

It is common to hear undergraduates and recent college graduates preparing for a career in science complain: "I think I wasted a lot of time in college being forced to take humanities classes that had nothing to do with my area of study." This is one of many manifestations of the ongoing centuries-long battle over the relationship between the sciences and the humanities.

From a historical point of view, until the mid-19th century, the humanities (i.e., grammar, rhetoric, history, literature, languages, and moral philosophy) held the upper hand. At Oxford and Cambridge Universities, the gold standard models for American education, the areas of study consisted mainly of classics, mathematics, or divinity.

However, in 1847 Yale College broke with this tradition and formed the School of Applied Chemistry. This became the Yale Scientific School and in 1861 it was renamed the Sheffield Scientific School. Sheffield's 3-year undergraduate program focused on chemistry, engineering, and independent research. It offered the best scientific training in America. The "Sheffs" studied and lived apart from other undergraduates taking the classic curriculum and roomed together in the "college yard." The two groups did not mingle. The old truism that a classical education assured success was being challenged. Science had begun its separation and was ascending vis-a-vis the liberal arts in American universities.

The need for science majors to take courses in the humanities has been contentious ever since. The required core curriculum at most colleges and universities has atrophied over the years, while at the same time governmental funds for support of any new research in the humanities has dried up. Authorities both within and outside of science have expressed concern that scientists do not learn enough about the humanities -- to the detriment of society.

In this environment, it's difficult for the undergraduate to determine the desirability of taking courses in the humanities -- or which and how many to take. In fact, some applicants to college regard a strong core curriculum requirement as a negative factor, opting instead for programs with a minimum number of required core courses and maximum flexibility.

All this considered, I would offer the following 10 reasons why students pursuing science careers should augment their education with a strong foundation in the humanities.

One of the most promising and rewarding career choices for the student contemplating a professional life in clinical medical research is that of a primary care physician scientist. As U.S. managed care evolves, the primary care physician (PCP) is assuming an increasingly prominent and responsible role in the healthcare system. The PCP is generally the first medical practitioner contacted by a patient. The PCP does the initial evaluation; acts as the collaborator and facilitator in referrals to specialists; coordinates the care among specialists, clinics, laboratories, and hospitals; and provides long term management of most patients. From an economic standpoint, the PCP is the "gatekeeper" who regulates access to costly consultations, studies, and procedures. Approximately one-third of practicing physicians in the United States are PCPs.

So where does the research come in? Modern medicine is increasingly oriented toward evidence-based practice; that is, treating patients according to methods and means that have been scientifically demonstrated to be the best choices. To achieve evidence-based practice requires practice-based evidence. PCPs are in the right place to provide this -- to study the effectiveness of medical care and the translation of innovation from the laboratory to the bedside and the community. However, to accomplish this, prospective PCP-scientists need additional training and research capability that goes beyond the standard training provided to become a PCP, training that is both available and well supported.

If you are a basic scientist, you probably work in a setting that is far away from the clinic -- literally and figuratively. Yet some of your research could benefit patients. The challenges are recognizing that potential and translating it into something that can be used by medical doctors, device and pharmaceutical companies, or patients. 

To address these challenges, Science Careers teamed up with the Federation of American Societies for Experimental Biology (FASEB) for a workshop called "Can Your Basic Research Contribute to Cures? Translational Research for Ph.D.s." Organized by Science Careers Editor Jim Austin, the workshop was held in Washington D.C. last week at the annual meeting of the American Association for the Advancement of Science (AAAS, which publishes Science and Science Careers). The session was chaired by Kate Travis, Editor of CTSciNet, the Clinical and Translational Science Network, an online career development community within Science Careers. 

On the panel were three early-career and established translational scientists: Sridevi Sarma, an assistant professor at the Johns Hopkins Institute for Computational Medicine (ICM) in 
Baltimore, Maryland, who uses her engineering background to develop computer models of deep brain stimulation as a treatment for Parkinson's disease; Kasey Vickers, a biomedical scientist currently studying the mechanisms underlying atherosclerosis as a postdoc at the  National Heart Lung and Blood Institute (NHLBI) in Bethesda, Maryland; and Laura Richman, a former veterinary pathologist whose current job as vice president for research and development for translational sciences at biotech company MedImmune in Gaithersburg, Maryland, is to coordinate research projects and develop clinical trials (Richman was recently profiled on Science Careers).

Below are some of the key points the panelists made:

Those embarking on a career in medicine or medical research are doing so at a time of tremendous change and challenge. In the span of 4 years, how are medical schools to simultaneously teach the exponentially expanding body of knowledge garnered by medical and basic science research, introduce students to new technologies and drugs that are revolutionizing diagnostic and therapeutic options, and train physicians to work effectively in an increasingly complex health care system? Last year the Carnegie Foundation for the Advancement of  Teaching published a book based on an in-depth study and blueprint for a major overhaul of medical education entitled Educating Physicians:  A Call for Reform of Medical School and Residency by Molly Cooke, David Irby, and Bridget O' Brien, three well credentialed medical educators (Jossey-Bass, San Francisco, 2010).

This study is compelling because it follows a template established a century earlier when the Carnegie Foundation carried out a study that revolutionized American medical education. Known as the Flexner Report, it established the basis for the curriculum and the standards for medical education that continue to the present day. To understand the changes called for in the 2010 Carnegie Foundation study, it is necessary to review the 1910 Flexner Study, including why it was done, what it reported, and the structure it created.

Wow, 2011. I'm still not used to typing that. I'll stop marveling at the new year soon, I promise.

Anyway, here's a tour around the web this week for career- and career development-related items of note:

*This week's Science has an editorial, Boosting Minorities in Science, from Freeman A. Hrabowski III, president of the University of Maryland, Baltimore County. "Because the

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minority groups underrepresented in science and engineering are the most rapidly growing in the U.S. population, the country must develop strategies to harness this resource to grow a robust science and engineering workforce and remain globally competitive," he writes. One place to start is to focus on retention of minority students who start, but don't finish, science and science-related degrees. Another is to focus on mentoring.

*A group of HHMI-funded investigators write an Education Forum this week called Changing the Culture of Science Education at Research Universities. "To establish an academic culture that encourages science faculty to be equally committed to their teaching and research missions, universities must more broadly and effectively recognize, reward, and support the efforts of researchers who are also excellent and dedicated teachers," they write. They then propose 7 ways in which universities can accomplish this.

*Teachers, check out this report on an intervention that improved test scores: Researchers asked college and high school students to write about their anxiety about taking an exam before taking the exam. These students ended up performing better on the exam itself than a control group that didn't complete a writing exercise. You can listen to a podcast interview with the author.

As usual, the fine folks at Science Insider have been busy:

*The National Research Council issued a report calling for the National Institutes of Health to "maintain or even increase the number of graduate students and postdocs it supports," Jocelyn Kaiser reports. Recommendations include increasing the postdoc stipend to $45,000 per year and increasing the Medical Scientist Training Program to train M.D.-Ph.D.s by 20%.

Other Science Insider items of note:

*This week's issue of Nature has a news feature that looks at the state of science in Romania and Bulgaria, both of which joined the European Union in 2007 and, according to the article, occupy positions at the bottom of the league tables for research expenditure and output. "Romanian scientists working outside the country say that the changes give them hope of some day being able to continue their research careers back home. Meanwhile, the Bulgarian diaspora despairs," Alison Abbott reports. Also see our recent article on nearby Turkey, which apparently is doing quite a bit better.  

*In his World View column in Nature, Colin Macilwain writes about how universities are faring in the era of tight budgets. "While governments defend research spending, they are simultaneously slashing public funding for universities, where most research takes place," he writes.

*Nature Jobs this week takes a look at scientists with disabilities.

*This week's PLoS Computational Biology features an editorial from Philip E. Bourne, of the Skaggs School of Pharmacy and Pharmaceutical Science at the University of California San Diego, called Ten Simple Rules for Getting Ahead as a Computational Biologist in Academia. "This is not just about you, but an opportunity to educate a broad committee on what is important in our field. Use that opportunity well, for it will serve future generations of computational biologists," he writes.

*For those interested in clinical and translational research, the organization FasterCures has issued a white paper called Crossing Over the Valley of Death, which emphasizes the importance of translational research in the drug development process. The report also identifies some of the major challenges in translational research and offers some solutions.

*As always, there are many insightful posts in the blogosphere about science career development. This week I'll point you to just one: How to Ask For Help on the American Chemical Society blog. This is an important topic, and, as Lisa Balbes (who has written for Science Careers) points out, it's one many of us are not very good at. "Building your own professional network, one person at a time, will hold you in good stead when you next need to ask for help.  And knowing what to ask for will make it easy for them to help you find it," Balbes writes.

*Last but not least, check out the new articles on Science Careers. First up is a profile of veterinarian-scientist Laura Richman, whose research at the National Zoo ultimately led her to become interested in human translational medicine. Now she's in charge of translational science R&D at a biotech company. Her story is an excellent illustration that career paths can lead in unexpected directions and that, rather than worrying about following in the footsteps of people before you, you should focus on following your interests and passions.

*We've also got a historical perspective on two African-American brothers who were chemists during the 1930s-1960s. Larry and William Knox achieved success despite discrimination against them. "Perhaps the strongest message of all is that science moves forward via the contributions of many scientists of all stripes, not only the great names -- a fact that a proper reading of the history of science must acknowledge," the authors write.


Introduction
 
Albert Einstein (1879-1955) is widely regarded as the father of modern physics. For those of us old enough to have seen him in person, listen to him speak in public or on the radio, and read his writings when they were current, these memories are precious. In addition to being a great theoretical physicist he was looked upon as a philosopher and statesman. His intellectual interests and profound observations extended widely into the other sciences and the social aspects of human endeavor. In the 21st century he remains one of the most influential and iconic thinkers of all time.

Einstein is possibly the most frequently quoted figure in the history of science, but as is often noted, many of these quotations are of dubious authenticity. Alice Calaprice, a senior editor at the Princeton University Press, has worked with the Einstein papers at the Institute for Advanced Study for more than 30 years. In 1996, she published a volume entitled The Quotable Einstein, a comprehensive, meticulously referenced, annotated, and carefully arranged compilation of Einstein's quotes. For 2011, Calaprice has enlarged this to The Ultimate Quotable Einstein, a nearly 600-page volume of approximately 1600 quotations--the "final" and definitive edition.

