Transcript John Horgan - Vanderbilt University Medical Center

How Young Faculty Can Avoid
Common Pitfalls in Academic
Life
David Robertson, MD
CRC Director
March 16, 2007
Limited Focus of this Presentation
• Medical School
• Clinical Department
• Physician Investigators
– Role of the physician
– Role of the investigator
Outline
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Clinical Research
Patient Oriented Research
An Era of Great Changes
Physician first or Investigator first?
Cultivating Creativity
Recognizing the Eve of Enlightenment
Miscellaneous Advice
Kinds of Clinical Research
and Level of Resolution
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KINDS
Human gene function
Human cell function
Clinical pathophysiology
Clinical therapeutics
Clinical trials
Outcomes
Epidemiology
RESOLUTION
Cell
Cell
Person
Person
Person/Population
Population
Population
Patient-Oriented Research
• Occurs when the patient and the scientist
are both in the room at the same time and
both are alive.
Kinds of Clinical Research
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Human gene function
Human cell function
Clinical pathophysiology
Clinical therapeutics
Clinical trials
Outcomes
Epidemiology
Patient
Oriented
Research
OLD PARADIGM
PHENOTYPE
ENVIRONOME
ENDOPHENOTYPE
PHYSIOME
PROTEOME
GENOME
NEW PARADIGM
PHENOTYPE
ENVIRONOME
ENDOPHENOTYPE
PHYSIOME
PROTEOME
GENOME
Clinical Research
is not an easy roadway
 Clinical research is
impeded by
escalating regulatory
requirements to
address the same
oversight concerns.
Elias Zerhouni
Your careers will span an era of
great change
“The End of Science”
…John Horgan
John Horgan
• Most disciplines … physics,
chemistry, mathematics … are
mature
• The best and most exciting scientific
discoveries are behind us
• Pure Science evolving to Applied
Science
• Discovery to Application
• Biomedical Science has a generation
of discovery before it becomes
Engineering + Business
The Problem
Bench
Bedside
Trench
(Practice)
The new multidisciplinary paradigm
• The multidisciplinary
paradigm could be
interpreted as NIH’s
way of introducing
what Horgan called
“the end of science”
Your Career: Physician or
Investigator
• Asking physicians to choose runs against
the grain
• Many never quite decide which is first in
their life
• Institutional leadership may foster this
ambiguity
• Some can be one sometimes and the
other sometimes
Be a great physician
• Study your patients
• Study the literature
• Study OMIM + links
Advice for Clinicians
• Cathell DW. The physician
himself. (Philadelphia: F. A.
Davis) 1893
• Tumulty PA. The effective
clinician. (New York:
Saunders) 1973
Study your patients
(for medical students and residents)
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2000 patients during residency
Listen to your patients’ observations
Master each H&P finding
Rationalize each lab abnormality
Maintain access (as HIPPA permits) to all 2000
H&Ps and summaries: they are your magnum
opus
• Reexamine them each decade to see what you
have learned
Maintain a targeted practice
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Focus on one lifetime clinical area
Choose that area with care
Limit your practice to that area *
Limit your practice to 10% effort *
Manage all aspects of their care
Look for heterogeneity
Think laterally about your patients
* may be difficult to do in 2007
Investigator or Physician
• Physicians are usually very intelligent,
decisive, and hard-working.
• These traits make great physicians, but
not necessarily great scientists.
• Does medical school stifle creativity?
• Very few Nobel Prizes go to physicians.
Is discovery central to your life?
The Search for Creativity
• How can the physician-investigator
cultivate creativity?
Flannery O’Connor
(1925-1964)
Reporter: “Ms O’Connor, do you
believe we are stifling the
creativity of too many young
writers in our literature graduate
programs?”
O’Connor: “Actually, I don’t think
we stifling enough of them.”