On a recent visit to Princeton, I had the good fortune to obtain an advanced copy of this work and delighted in it as I have in few other books. I have selected and arranged these quotations to simulate an interview with Einstein, circa 1955, on the topic of science careers.

Today's Chronicle of Higher Education includes a nice profile, by Kevin Kiley, of chemist Emily Carter, who was recently appointed the director of Princeton University's new Andlinger Center for Energy and the Environment, which was funded by a $100 million gift.

With our CTSciNet project, Science Careers has been focused lately on translational research. That phrase normally refers to medical research and the pursuit of human therapies, but there's a lot in the Carter profile that resonates with translational-research ideas.

Kiley was trained as a quantum chemist, with a Ph.D. from the California Institute of Technology. She spent the first part of her career doing surface chemistry. "I had been working a lot of different projects and developing software tools to probe the properties of materials, but I hadn't had a laser-beam focus on any one particular issue," she says.

Then she read the Intergovernmental Panel on Climate Change's 2007 report and altered the direction of her career. "I felt like I had an obligation, a responsibility to use my expertise to solve these big problems," she says. "I no longer had the luxury to just do intellectually stimulating research projects. My research had taken on a purposeful perspective." Specifically, Carter began to apply her scientific skills to solving the problems of energy and the environment. "Anyone who has expertise in an area related to this should be working on these problems," she says.

There's much about Carter's approach to science that resembles common ideas in translational research. First, there's a belief that purely curiosity-driven research is an indulgence we -- or at least scientists with sets of skills appropriate to solving practical problems -- can't afford right now; social needs are too compelling. Second, there's her interdisciplinarity: Her lab includes physicists, chemists, materials scientists, and engineers, Kiley writes. She calls herself "multilingual" because she can talk with scientists in different fields and departments.

The idea that we should all be applying our scientific skills to solving the day's most important problems is compelling. But there is an alternative point of view:  Fundamental, curiosity-driven research often yields insights that are important for the next generation of practical technologies. Applied research can be short-sighted because it can be difficult (probably impossible) to know ahead of time what will ultimately matter. So we need to keep dedicating resources -- funding and human resources, including our own -- to fundamental, curiosity-driven research. That's the argument made by many basic scientists.

Of course we do. But not every researcher who eschews applications does the kind of basic research that's likely to yield such high-powered fundamental insights. As Carter says in the article, "You have to look at your technical strengths and say, Where I can make the best contribution?" Your set of skills may best prepare you to work on important fundamental problems. But if, after some honest reflection, your work doesn't seem to be headed towards such fundamental insights, consider asking yourself, as Carter did, what important problem those skills might effectively address.

The new Andlinger Center, by the way, plans to hire 9 new scientists.

1.    Learn on whose shoulders you stand.

On February 5, 1676, Isaac Newton wrote a letter to his rival and adviser, Robert Hooke, which he concluded with his famous aphorism: "If I have seen further it is by standing on the shoulders of giants." Two hundred years later another great scientist, the French physiologist Claude Bernard, enlarged on these words: "Great men have been compared to giants upon whose shoulders pygmies have climbed, who nevertheless see further than they. This simply means the science makes progress subsequently to the appearance of great men, and precisely because of their influence. The result is that their successors know many more scientific facts than the great men themselves had in their day. But a great man is, none the less, still a great man, that is to say, a giant."

Scope, the blog from the Stanford University School of Medicine, posted the video below this week of Stanford scientists Carla Shatz and Helen Blau. According to the video, Shatz and Blau met in 1978 when they became the first women to be hired on Stanford medical school's basic science faculty as part of an affirmative action initiative. The video doesn't dwell on this, though, and instead lets the women talk about their research careers, and their friendship over the years. Well worth the 7 minutes to watch.



Hat tip: Dr. Shock MD PhD


September 14, 2010

Language barriers in science

Today's The Daily Scan uncovered a real gem: A YouTube animation of a hypothetical conversation between an investigator and a biostatistician.

Judging by the comments on the video on Genome Web and on You Tube, it resonated with several viewers. (I just thought it was really, really funny.) It highlights well the language barriers across scientific disciplines. 

A first-year medical student I mentor recently asked me:  "What's the point in buying textbooks? Sure, I could pull it from a shelf in the library - or save time and just Google it. But wouldn't I learn more from a Google search or a Medline search than by reading all those pages?"

This seems to be the current thinking of students in general. Our medical book store recently removed a large portion of its shelves of books and replaced it with a bigger area for computer hardware and software; the store's manager tells me that textbook sales have declined by 10-15% in each of the past several years. The medical library has replaced a major portion of its text reference section with computer carrels. Fewer new textbooks are being published, and new editions of standard texts are appearing less frequently. And the financial news tells us of the loss of profitability and financial difficulties faced by publishers.

About 34% of regulatory affairs professionals are involved in comparative effectiveness research, health technology assessment, and reimbursement, compared with 25% just 2 years ago, according to a new survey released in August by the Regulatory Affairs Professionals Society (RAPS). The survey includes 3120 respondents from 55 countries around the world (81% from the United States, and most others from Europe and Canada).

According to RAPS, "Regulatory professionals play critical roles throughout the healthcare product lifecycle, from concept through product obsolescence. They provide strategic, tactical and operational direction and support for working within regulations to expedite the development and delivery of safe and effective healthcare products to people around the world." Science Careers published an article about careers in regulatory science in April ("All in the Details: Careers in Regulatory Science").

The new survey found that 72.6% of the respondents work in industry, with the remainder employed in academic institutions (2.3%), government (3.2%), independent research organizations (3.5%), consulting firms (13.1%), hospitals (1.3%), and law firms (0.4%). More than 68% of respondents work with multiple product types, including different types of pharmaceuticals, medical devices and materials, veterinary products, cosmetics, and foods.

An increasing number of respondents (compared to previous years' surveys) report taking part in the business side of their work, which includes activities such as business and corporate strategy, finance, management, personnel management, and legal activities. On average, respondents reported spending 18.2% of their time on business aspects of their job; this figure varies substantially by job level. At the more junior levels, the duties usually include smaller business-related issues, as opposed to overall business strategy and functions among higher-level managers. Given those figures, it's perhaps not surprising that the number of respondents holding MBAs has increased in recent years, and is now up to 12%.

Almost all the respondents (99%) have a university degree, and more than 60% have degree credentials beyond the baccalaureate level. More than 86% have degrees in life sciences, engineering, or clinical professions, reflecting the scientific and clinical focus of this work.

Base salaries for US-based professionals currently range from an average of $55,606 at the coordinator level to approximately $200,000 for vice presidents and CEOs. Most employees in this field have seen their salaries stay constant or slowly increase despite the recession. The exceptions to this are vice presidents and CEOs, whose base salaries have been stable, but total compensation has decreased due to a reduction in bonuses. Somewhat lower salaries are reported in academic and clinical settings, while the highest ones are found in industry and government positions.

Consultants, 55% of whom are self-employed, have experienced a 17% decline in base salary and 21% decrease in total earnings. The number of consultants has increased over time, and 30% are self-employed with less than 2 years of work experience. Taken together, these data suggest that an increasing number of people have recently become independent consultants, likely due to loss of work in the economic downturn.

The majority of the report's findings overall were true across national boundaries, with the main differences related to the level of interest in health technology assessment/comparative effectiveness research and reimbursement, which was less common in Latin America and the Middle East. Salary levels differed by country and varied with local standards of living. The factors influencing the salary, however, such as job experience and education, were largely the same regardless of geographic location.

The RAPS Scope of Practice & Compensation Study is available online from the Regulatory Affairs Professionals Society.

-by Yevgeniya Nusinovich



Physician-scientist Peter Agre's biggest research contribution to date is his discovery of aquaporins, the proteins that regulate and facilitate the transport of water molecules across cell membranes. Aquaporins are important in physiological processes such as kidney concentration and spinal fluid secretion, and play a role in several diseases as well. Their discovery in the early 1990s earned Agre the 2003 Nobel Prize in Chemistry.

These days, Agre, 61, is contributing to science in slightly different ways: by addressing infectious diseases in the Third World, and by promoting scientific diplomacy.

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Agre, currently the director of the Johns Hopkins Malaria Research Institute in Baltimore, Maryland, is now using his basic science discoveries about aquaporins to understand the role the proteins play in the parasite that causes malaria. The goal is to find innovative ways to target and treat the disease, which causes nearly 1 million deaths annually, most of which occur in sub-Saharan Africa.

"About the year 2000, after we'd worked on aquaporins for almost a decade, we'd answered the questions we felt were most important," Agre said in an interview in July at the Euroscience Open Forum meeting in Turin, Italy. "It was a matter of doing some translational work ... . There were a lot of groups that are really good at cancer biology and neuroscience, but the Third World diseases are still largely neglected." The shift to disease-focused research represents a return to Agre's original humanitarian goals when he went into medicine. "It was always something I wanted to do -- to get involved in Third World medicine," he said. "I had ... hoped at about age 50 to make a new direction in science in Third World diseases, human rights, and areas I felt were important."

In the mid 2000s, Agre got involved in science advocacy and politics; he even considered a run for the U.S. Senate. He ultimately didn't pursue a political career, but he did find a different platform a couple of years later: In 2009, he became the president of the American Association for the Advancement of Science (AAAS - the publishers of Science, Science Translational Medicine, and Science Careers). In that role, he traveled to Cuba, North Korea, and Myanmar as a member of scientific delegations tasked with finding common scientific ground with these countries, which are at odds politically with the United States. In an editorial in the August 25 issue of Science Translational Medicine, Agre explains how such science diplomacy can have an impact on medicine in such developing countries.

"Clinical and translational medicine represents an important arena of investigation ripe for 21st-century science diplomacy, beginning with -- although by no means limited to -- infectious disease research," he and co-author Vaughan Turekian, chief international officer and director of the AAAS Center for Science Diplomacy, write. "As private American citizens, we brought a message of good will, formed by a shared interest in science and science-based solutions to problems, that would have been greeted with great suspicion if delivered by officials of the U.S. government." Agre and Turekian conclude by noting that addressing global health needs will require scientific cooperation that transcends political borders.

Agre embraces all the aspects of his career these days. "I love the job, I love the excitement," Agre said in the July interview. "It's a new adventure for an old scientist."

Listen to my conversation with Peter Agre, recorded in July at the Euroscience Open Forum meeting in Turin, Italy: 



Alternate link to mp3


The percentage of new faculty hired on the tenure track at U.S. academic medical centers and medical schools has been falling steadily for almost a quarter of a century, according to a report out this month from the Association of American Medical Colleges. Only a quarter of new clinical faculty hired in 2009 were on the tenure track, as opposed to 46 percent in 1984.

Seven of the country's 126 accredited medical schools have no tenure at all, and eight more offer it only in basic science, rather than clinical, positions. In the rest of the schools, including recently established ones, the tenure system remains "embedded," the report finds. Even so, tenure is now available to fewer and fewer potential medical school professors. For years, the absolute number of new hires on the tenure track continued to rise despite the decline in their percentage of total new faculty because of the drastic growth of faculties overall. However, this trend plateaued in 2003.
 
One figure has been virtually unchanged: The number of men in tenure track positions exceeded that of tenure-track women by eight percentage points in 1984 and in 2009. "Future research could assess the personal significance of tenure to women, as tenured positions may become more scarce for this subgroup of faculty," the report's authors write.

Given current trends, the report concludes, "a continual decrease in the overall percentage of faculty in tenured or tenure-eligible positions" appears likely.

See also: the March 6, 2009, Science Careers article, Redefining Tenure at Medical Schools.


Each year, the American Academy of Ophthalmology meets in a major U.S. city and attracts around 25,000 ophthalmologists from the United States and abroad. Among the courses frequently offered at the meeting is one, entitled "Key to Successful Publications in Peer Review Literature," taught by the editors of the three leading clinical journals in our field.  The course tends to attract residents and young doctors at the start of their careers. I have enjoyed being involved in teaching this course for a number of years and have come to anticipate the questions that will be asked. These include the following four questions, all related to the first steps in research publishing:

1.    Why should clinicians do research?
2.    Is the scientific method optional for current medical reports?
3.    What is "peer review" and why is it important?
4.    How do I select a journal to publish in?

These questions apply to persons interested in participating in medical research, and I will  discuss them briefly here.

As the practice of medicine and the delivery of health care over the last half-century has grown in complexity and content, training to be a practicing physician has gone from being analogous to a cross-country track event to a virtual marathon in time, effort, and expense. With the explosion of knowledge and technical complexity in the biological sciences, M.D.-Ph.D. candidates preparing for a life of medical research are found in a triathlon by comparison. Those who cross the finish line are well equipped to take on the challenges of being a physician-scientist.

Based on personal involvement within my own institution, discussion with program directors, and interaction with M.D.-Ph.D. program graduates, I will present a brief overview of this challenging pathway to a science career.

Why was the M.D.-Ph.D. program created?

Conflict of interest policies have been a hot topic in recent weeks. Here's an unscientific roundup of some recent articles on the subject:

A couple of weeks ago Science Insider reported on new conflict of interest guidelines from the National Institutes of Health. Jocelyn Kaiser writes: "NIH wants to lower the definition of "significant" financial conflict from $10,000 to $5000, or any equity in a nonpublicly-traded company (the previous cutoff was 5%). Researchers would have to tell their institutions about all conflicts over this threshold that "reasonably appear to be related to the Investigator's institutional responsibilities"--leaving administrators, not the investigator, to decide which are related to a specific NIH-funded project."

In a May 21 JAMA editorial about the proposed regulations, NIH Director Francis Collins and Deputy Director for Extramural Research Sally Rockey wrote: "Capitalizing on innovation to benefit health requires a robust partnership that joins bias-free research with the most effective methods for translation and dissemination. As NIH strives to accelerate the movement of discoveries from the laboratory to the clinic, it is clear that already complex relationships between NIH-funded researchers and industry will likely become more complicated, even as they become more exciting and more productive."  That editorial also includes a handy table to illustrate the current and proposed rules.

In today's JAMA, Bridget Kuehn writes about provisions in the health reform law passed in March that will require drug and device manufacturers to report any payments they make to physicians and hospitals. The new law "will require manufacturers to disclose individual payments or goods or services with a value of $10 or more and cumulative payments or gifts exceeding $100, including travel, meals, consulting fees, honoraria, research funding, and royalties," Kuehn writes.

The May/June issue of Boston Review includes an editorial by Marcia Angell, former executive editor and editor in chief of the New England Journal of Medicine, called "How Corporate Dollars Corrupt Research and Education." She writes, "Much of the time, the institutional conflict-of-interest rules ostensibly designed to control these relationships are highly variable, permissive, and loosely enforced. At Harvard Medical School, for example, few conflicts of interest are flatly prohibited; they are only limited in various ways."
And later on:
"To be clear, I'm not objecting to all research collaboration between academia and industry--only to terms and conditions that threaten the independence and impartiality essential to medical research. Research collaboration between academia and industry can be fruitful, but it doesn't need to involve payments to researchers beyond grant support. And that support, as I have argued, should be at arm's length." She goes on to suggest her three "essential" reforms.

In a February Perspective in the New England Journal of Medicine, UC San Francisco professor of medicine Bernard Lo discusses conflicts of interest in the context of the differing missions of academic health centers and for-profit companies. "Sound conflict-of-interest policies require careful analysis of the benefits and risks of a relationship between academia and industry," he writes, following that with several questions policymakers should ask when crafting conflict-of-interest policies.

Later, Lo summarizes the responsibility of the individual physician-investigator in developing such policies: "In their roles as clinicians and researchers, physicians tackle difficult, complex problems, clarify countervailing interests and values, make tradeoffs explicit, develop innovative approaches, and rigorously analyze the advantages and disadvantages of various options. Physicians should apply these skills to help improve conflict-of-interest policies for AHCs and professional societies."

While it's important to communicate potential conflicts to scientific peers, the true end users of that information are patients. Do they really care? An April study in the Archives of Internal Medicine suggests that they do. In a literature analysis of studies of patients', research participants', and journal readers' views of financial ties to drug and device companies, researchers found that, overall, patients do believe disclosure of financial ties is important, and research participants say that such disclosures would affect their decision on whether to participate in a clinical study.



In recent days, sports writers and broadcasters have focused on the death of former UCLA basketball coach John Wooden.  Wooden's impressive record of 10 NCAA championships in 12 years and 88-game winning streak by the Bruins received much attention.  However, the emphasis from his former players was "...how he taught us about life....he had the perspective of what was really important, and he always reinforced what he said by what he did," as Andy Hill says, quoted in the June 7 NY Times.  In other words, his players insisted he was more than a coach - he was a mentor. 

Lorraine Stomski, an expert in leadership education and coaching, explains, "People often confuse coaching with mentoring.  Coaching, which provides specific feedback, can be used within mentoring.  But mentoring is more holistic than coaching, in that it develops the whole individual - through guidance, coaching and development opportunities" (June 6 NY Times).

This was of particular interest to me because I was recently asked to give a talk to medical students on the topic, "Optimizing Your Mentored Experience."  In preparation for my talk, I spent a weekend perusing material in print and online.  My initial impression was that everything that can be said has been said and is readily available, so the best one can do is to summarize succinctly and emphasize a few key points from the mind-numbing expanse of material.  But reflecting on my more than 50 years experience being a mentor and mentee (protégé is now the preferred term), I want to share my perspective and first hand observations.

Healthcare in America has been in the spotlight for a number of months. The picture portrayed in the media is of a giant "black box" into which 16% of our gross domestic product (GDP) goes and out of which comes healthcare whose quality and quantity is under debate.  Within that black box is a complex mix of healthcare workers and their organizations, hospitals, insurance companies, government agencies, private agencies, big and small pharma, instrument corporations, citizen groups, corporate executives, politicians, lobbyists, and scientists, each with its own agenda and goals.

Of these components of healthcare, none is more attractive and respected than the group committed to the "protection, promotion, and optimization of health and abilities; prevention of illness and injury; alleviation of suffering through the diagnosis and treatment of human responses; and advocacy in healthcare for individuals" -- the nurses. (The definition is from the American Nurses Association.)  Holding a special position in the nursing profession, a carefully chosen group carries out research -- a career choice that merits consideration by qualified young individuals seeking a research career in healthcare.  A nursing Ph.D. program is an excellent way to enter such a career.

Since I work as a physician-scientist at the University of Wisconsin (UW) School of Medicine and Public Health, I have long been aware of the increasingly important role nurse researchers and nurse Ph.D.'s play in modern healthcare.  Barbara J. Bowers, Associate Dean for Nursing Research at UW-Madison, kindly gave me a generous amount of her time to convey an in-depth view of the opportunities and challenges of nursing Ph.D. programs and research careers in nursing. Much more information nursing Ph.D. programs and research careers is available on these institution's Web sites.

My discussion with Dr. Bowers made it clear that -- to paraphrase an old General Motors ad -- this is not your mother or grandmother's career in nursing.  For starters, nursing is no longer a gender-specific profession.  Nearly 15% of the entering class in nursing at the UW is men, a number that reflects the national average -- and that is increasing.

Let's look at how nursing education has changed in the last couple of decades.  In decades past, great number of nurses entered the profession with an associate degree -- a technical degree conferred after 2 to 3 years in a community or technical college or hospital. With additional coursework, these nurses could earn a bachelor's degree.  Those interested in a research career could later earn a master's degree, and eventually a Ph.D., most commonly in education, psychology, or sociology. 

In present-day nursing education, many students begin with a 4-year Bachelor of Science in Nursing ( BS or BSN) program.   These programs are often competitive; at UW-Madison, about 400 applications are received for 150 places. Those accepted generally have GPA sof 3.5 or higher.  Nursing-bound high school students need courses in mathematics, science, social studies, humanities, foreign languages, and communication skills.  Strong preparation in physical and social sciences is essential.