Wassily Kandinsky: Old Town II
Practicing Clinical Research
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Creativity and innovation
Be a clear thinker
Hypothesis-testing is the liturgy of POR
You must work very hard
Cultivation of Creativity
Cultivating Creativity: Education at
Vanderbilt in 1999-2006
• 163 new clinical investigators (MPH or
MSCI) are produced (Nancy Brown)
• These investigators have 185 CRC
protocols (37% of all CRC activity)
• Projects: 1/3 by MPHs and 2/3 by
MSCIs
• Average age of CRC users declines by
~7 years after two decades of increase
• With this greening of the CRC has come
creativity, innovation and productivity
Cultivating Creativity
Lateral Thinking
Edward de Bono
• Alternatives: Use concepts to breed new ideas
• Focus: Sharpen or change your focus to improve
your creative efforts
• Challenge: Break free from the limits of accepted
ways of operating
• Random Entry: Use unconnected input to open new
lines of thinking
• Provocation: Move from a provocative statement to
useful ideas
• Harvesting: Select the best of early ideas and shape
them into useable approaches
• Treatment of Ideas: How to develop ideas and
shape them to fit an organization or situation
Benefits of Lateral Thinking
• Constructively challenge the status quo to enable new
ideas to surface
• Find and build on the concept behind an idea to create
more ideas
• Solve problems in ways that don’t initially come to mind
• Use alternatives to liberate and harness your creative
energy
• Turn problems into opportunities
• Select the best alternate ideas and implement them
The Landscape on the Eve of
Enlightenment
Stanley Cohen
• Vanderbilt Biochemist
and Teacher
Arthur C. Guyton
• Medical Physiology Text
• So masterfully written,
that the 95% of the
undiscovered world was
almost invisible
Eve of Enlightenment
• Aspirin and Prostaglandin
• Aquaporin
• Ulcer Disease
Miscellaneous Advice
• Learn to enjoy writing grant proposals
• Select a mentor who is successful and who
fights for proteges
• Help your mentor succeed; you may get
his/her job
• Never do something wrong:
in research there may be no second chance;
in clinical research there is no second chance
Develop Good Habits
• Make your tasks educational
• Be competent; know your methodology
• Remember that a scientific career is a
pleasure but also a business
You have to take care of
yourself
Quality Supersedes Quantity
You’ve got to be willing to fall flat on
your face
Expect noise in the system
What is the secret of working
successfully with a difficult chair?
• Learn to use different
words in describing
your goals
Dean John E. Chapman
The Five Academic Deadly Sins
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Failure of imagination
Superficiality
Lack of focus
Sloth
Majoring in the minors
Boundary Crossing
Writing Grants
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Try to make the project compelling
Leave no doubt you will succeed
Prepare a fault-free application
Take plenty of time to write
Seek and use feedback from anyone
Can you explain it to Aunt Tilley?
Can you explain it to a Congressman?
Keeping on the Cutting Edge
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1. F1000, PubMed, OMIM
2. Eskind Digital Browsing
3. NEJM, JCI, et al.
4. Nature, Science, Cell et al.
5. The New York Times
6. Maybe The National Enquirer
At any given moment, have …
• 6 projects in planning
• 4 projects in process
• 2 projects in press
….Victor A. McKusick, Advice to
Housemen, 1964
Career Advice
• Boss JM, Eckert SH.
Academic scientists
at work: Navigating
the biomedical
research career
(New York: Kluwer)
2003
ISBN 0-306-47493-X
Career Advice
• Barker K. At the helm: A
laboratory navigator. (New
York: Cold Spring Harbor)
2002
Career Advice: The Far Side
• C. J. Sindermann,
Winning the Games
Scientists Play
(Cambridge: Perseus)
2nd edition. 2001
ISBN: 0-7382-0425-0
Career Advice: The Far Side II
• Voltaire Cousteau, How to Swim
with Sharks,
http://www.apor.org/html/Articles.
htm
• Johns, RJ. Dinner address. How
to swim with sharks: the
advanced course. Trans Assoc
Am Physicians. 1975; 88: 44-54.
Vanderbilt Clinical Research
Center