The curriculum of the nursing baccalaureate program at UW-Madison is representative of most programs.  The first 2 years concentrate on general education and includes prerequisite courses in the sciences, humanities, and social studies.  Applied skills are acquired during the junior and senior years via core lecture, laboratory, and clinical courses and elective courses that allow students to pursue individual interests.

UW-Madison offers an innovative option for top students interested in entering a research career in nursing:  the early-entry Ph.D. program selects first year students who are invited to plan, in conjunction with the faculty advisory committee, an individualized program of study and research. The program includes early and intensive research training, clinical practice, and required and recommended coursework.  Each student works closely with a senior faculty member whose research matches their own interests.  This research  is combined with graduate courses in the area they select and completion of the required and recommended undergraduate and graduate courses in nursing and related disciplines.  Students completing the program receive 3 degrees: B.S., M.S., and Ph.D. 

Research areas of current students in this program include the ethnocultural influences on pain and pain management, effects of global environmental change on human health, and symptom management for patients.  Students publish their findings in major professional journals and present their work at research conferences.

More traditional post-baccalaureate Ph.D. nursing programs -- my university has one of those, too -- offer a strong emphasis on research training in nursing through an apprenticeship model.  Students work closely with their nursing school preceptor and faculty committee to follow an individualized, research-driven program of study.  The preceptor advises the student on the selection of courses and serves as a liaison to the major department and other departments in the graduate school. 

Students in both programs receive financial support through graduate assistantships and traineeships. Stipends usually run about $30,000, plus tuition remission.

A major financial supporter of these programs is the National Institute of Nursing Research (NINR), part of the National Institutes of Health (NIH).  NINR currently has fourteen "priority areas":

  1. Research related to low birth weights
  2. HIV infection care delivery
  3. Long-term care for older adults
  4. Management of pain and other symptoms associated with acute and chronic illness
  5. Nursing informatics to enhance patient care
  6. Health promotion for older children and adolescents
  7. Technology dependence across the lifespan
  8. Community-based nursing models
  9. Preventing HIV/AIDS in women
  10. Preventing diabetes, obesity, and hypertension
  11. Cognitive impairment
  12. Coping with chronic illness
  13. Families at risk for violence
  14. Behavioral factors relation to immunosuppression

This list illustrates the scope and importance of some of the key issues that are the focus of  nursing research

At a time when job opportunities in general can be hard to come by, graduates of nursing Ph.D. programs are in demand in a variety of educational, clinical, and governmental settings. Ph.D. nurses have faculty appointments or positions as research scientists or research directors.  Faculty positions usually start at the assistant professor level, on the tenure track, with annual salaries of about $70,000 to $80,000 a year.

What's unique about this type of research career, Bowers stresses, is its involvement with people -- living and working with them and dealing with the challenges their health problems present.  It's a stable and rewarding career with a range extending from gerontology to health policy.  Graduates entering into it can expect to remain engaged, satisfied, and see their research funded. 

Are there special characteristics that identify people particularly well suited for a career in nursing research?   Bowers cites an interest in finding more effective ways to solve complex care problems and a high level of curiosity. Physicians tend to be more interested in diagnoses and treatment while nurses are more focused on prevention of poor health outcomes by changing lifestyle and helping patients and their families live with diseases.  Beyond this, the attributes she associates with students suited for a career in nursing research are commitment to improved health and more effective health care delivery, initiative, a desire to "push the envelope," and, above all, a feeling of excitement when carrying out research.

For those qualified individuals who want a "hands-on" career in dealing with people and their health problems, consider nursing research.  Few other careers can match its challenges and rewards.


Seven months after Yale graduate student Annie Le's body was found in the basement of the Yale laboratory building where she worked, a Yale postdoc has been murdered, this one outside his home in nearby Branford, Connecticut.

According to the Yale Daily News and several local news outlets, Vajinder Toor, a physician scientist and a first-year postdoctoral fellow studying infectious diseases at Yale's School of Medicine, was shot "several times" in a parking lot outside his Branford, Connecticut, apartment at about 8 o'clock this morning.  Reports say the shooter also tried to shoot Toor's wife, but -- according to a neighbor -- missed as she hid behind a car.

In an e-mail sent to the Yale community, Yale Police Department Chief James Perrotti wrote that the Branford Police have a suspect in custody. According to news reports, the suspect had worked with Toor at Kingsbrook Jewish Medical Center in New York.

The recent book The Immortal Life of Henrietta Lacks, by Rebecca Skloot, has become a "must read" bestseller among scientists and non-scientists (Science, vol. 327, 26 February 2010 p. 1081).  When I read this book and heard Skloot speak at length about the "HeLa experience," it led me to think about the role these cells had on my own career and the subsequent lessons I learned related to them.   

When HeLa cells became available in the 1950s, I was an undergraduate biology major in need of a project for my honors thesis.  My older brother, a medical student in the Baltimore area, alerted me that I could obtain a unique immortal line of cancer cells, the HeLa cells, to use as a basis for my project.  I got caught up in the excitement among researchers and in the lay press about the fact that this cell line was the successful culmination of decades of effort to keep cancer cells alive outside of the body.  In Skloot's words, "cell culture was going to save the world from disease and make man immortal."

This week, CTSciNet, the Clinical and Translational Science Network, teamed up with Science Translational Medicine for a podcast on fostering a translational medicine workforce.

The podcast features an interview with Garret FitzGerald, director of the Institute for Translational Medicine and Therapeutics at the University of Pennsylvania School of Medicine in Philadelphia. FitzGerald and colleague Carsten Skarke write in a Perspective, published this week in Science Translational Medicine, that expertise in translational medicine and therapeutics is scarce in academia, industry, and regulatory bodies.

"To facilitate the translation of more personalized therapeutics, we require investigators facile with model systems, informatics, principles of drug action, quantitative signatures of drug exposure, and both mechanism-based and unbiased readouts of drug effects," they write. The article goes on to describe how such expertise could be developed.

In the podcast interview, FitzGerald further discusses translational medicine and therapeutics as a specific subset of clinical and translational science, where deficits exit in the workforce, and how researchers can direct their training to prepare themselves for a career in translational science.



Find more online:



The hotly debated Patient Protection and Affordable Care Act that passed the Senate in December and House of Representatives last night establishes a new center for comparative effectiveness research in health care costs and quality, a topic discussed earlier this month in a Science Careers article.

Section 6301 of the bill establishes an independent, not-for-profit corporation, the Patient-Centered Outcomes Research Institute (PCORI)

"to assist patients, clinicians, purchasers, and policy-makers in making informed health decisions by advancing the quality and relevance of evidence concerning the manner in which diseases, disorders, and other health conditions can effectively and appropriately be prevented, diagnosed, treated, monitored, and managed through research and evidence synthesis that considers variations in patient subpopulations, and the dissemination of research findings with respect to the relative health outcomes, clinical effectiveness, and appropriateness of the medical treatments, services, ... "

PCORI would be funded by a Patient-Centered Outcomes Research Trust Fund, financed by transfers beginning in 2013 from two other federal medical trust funds. The use of a trust fund for financing helps protect the institute from day-to-day political considerations in funding decisions.

The bill calls for PCORI to establish research priorities and a project agenda based on the prevalence and burden of diseases in the U.S. particularly chronic conditions, as well as a host of patient care and cost-control variables. The proposed research priorities will be open to a public-comment period as well.

The bill also identifies PCORI's research methods: primary research and systematic reviews of existing studies. To conduct its research, the institute will contract with federal agencies -- the National Institutes of Health (NIH) and Agency for Healthcare Research and Quality (AHRQ) to start -- and non-government researchers.

Research conducted for the institute will be peer reviewed, and the bill allows PCORI to use the processes of the NIH and AHRQ or academic journals. Within 90 days, research findings will be made available to the medical community and general public. AHRQ is also authorized to take proactive steps to disseminate the findings to physicians, health care providers, patients, insurance providers, and even health care technology vendors. The bill calls as well for AHRQ to award grants for training in the research methods used by the institute.

The new law imposes some restrictions on the use of comparative effectiveness research. Perhaps in response to the phony "death-panel" claims -- that comparative-effectiveness research would be used for making end-of-life decisions on individual patients -- made by the bill's opponents, the bill prohibits the use of comparative effectiveness research findings "in a manner that treats extending the life of an elderly, disabled, or terminally ill individual as of lower value than extending the life of an individual who is younger, nondisabled, or not terminally ill."


In the Doctor Dolittle children's series by Hugh Lofting, the amazing Doctor Dolittle gains the gift of talking to the animals and learning their secrets. Today there are real "Doctor Dolittles" -- veterinarians learning the secrets of animals and their genetics, immunologic mechanisms, brain and nerve functioning, pathogenesis of malignancies, and much more -- by state-of-the-art scientific means. And the knowledge they gain is extremely important to humans and for understanding human diseases.

The University of Wisconsin School of Veterinary Medicine is one of the most research-orientated veterinary schools in the United States. The Veterinary school is located a stone's throw from the University of Wisconsin School of Medicine and Public Health, and there is much interaction and collaboration between the two schools.

Having partnered in research with some academic veterinarians and communicated with many others, I thought I had a pretty good idea what they did. I assumed their research training and research prospects were analogous to ours in the human-focused medical field.

However, in preparation for writing this blog entry I sat down with one of their most distinguished veterinarian-scientists, Richard Dubielzig, and was surprised to learn that while many parallels exist, there are also striking differences between their careers and those of their medical school counterparts.

The curriculum at veterinary medicine schools is very similar in concept to the medical school curriculum:  an intensive 4 year course divided between basic science and clinical learning. As at medical schools, the amount of research emphasis varies widely by institution. The following is a partial list of veterinary schools that have built a solid reputation for doing research and producing quality researchers in veterinary medicine:

University of Wisconsin
University of California-Davis
Colorado State
Ohio State
Cornell
University of Pennsylvania
University of Florida
North Carolina State
Tufts
Washington State

One difference between veterinary and medical training is that in veterinary training there is less opportunity to train for a career in research than there is in pursuing a medical degree. So if you want to be a veterinary researcher, you'll need to earn a Ph.D. degree either before, during, or after veterinary school. Opportunities for combined degrees -- D.V.M.-Ph.D. -- are more rare and less well-defined than at medical schools.
 
Veterinary schools offer excellent opportunities for an introduction to veterinary research. Most schools offer summer vacations between the first and second and second and third years; these are great opportunities to spend a few weeks in a research lab. Frequently, students planning a research career will take leaves of absence and work in a laboratory or on a research project between years 2 and 3, or between years 3 and 4, of veterinary school. NIH T32 grants, which pay students stipends to spend a year in a research laboratory, are available at several schools.

The usual route for veterinarians planning a research career is to earn a Ph.D. after veterinary school graduation. That graduate training may or may not have a clinical component. To qualify for an entry-level (Assistant Professor) tenure-track faculty position in a veterinary school, a candidate usually must have completed a  D.V.M., a Ph.D., residency training, board certification, and postdoctoral training.

Many veterinarians with research ambitions find fulfilling careers in the safety or research and development (R&D) divisions of pharmaceutical companies. Here, a Ph.D. in toxicology or board certification in veterinary pathology, respectively, is required. While these jobs have higher salaries than academia, the scope of research is narrower and more directed.

Both Dr. Dubielzig and I are impressed with the enthusiasm and gratification veterinary scientists show for their research. And once appointed to a tenured track, achieving tenure is usually less stressful than it is in most medical schools. The greatest professional challenge is often managing to meet clinical responsibilities while also getting research done. This can lead to stress, insecurity, and feelings of being under-appreciated. Not surprisingly, there is more moving around among positions in both academia and industry among veterinary scientists than there is for physician scientists. But when you ask the veterinary scientist if they would do it all again, the answer is usually an enthusiastic "yes!"

In 1925 the American author Sinclair Lewis published the Pulitzer Prize-winning novel, Arrowsmith, which inspired subsequent generations of 20th century high school and college students, including me, to consider a career in medical research.

Arrowsmith relates the tale of the bright and research-minded Martin Arrowsmith, from a small town in a fictional counterpart of Wisconsin, who progresses through medical school, private practice, and a position as a regional health official to become a dedicated medical researcher. In the story, his research talent is recognized by his medical school mentor, and Martin attains a position in a Rockefeller-like institute in New York where he discovers a phage that destroys the bacteria causing bubonic plague.

There's much more to the plot, and if you haven't read it yet I suggest you do. The issue at hand, however, is, could Martin, as a medical student and physician interested in research, follow the same path and make as meaningful a contribution in the 21st century? My answer is yes, he could, but if I were Martin's mentor, I'd suggest other ways that might suit him as well or better.

It is worth noting from a historical point of view that when Arrowsmith was written, the doctor of medicine degree in the United States had only recently gained a full measure of respectability. As a result of the Flexner Report, sponsored by the Carnegie Foundation, the standards and curriculum of present-day medical schools came into being. Medical schools became integral parts of large and established universities, the length of medical education became 4 years, faculty became "true university teachers" typically with full-time university appointments, and students were required to have college or university preparation. Also, medical education came to consist of two years of basic science training followed by two years of clinical work in a teaching hospital.

In this setting, and within the confines of this curriculum, there was opportunity for individuals such as Martin Arrowsmith to identify areas of particular interest and specific researchers they wanted to work with, through the lectures they attended. The students would work in the researchers' laboratories, under the mentor's guidance, during their vacation and spare time. This led, in turn, to numerous outstanding and gratifying research careers well into the late 20th century.

It is a path still available to medical students today, but with somewhat greater difficulty, and modified rewards. The alternative routes for a career in medicine or as a clinician-scientist include pursuing a combined M.D.-Ph.D. curriculum, or Ph.D. training before or after getting an M.D. degree. So what are the main advantages and disadvantages of these approaches over the Arrowsmith pathway?

The Arrowsmith approach is easier and more flexible. No formal or written applications, contracts, or other types of commitment are required -- just select a researcher and a topic of research according to your desires. The amount of effort and the logistics are arranged to fit with the schedule of the student and researcher. Required reading, seminars to be attended, and courses to be audited are all determined by mutual decision. The length of medical training usually is not extended, unless the student decides to take a year or semester off to devote entirely to research. There are no additional tuition costs -- beyond the cost of medical school -- and often the trainee can obtain a student grant or be listed on the established researchers grant to help defray his or her living expenses. The entire arrangement is "customized" to suit the student and the teacher. If either is dissatisfied, the arrangement is easily dissolved.

Because of the ongoing clinical training, the Arrowsmith pathway is particularly well suited for careers involving clinical trials, other forms of clinical research, or translational research.The medical degree is sufficient to qualify one for a postdoctoral position and ultimate consideration for a faculty appointment in a clinical academic department.

However, there are some negative aspects to this pathway. With the advent of problem-based learning as a major tool in medical school curricula, there has been a melding of clinical and basic science training. Also, with the explosion of knowledge in the biological sciences in past decades, basic science training for the physician is less comprehensive and rigorous than it used to be in earlier years.

Accordingly, the Arrowsmith pathway is not ideal preparation for a career focused on basic science research. Nor is the M.D. degree alone sufficient for a faculty appointment to most medical school basic science departments. While such preparation suffices for a career in clinical medicine and for concurrent clinical and translational research, it is problematic for assurance of a long-term research career in basic science. These gaps and blind spots in one's knowledge can be filled in on the basis of individual effort, but this can be difficult.

This problem was illustrated to me in a striking way while I was a clinician-scientist on the Harvard Medical School faculty. There were a number of gifted undergraduates potentially interested in a medical physician-scientist career working in various laboratories in our department. In order to motivate them to consider the Arrowsmith pathway toward a physician-scientist career, our Chair assembled them for a group meeting with a distinguished Ph.D. basic scientist who were also on the medical school faculty. We anticipated an inspirational talk encouraging the undergraduates to pursue such a career. To our surprise, the message given was a short and blunt: "If you follow this pathway for a career in basic science, the PhD's will 'eat your lunch.'"

In summary then, while it's still possible to emulate Martin Arrowsmith, today his pathway is better suited for clinical or translational research than a long-term career in basic science.

An interesting footnote to the Arrowsmith novel is the fact that Lewis was greatly assisted by a Ph.D. microbiologist, Paul de Kruif, now best remembered for his book Microbe Hunters. Even though Lewis was listed as sole author, De Kruif's contributions were sufficient to merit receipt of 25% of the royalties. Thus, even in the creation of a story of a successful physician-scientist, a Ph.D. proved invaluable.
We write about dual-scientist couples every so often, since scientists do have a knack for pairing off with each other. This month, we've published two articles on dual-scientist couples in which both partners work in the same -- or a very similar -- field.

Today we've posted a profile of physician-scientists Deepali Kumar at Atul Humar, transplant infectious disease specialists at the University of Alberta in Edmonton, Canada. When I spoke to them earlier this month, they offered this advice on working with your partner: "If you're going to work together as a couple, you really, really have to like each other and get along well," Atul said. "A lot of people tell me, 'oh, if I had to work with my wife all day, I think I'd go crazy.' For us it's just not the case. I think we work really well together."

Earlier this month in A Husband and Wife Play Science on the Same Team, we noted that Michael Crickmore and Dragana Rogulja had different interests when they started out in science, but their work and research questions now regularly overlap. An excerpt:

Even as their research interests have converged, Crickmore and Rogulja have tried to keep their careers and professional identities separate. They decided, for example, not to include each other as co-authors on their papers even though "we easily could have been," Crickmore says. "Dragana reads my manuscripts more than my boss." It's not rivalry, they say: They simply think they can help each other more if they keep some distance. "My secret weapon is that Dragana is both my adviser and my postdoc," Crickmore says. They even have complementary traits, they say: Crickmore obsesses over the details of problems whereas Rogulja likes to zoom out to see the big picture.

You might think we planned these stories around Valentine's Day, but really it just worked out that way. Eric Berger at the Houston Chronicle did plan his Valentine's Day article: an excellent profile of Wadih Arap and Renata Pasqualini, both based at M.D. Anderson Cancer Center where they study the unique molecular signatures of blood vessels. Medical oncologist Christopher Logothetis had a nice observation about the couple: "They feed off of each other and it creates a synergy," he said in the Chronicle article. "Him being a physician, her being a pure scientist, he's more pragmatic, and she's more of a risk-taker. Together, they're a perfect match."

February 20, 2010

Getting Closer to the Clinic

In a career session at the AAAS Annual Meeting in San Diego yesterday, Associate Dean for Physician-Scientist Training at UCSD School of Medicine Ajit Varki and Eric Topol, Director of the Scripps Translational Science Institute, discussed job opportunities for Ph.D. scientists in clinical and translational research and related topics.

 

If I had to convey just one message from the workshop, it would be: if you are passionate about alleviating the burden of human disease and are willing to step onto new ground, there has never been a better time to enter clinical and translational research.

 

In the last several decades, a unique culture has developed in the United States in which many medical doctors pursue research. This culture has been well supplemented by M.D.-Ph.D. dual-degree programs. But the number of physician-scientists has been declining sharply over the years, and even if they were to expand, M.D.-Ph.D. programs would find it difficult to fill the open slots. The resut: "There are huge opportunities for Ph.D. scientists who want to train and affiliate with medics," Varki said.

 

Increasingly, disease-specific programs and Clinical and Translational Translational Science Awards (CTSA) programs are being put in place to help nurture careers in translational science among Ph.D. scientists. The Burroughs Wellcome Fund (BWF) also offers Career Awards at the Scientific Interface for scientists with a background in the physical, mathematical, or computational sciences addressing biological questions. Still, "there is not a very good mechanism in place right now" to get into the field "if you haven't got an M.D.," Varki said. As a Ph.D. scientist, "You have to make it up for yourself."

 

This is not necessarily a bad thing, pointed out Jim Austin, Science Careers Editor and PI of CTSciNet, the Clinical and Translational Science Network, who was moderating the session. This also means that opportunities are wide open: "Start with a disciplinary training, see how it relates to medical applications, and go and find it."

 

Look for "opportunities where you feel you can have an impact," Topol said. For example, you could develop a particular area of expertise related to a disease or a biological pathway, and build up on that, he added.

 

Importantly, don't sell yourself short if you have no specialized training in a medical-related field, intervened Bill Galey, of the Howard Hughes Medical Institute, from the audience. Other scientific disciplines, like chemistry, physics, computer sciences, and mathematics are all be relevant to translational research. Medical imaging and nanotechnology are two examples of emerging areas needing physical scientists, and "as biology gets more quantitative, there is a greater need for people trained with that kind of quantitative skills," Galey said.

 

The best way to get in is to find a postdoc in the lab of a top-notch physician-scientist, Varki said. "You have to convince them that you really care, are serious, and want to give it a shot," Austin added. Also key is to spend some time in medical schools or in the clinic. At UCSD, for example, Ph.D. students are attached to clinical divisions for 3 months "to really feel... and smell what goes on at the medical side," Varki said. Some medical departments are too busy to do research, but more and more of them are now looking for researchers, Topol added. "It could be a department that doesn't do intensive research, but supports the research."

 

As you progress in your translational research career, make sure to remain open-minded about opportunities as they come up. "Keep it flexible because you never know where science and medicine [will] get you," Varki said. For example, Topol, who trained as a cardiologist, pioneered the clinical use of tissue plasminogen activator (tPA), an enzyme involved in the breakdown of blood clots, after hearing about tPA in a journal club. When that project "hit the wall," Topol started thinking: "'Why not get into the genetics of heart attack'," he says. "You've got fantastic project opportunities," Topol added. You just have to go and find them.

 

Another topic that came up for discussion during the workshop was the leaky pipeline for women. While during medical school, there is gender neutrality, but there is "never parity in those interested in research," Galey said. There is a general perception among women that combining an academic career with a clinical career and a family is very hard, he added. But "research is not inconsistent with family." Galey said, "It is much easier to tell your lab that you need to leave" to take your kid to the doctor "rather than a waiting room with lots of patients."

 

"Women need to stand up and say what needs to be done rather then having a few guys" trying to raise the issue, said Varki, who wrote an opinion piece on the need for on-site childcare facilities in the American Society for Cell Biology (ACSB) Newsletter a couple of years ago.

 

"The more you move towards patients, the more complicated it gets," Varki said. And getting a physician-Ph.D. position is in no way as competitive as getting a faculty position in the more traditional disciplines, he added.

 

Certainly, "The most exciting time in biomedical research is now," Topol said.


 

Several years ago, during an internship in the NIH Director's office, while fulfilling a requirement for my Master's of Health Administration, I learned an interesting fact. In an internal review of when and why researchers falter in their request for NIH R01 grants, it was determined that revised applications become increasingly necessary after the 3rd 3-5 year cycle, and rejections peak after the 4th and 5th cycle. At that point in their careers, researchers are often no longer at the cutting edge in their field and, despite the benefits of experience and accomplishments, are less competitive for NIH grants.

For these applicants, there is a need to retool: to learn new techniques, gain new skills, and get fresh insights and ideas. One of the most efficient and enjoyable ways to do this is to take a sabbatical year. The origin of the term sabbatical is a "year during which land remained fallow, observed every year by the ancient Jews" (American Heritage Dictionary, 2nd College Ed. p. 1082). In modern academic parlance, it means a leave of absence with financial support given to tenured faculty member for the purposes research in a new venue, academic study and writing,  and related travel. However, from there the working definition diverges, depending on the university and department you're with.

Having a more competitive faculty member with his or her battery recharged would seem to be in the best interests of both the institution and scientist, but institutions don't always encourage sabbaticals, or support them well. I spent the first half of my career at Harvard; I've spent the last half (so far) at the University of Wisconsin. At Harvard, sabbaticals were encouraged, facilitated, and well supported. At Wisconsin, sabbaticals are less common and, in the medical school at least, require outside funding and considerably more advance planning, personal effort, and perseverance. A university's policy toward sabbaticals depends on precedent and culture, as well as finances and manpower issues. If you have a sabbatical in mind, the time to explore an institution's policies on sabbaticals is during your recruitment.

In my experience, a successful sabbatical requires at least 3 years of planning. First, you must figure out what you expect from the experience, your personal goals for the sabbatical. Then you have to match them up with the available opportunities, finding the best people and environment to help you achieve your goals. The best way of investigating this is professional interactions at meetings, conferences, and collaborations, and preliminary, exploratory visits. You may need to visit several labs before you find the right situation, or it may be obvious early on which situation is best. You may select a laboratory half a world away, but you could also end up in another laboratory on your own campus.

Traditionally, home institutions will support a semester away at full pay or an entire academic year at half pay. Departmental and institutional support varies widely; you may need to find supplemental support, especially for a year-long sabbatical, through the host institution or a funding agency. Happily, targeted support for sabbaticals from government agencies and foundations is generally not difficult to obtain, and is often generous. Almost all are posted on the Internet and easy to find and apply for.

Well in advance of granting leave, all institutions require that the faculty member make provisions for the supervision of his or her laboratory and the fulfillment of teaching and administrative responsibilities. You may need to twist your colleague's arms or do some horse trading. It is also important to know what the host lab expects. Often you're expected to teach as well as learn, which can come as a shock if you haven't worked this out ahead of time.

My own experience has been that housing is not a problem if the sabbatical term is spent at a major institution. At any one time, a portion of an institution's faculty is on sabbatical, and many institutions own faculty housing, so there are good housing options available at reasonable cost; housing can be arranged through the institution's housing office. Sometimes, though, housing arrangements aren't made until the last minute; it can be disconcerting not knowing where you will live.

Your home institution is likely to require written assurance that you'll return after the sabbatical and remain for a year or two -- which could be inconvenient if your very successful sabbatical leads another institution to offer you your dream job soon after your return.

Is sabbatical worth all the trouble? My answer is an emphatic YES. Ask the scientist who just returned from a sabbatical -- which is a very good place to start your planning.
Each year during the last week in April, more than 12,000 members of the Association for Research in Vision and Ophthalmology (ARVO) gather in Fort Lauderdale, Florida, for their week-long annual meeting.  If you ask any of the attendees what they do, they'll tell you that they're "visual scientists." But if you dig deeper you'll discover an amazingly multidisciplinary group of researchers. 

The major components of this community by training are (1) PhD's, (2) MD/Ophthalmologists, and (3) optometrists, osteopaths, and veterinarians.  A more meaningful insight into what the members do in their visual science careers can be gained from the titles of the 13 scientific sections of the organization:  Anatomy & Pathology; Biochemistry & Molecular Biology; Clinical & Epidemiologic Research; Cornea; Eye Movements, Strabismus, Amblyopia & Neuro-ophthalmology; Glaucoma; Immunology & Microbiology; Lens; Physiology & Pharmacology; Retina; Retinal Cell Biology; Visual Neurophysiology; Visual Psychophysics & Physiological Optics.

A pervasive presence at ARVO meetings is the leadership and staff of the National Eye Institute (NEI), an NIH institute dedicated to research on human visual diseases and disorders.  With an annual budget close to $700 million, the NEI is the principal source of funding for the research done by the eye-research community -- and presented at the ARVO meeting.  Hence, ARVO meetings provide an ideal venue for close communication between visual scientists and the government agency that pays for most of their research.  Jointly, they engage in strategic planning and set priorities and goals for vision research.  

Since its creation by Congress in 1968, the NEI, along with the vision science community have been successful in fulfilling the NEI's stated mission to "conduct and support research, training, health information dissemination, and other programs with respect to blinding eye diseases, visual disorders, mechanisms of visual function, and the special health problems and requirements of the blind."  The commitments of vision scientists to preserve vision and prevent blindness is a vital element in the cohesion and collegiality of the vision science community.  Both the NEI and ARVO provide information about vision science as a career and available job opportunities.  A personal visit to the ARVO annual meeting is highly recommended for anyone interested in vision-related science; it is not only informative but also inspiring.

Where do members of the vision research community work?  The vast majority are employed by universities.  Extrapolating from figures available from the University of Wisconsin - Madison, I estimate that slightly more than half are members of  departments of ophthalmology in medical schools, with most Ph.D.'s holding joint or adjunct appointments in a basic-science department.  The other vision scientists are distributed among medical school basic science departments, or science departments outside the medical school.  In addition, many pharmaceutical companies have ophthalmic divisions and career opportunities for vision scientists.

From my own personal experience, I can attest to the fact that vision science is a challenging and highly gratifying career.  

Newly implemented guidelines at Massachusetts General and Brigham and Women's Hospitals will restrict the amount of pay top officials at the research hospitals can receive for serving on boards of pharmaceutical companies, the New York Times, Boston Globe, and others report. Junior faculty will face new restrictions, too: All faculty members within the Partners HealthCare system may no longer accept speaker's fees from drug companies, nor can they participate in industry speakers' bureaus.

One of the senior officials affected is physician-investigator Dennis A. Ausiello, chief of medicine at Massachusetts General and chief scientific officer of Partners HealthCare. He received more than $220,000 from Pfizer last year for service on the company's board. He told the New York Times that the drug companies are "crucial to translate academic research into drugs that benefit patients," the Times reports. "I'm very proud of my board work," he told the Times. "I'm not there to make money. I certainly think I should be compensated fairly and symmetrically with my fellow board members, but if my institutions rule otherwise, as they have, I will continue to serve on the board."

Not everyone agrees that top brass at medical centers should be interacting at all with drug companies. Thomas Donaldson, a professor of business ethics at the Wharton School at the University of Pennsylvania, told the New York Times that "dual roles in a hospital and at a drug maker were 'dicey at best' because a director's duty is to look out for the corporation's financial interests," the Times reports.

The rules for senior officials, which, according to the Boston Globe, affect about 25 senior officials and executives, limits physicians to receiving $500 an hour to a maximum of $5000 per day for serving on drug company boards. They also may no longer accept stock. The new guidelines stemmed from recommendations made last April by an internal commission appointed to examine Partners HealthCare's policies regarding interactions with drug and device companies.

The issue is somewhat of a moving target, concedes Eugene Braunwald, a Harvard professor and former Partners chief academic officer who chaired the internal commission. "In all fairness," he told the Times, "what was OK three years ago is not OK now."

As it happens, the January issue of the journal Academic Medicine has a special series of articles on academia-industry relationships, including two articles that are available for free to non-subscribers: "Commentary: Conflict of Interest Policies: An Opportunity for the Medical Profession to Take the Lead" and "Can Academic Departments Maintain Industry Relationships While Promoting Physician Professionalism?"  

You can read more from AAMC on financial conflicts of interest from its Web site, Financial Conflicts of Interest in Academic Medicine, and you can read about the subject on CTSciNet in For Physician-Scientists, Conflict-of-Interest Issues Are Complex.

 
More than a century ago, Sigmund Freud famously (or infamously) wrote, "The great question that has never been answered, and which I have as yet been unable to answer despite my 30 years of research, ...is, 'What does a woman want?'" In a similar vein, medical students engaged in research projects, both male and female, frequently ask, "What does my principal investigator (P.I.) want?" Unlike Freud's question, this one can be easily answered.  The answer is, 'commitment.'

The major frustration for the dedicated lab head working with medical students was presented to me, as a medical student, in a talk by the great renal physiologist Homer William Smith. Smith noted that many interested, willing, and highly competent young men and women had come and gone through his laboratory, spending 2 or 3 years involved in his research. But when they launched into their medical careers they were all too frequently absorbed by their clinical activities and no longer incorporated research into their professional lives. Smith knew that the greatest payback for a senior investigator who accepts a medical student on his or her research team and spends time teaching and mentoring that student is the future research contributions that student will make throughout his or her career.  And the preceptor knows that unless real commitment is in evidence when the student first arrives then the outlook for long-term dedication to research is bleak.

This does not preclude the important need to introduce medical students without previous research knowledge or experience to the laboratory, or to some realm of clinical research, as an interested observer or limited participant. Research faculty welcome such an opportunity and are pleased if the student progresses to a more significant role. But it is disheartening for scientists to take on students who express a desire to play a meaningful research role, and accept responsibility for a portion of a project, and then fail to fulfill those responsibilities.

How does a student beginning work on a research project manifest commitment? The research faculty in medical schools are well aware of the rigorous schedule medical students face and understand that only a limited amount of time can be devoted to research. Moreover, they are forgiving when genuine conflicts arise and the time scheduled for research is of necessity missed.

Rather, it is the student's seriousness, level of interest, and intensity of effort that are of primary concern. Students who initiate and maintain a dialogue about the research, ask questions, and show evidence of related outside reading and independent thinking are highly regarded. In fact, committed students who are new to a research discipline are especially valuable because they ask basic questions and do not accept fixed ideas and dogma as sacred and beyond questioning.  In addition, because of their concurrent medical training, they are often in a good position to recognize previously unappreciated clinical implications and significance for the research they are undertaking. Original ideas and suggestions for advancing the research, a good learning curve for the technical aspects of the project, careful data keeping, courtesy and thoughtful behavior to all members on the team -- including technicians and assistants -- and participation in the group's social activities are all important to the student's success.

The short-term endpoint the preceptor wants is not merely a student co-authored publication, or presentation or for the student to receive a favorable evaluation or letter of recommendation; rather, it is for the student to be able to formulate a hypothesis and design a sound protocol to test it, and experience the challenge and rewards of gaining new knowledge that come with a hands-on research effort. Hopefully that initial effort and commitment will lead to research becoming an integral part of that student's later professional life, whether it is at the bench, in translational research, or in clinical studies.

A scientific career is, for many of us, one of the most intense endeavors that we undertake.  It both captures and defines our lives.  As a scientist, you often think and worry about your work when you are out of the laboratory -- even while lying in bed at night.  You experience waves of enthusiasm, rebelliousness, and even self-doubt as you continually weigh your efforts.  You are sometimes haunted by the feeling that your results justify your existence.  Yet no matter the extreme stresses that come with the work, the benefits of gaining new knowledge and insight into the natural world bring rewards that make other aspects of everyday life dull and drab in comparison. 

A successful career in science depends on many factors beyond native abilities, skills, education, and experience.  The importance of mentors and mentoring has been greatly emphasized in academic centers;  the need for wise and dedicated counselors and teachers is self-evident.  The necessity for colleagues, collaboration, and networking is well understood.

But the importance of friendship can often be taken for granted.  The intangibles that build professional relationships into the knowledge, trust, and bonds of friendship are complicated and deep.  Certainly they involve elements of equality, unselfishness, and concern.  The components of friendship are many and hard to define.  Out of the multitude of definitions for friendship, a favorite of mine is "one who knows all about you and loves you all the same."  It contains more than a grain of truth.

I was strongly reminded of the importance of friendship in my own career as a visual scientist by the recent death of Ruth Kirschstein (See Retrospective, Science 13 November 2009: Vol. 326, p. 947, and Beryl Benderly's recent tribute in Science Careers).  My years as a Clinical Fellow at the NIH in the 1960s provided me with training and direction that were important in ensuing decades.  Although assigned to an ophthalmology and visual science section at the NIH, I was given sufficient "elective" time to find my way to the laboratory of Alan Rabson, a rising star in experiential pathology.  Here I was introduced to viral oncology and became grounded in the fundamentals of pathology, tissue culture, viral transformation, and electron microscopy. 

To know and be mentored by Al Rabson was to know Ruth Kirschstein, his wife, for they were an inseparable team.  She too was in the early stages of her distinguished career in research and administration.  Their interest and support, as well as gracious hospitality, made my years at the NIH a very special time that has been an inspiration for me ever since. 

I later returned for visits to NIH and stayed in contact with both of them.  We shared scientific and personal updates and sought and offered advice to each other as opportunities and adversities presented themselves.  As the decision tree in my scientific career unfolded, their friendship was a resource I came to treasure. 

In recent years, when my own career took an administrative turn and I spent time meeting my Masters of Health Administration requirement with an internship in the NIH Director's Office, I came to appreciate fully and benefit from their idealism and vision.  Their friendship and the friendship of others has been a major factor in the advancements and enjoyments that I have experienced throughout my career.  
 
For individuals starting a scientific career today, the stresses and complexities of science are certainly more intense than 40 years ago.  But the opportunities to build friendships are there if one takes the time and makes the effort.  When such an opportunity arises, I implore you to go beyond a mentor-student, role-model, or colleague-to-colleague relationship and build a lasting friendship. Such friendships will enrich and support your career.  Friendships formed and continued early in your career have a strength and value that more than justifies the effort.  

The Howard Hughes Medical Institute (HHMI) has awarded $16 million to 23 universities for its Med Into Grad initiative, a program that integrates clinical medicine into the graduate school curriculum. Each of the winning institutions will receive up to $700,000 over 4 years.

The Med Into Grad program began in 2005 with awards to 13 schools with the goal of finding out "how graduate schools could provide doctoral students the skills necessary to investigate the scientific mechanisms of disease and translate scientific discoveries into clinically relevant treatments, diagnostics, and public health practices--and whether such programs would attract students," it says in HHMI's press release on the new grants.

Just how the universities use those funds varies. For example, the press release notes, "Some schools, such as Baylor College of Medicine and Cleveland Clinic/Case Western Reserve University, are creating entirely new doctoral programs that teach clinically relevant topics in the classroom, in the clinic, and in the laboratory. Others, such as the University of California, Davis, designed a series of extra classes and clinical experiences for students interested in clinical research. These students can earn a master's degree or emphasize translational research in their studies."

The new awards include those original 13 schools and add 12 more. (Click here for a full list of all participating institutes.) We've written about some of the Med Into Grad programs and the students in them in Basic Scientists in the Clinic, Programs Aim to Train Translational Scientists, and Carving a Career in Translational Research.

Disclosure: HHMI is a partner in CTSciNet, the Clinical and Translational Science Network, a joint project of Science Careers and the Burroughs Wellcome Fund.

The Wellcome Trust plans to phase out its 3-year to 5-year research grants in favor of larger and more flexible grants that last up to 7 years, reports Jocelyn Kaiser in this week's issue of Science. The organization will put $183 million toward the new Investigator Awards beginning in 2011.

"The idea is to empower the very best scientists to tackle difficult, long-term questions," says Mark Walport, director of the Wellcome Trust, a U.K.-based charity that funds biomedical research. The organization hopes that the awards will help researchers more successfully tackle large research questions without the constraints of low funding or a short grant cycle.

Read the full story in this week's issue of Science, and see the Wellcome Trust Web site for the announcement of the new program.

As the fall ends and winter approaches, next summer may seem far away. But this is the ideal time to arrange for next summer's research position.  This is especially true for first-year medical students who, at most schools, have the prospect of a long summer break.

A good place to find out about available opportunities is from your Dean's office or from the Associate Dean for Research.  Most medical schools offer a wealth of opportunities.  How do you choose?  A good place to begin is by determining what area interests and excites you the most: Neuroscience? Reproductive biology? Robotic surgery? Space medicine? AIDS research? It's all out there. 

Today marks the launch of Science magazine's spinoff journal, Science Translational Medicine. One of the papers in the inaugural issue is by a group of Canadian researchers who have developed a "lab on a chip" device that can measure levels of the hormone estrogen in a tiny sample of blood or tissue. The researchers hope that this device can be used in the future to measure the risk of breast cancer--which is closely linked to estrogen levels--or the effectiveness of certain therapies that affect estrogen levels.

I heard about this paper on Tuesday in a teleconference for reporters. What struck me as the most interesting part of the research is the group of researchers themselves. The paper is the result of a collaboration between two research groups: A group of chemists and engineers, headed by Aaron Wheeler at the University of Toronto; and a group of clinical researchers, headed by physician-investigator Robert Casper at Mount Sinai Hospital.

The lead author of the paper is Noha Mousa, a Ph.D. student working with Casper. She's also a physician. It was her initiative that got the collaboration going: "Me and Dr. Casper ... have many patients on aromatase inhibitors as a preventive therapy, and we wanted to measure [estrogen levels]," Mousa said in the teleconference. "I contacted Aaron and I told him about the idea, and he said, we can give it a try. So we got together and made a diagram of the device." They brought in more collaborators and people from both labs to fine-tune the idea,  build the device, and eventually test it. "We developed it gradually, step by step," Mousa said. "I was in Dr. Wheeler's lab all the time, and really enjoyed that and learned a lot from it."

I think this paper illustrates a key goal of translational research: To bring together research groups who normally wouldn't work together to solve critical questions to improve human health. Indeed, Wheeler summed it up nicely: "We live in completely different worlds, and I've learned so much working with this other group," he said in the teleconference. "This has been the most fun I've had in science."


Dear Editor,

I read with interest the following article: "A Physician-Researcher Thrives in the Balance" by Chelsea Ward, September 11, 2009.

I congratulate Dr. Regan Theiler on her accomplishments. However, I believe you are giving the wrong message to young women physician-researchers. In this article, Dr. Theiler had essentially stated that having a successful personal family life and a successful translational research career are both not possible. The author of the article further highlights this point in bold.

In the 21st century, I think that it is quite possible to be a physician-researcher and have a successful personal life. I am an example and so are many professional women that I interact with. The article implied that a career must be given up to have a good family life or vice versa. It is certainly not an example that I would share with my children or the upcoming women researchers of today. Perhaps it would be more important to share with others how successful women balance family and career.

Thanks for your attention.

Sincerely,
Deepali Kumar MD MSc FRCPC
Assistant Professor of Medicine
Transplant Infectious Diseases
University of Alberta


Dear Dr. Kumar,

Thank you for taking the time to send us your thoughts about our recent profile of Regan Theiler. We are aware that Theiler's statement was rather provocative. (To remind us all, here it is: "This career path is not for someone who wants to have a big, happy family and go on three vacations a year with them and eat dinner with them every night. It's just not going to happen.")

We are dedicated to promoting women in physician-scientist careers, and I know her statement seems to contradict that. Nevertheless, we thought it important to convey an honest account of Dr. Theiler's experiences and opinions. In my interactions with the physician-scientist trainee community, there are many women (and men) who ask the question, "can I succeed at having both a family and a career?" Theiler gave her honest opinion, which I appreciate and I hope others do, too. But this answer will be different for people in different specialties, in different medical centers, and with different work ethics. Each person's work-life balance is unique.

We will tell stories in future issues of women with different opinions on the subject, and we'll tell the stories of women who do have families and different work-life interactions. Earlier this year, we published two articles on women physician-scientists -- "Women M.D.-Ph.D.s: Life in the Trenches" and "Perspective: Ensuring Retention of Women in Physician-Scientist Training".

I hope to publish more on the issue, and I hope there will be a lively discussion of the subject on our online community for clinical and translational scientists, which will launch in a few weeks. Meanwhile, I thank you for sharing your concern.

Regards,
Kate Travis
Contributing editor, Science Careers
Editor, CTSciNet, the Clinical and Translational Science Network

The National Academies of Science have just released a 7 minute film on their YouTube Channel. Go and watch it.

On Being a Scientist is based on the book of the same name, also from the National Academies.

The focus of the video is scientific ethics, but what makes it great is the way the ethical issues are presented: not as abstract philosophy but as growing directly out of--indeed, being as one with--the everyday practice of science.

Thoughtful scientists may not find anything new here; cynical ones may even find the treatment naive. Yet, I think watching the video could change the way you think about your job in an important way. Plus, I love the funky, early-'70s vibe of the introduction. You won't regret the 7-minute investment. Highly recommended.
 
The Department of Defense (DoD) is confronting the mounting medical problems of members of the armed services and veterans with a new research and development funding program to help relieve their suffering.

From 2003 to 2007, an estimated 44,000 U.S. service members were diagnosed with some form of traumatic brain injury (TBI). Another 39,000 current or former service members suffered from post-traumatic stress disorder (PTSD) well after they returned home, according to the Congressional Research Service

To meet these needs, DoD is offering its Defense Medical Research and Development Program (DMRDP) Applied Research and Advanced Technology Development Award. This award is designed for independent investigators interested in conducting research on battlefield injury and care, particularly in the areas of PTSD, TBI, prosthetics, and restoration of eyesight and other vision-related ailments. Additional research topics include operational health and performance, rehabilitation, and psychological health and well-being tools for U.S. service members.

The DMRDP announcement calls for applied research, which it defines as "work that refines concepts and ideas into potential solutions". The intention is to enhance pharmacologic agents (drugs and biologics), diagnostic and therapeutic devices, behavioral and rehabilitation interventions, clinical guidance, supporting medical information, and training systems.

The DMRDP Applied Research and Advanced Technology Development Award is a three-year funding opportunity. Investigators will be awarded a maximum of $750,000 a year to fund their research efforts. DoD expects to make about 100 awards, divided between internal and external applicants. The deadline to apply is September 25, 2009.

For an overview of this grant visit GrantsNet. For the full announcement visit the DoD Web site.

- Donisha Adams

Donisha Adams is the GrantsNet Program Associate for Science Careers.

September 1, 2009

Smart Child Left Behind

Don't know if you saw it: There was an op-ed late last week in the New York Times--here it is--that argued that while the No Child Left Behind law seems to be helping the worst students, the best students have suffered from what the article calls the law's "benign neglect".

Today there's news from the University of Texas at Austin--see this entry from the Chronicle of Higher Education--that the university will stop giving a full ride to winners of National Merit Scholarships. The university's administration, under budget pressure, decided to devote those resources to need-based financial aid. "When we looked at what was happening in the economy, we decided it was important to redirect resources to make sure that all students that are qualified to be admitted to the university are able to attend regardless of need," said Tom Melecki, director of student financial aid. Thus passes one of the very few remaining programs to reward academic excellence regardless of financial need.

I support economic equity, but, as someone who is profoundly interested in the future of science, I can't help but regret the apparent abandonment of our most able young scholars.

 

August 28, 2009

Treating Employees Well

This column in Business Week describes a call-center business where employees are offered full health-insurance benefits and can earn 6 figures. The idea is to treat employees as valuable assets instead of as faceless commodities to be exploited.

The column focuses on the conventional notion that we can't compete with low-wage countries (to which U.S. jobs are often outsourced), which, argues columnist Vivek Wadhwa,  is based on a misunderstanding of the nature of competitiveness and of our competitive advantage. "With smart processes and the proper incentives, U.S. companies can keep jobs here in America, and do so in a way that is actually better for the company and its employees," Wadhwa writes.

The company in question, IQor, Inc. (the link is to the Business Week "Company Overview"), which, as Business Week writes, has seen its revenues increase 40% annually for the last 3 years. Its salaries are nearly 50% above "industry norms." Aside from the call-center work, the company provides support for a number of "back-office" tasks in the finance, media, and telecommunications industries--"work that's largely been relegated to the scrap heap in the U.S., considered a source of little more than low-wage, low-value, and low-self-esteem jobs." And, just like call centers, many of those jobs have been off-shored. IQor has 11,000 employees worldwide, but its U.S. operations have grown fastest.

The notable thing is that the company has succeeded by treating its employees well. No, these are not future scientific stars. But they are, nonetheless, the keys to the company's performance. And the way to attract and keep the best employees--and to extract maximum performance from them--is to treat them like stars, not interchangeable parts. "To ensure that employees don't feel like a job at iQor is a dead end, the company creates career path programs that clearly lay out a worker's road to advancement. IQor regularly promotes employees who started out working the phones to management." The result is low turnover and high performance."iQor invests in its people, and doesn't view them as expendable or replaceable. The company values tenure and seeks to promote from within its walls, a hallmark of companies with strong cultures."

So what's this got to do with science careers (or with Science Careers)? Well, consider the implications for academic science, where a relatively small fraction of the workforce--namely, the PIs--make as much as half what IQor's top call-center employees make.  If treating a worker like a valuable employee helps a call center's productivity and bottom line, imagine what it could do for scientific productivity--the ultimate knowledge work. 

For years we have written that the key to extracting the most from knowledge workers is to treat them well, help them feel comfortable, and see to it that they have the support they need to focus on their work (without sacrificing their families and personal lives). The competing perspective--that workers are like machines, or interchangeable parts of machines, to be driven as cheaply as possible--never made much sense in a scientific context, though that's still how some administrators and policy makers seem to view postdocs.

IQor demonstrates that it might not make much sense even in a call-center context--and that this might be a key idea for America's future competitiveness.

Hat tip: Slashdot

The Science Careers feature last week on career renewal has pointed us towards several stories involving strange career turns, including this report, spotted by editor Jim Austin, on Wayne Marasco, M.D., Ph.D., appearing today on the U.S. News and World Report site.

According to the article, Marasco developed a technique for identifying common antibodies in viruses that could lead to a breakthrough for more comprehensive vaccines to treat viral illnesses, such as influenza or HIV/AIDS. He is on the faculty at Harvard Medical School and research staff of Dana-Farber Cancer Institute in Boston, and is also founder of the National Foundation of Cancer Research Center for Therapeutic Antibody Engineering.

Marasco's path into science was most unusual. After college, Marasco took a job as a technician in a kidney dialysis lab, where he developed an interest in medicine. This interest had to wait, however, because he started a roofing and siding business that became successful. His interest in medical science stayed in the background until he decided to return to the University of Connecticut School of Medicine, where he earned his Ph.D. in 1980. Marasco later did a postdoc at University of Michigan Medical School, where he also got an M.D. degree in 1986.

A decade ago, Marasco started compiling a library of 27 billion anibodies. Researchers can mix the antibodies in his library with target viruses and catch the antibodies that bind to the target. His work has been applied to the H5N1 (SARS) virus and most recently to the H1N1 (swine flu) virus.  In the H5N1 case, Marasco's technique led to the discovery of a common feature of bird flu viruses that rarely mutates--and a common antibody that binds to it--and thus could make possible a common vaccine against these viruses. Vaccines now must target specific strains; when the viruses mutate, the vaccines become less effective. Marasco's discovery could change all that.

While our country needs good roofers, Marasco's career choice will likely have more widespread and beneficial consequences.