Forum for Clinical Mentored K Awardees
Meeting Summary
December 4-5, 2014
Co-Chairs
Stephen I. Katz, M.D., Ph.D.
Susana A. Serrate-Sztein, M.D.
Marie Mancini, Ph.D.
Amanda Boyce, Ph.D.
Introduction
The NIH K08 and K23 Career Development Awards provide support for a sustained period of “protected time” (3-5 years) for intensive research career development under the guidance of an experienced mentor, or sponsor, in the biomedical, behavioral or clinical sciences leading to research independence. Previous discussions have identified the K-to-R01 transition as a critical point in the development of investigators’ independent research careers.
Purpose
This forum was first held in 2012. Based on the positive feedback received from participants, NIAMS also held the meeting in 2013 and 2014. The purpose of this forum was to bring together current NIAMS K08 and K23 awardees who are in their third year of award, as well as physician-scientists who have recently received an R01 (or equivalent independent research award), established clinician-researchers, and representatives of professional and voluntary organizations for a shared, open discourse on the challenges junior investigators face in pursuing research independence. The forum also provided an opportunity for the awardees to network with one another, as well as to interact with NIAMS leadership and extramural staff. The long-term goal of this forum is to enhance the Institute’s support of early-stage physician-scientists by encouraging and enabling K08 and K23 awardees to continue performing basic, translational, and/or patient-oriented research in their chosen fields.
Overview
In preparation for the meeting, participants were asked about obstacles facing clinician-scientists and about what NIAMS, as well as the broader medical/scientific community, might do to help support clinician-scientists to achieve research independence. Current K awardees and invited early career stage investigators were also specifically asked about the challenges they may have faced when accessing NIH or university research resources (e.g., core facilities, biological materials, data, biostatistical support, collaborations). Common themes from participants’ responses included challenges in balancing patient care and research, managing relationships with mentors and collaborators, and obtaining research resources.
Research Presentations
The forum started in the afternoon of December 4, with an overview of the current K awardees’ research. Awardees briefly outlined their research projects and progress. Each presentation was followed by a short period for questions and discussion. This session provided attendees with the opportunity to hear about each other’s research projects and to exchange information about strategies for overcoming challenges. The discussions, combined with the material collected in advance, set the stage for the rest of the meeting.
Concurrent Sessions
On Friday, December 5, K awardees participated in a morning “Round Robin” session with NIAMS program, grants management, and review staff, as well as with NIAMS staff who coordinate clinical research. At the beginning of the session, Dr. Marie Mancini provided a brief overview of the structure and budget of the NIH and the NIAMS, as well as information about the NIAMS extramural program. The K awardees then met in small groups with NIAMS staff to ask questions and learn about the Institute’s policies and procedures. While the K awardees spoke with extramural staff, the other participants met with the NIAMS Director, Dr. Steve Katz, and Deputy Director, Dr. Robert Carter, to discuss ways to enrich the pipeline of basic and clinical physician-scientists in the NIAMS mission areas.
Setting the Stage
After the morning sessions, the two groups reconvened to discuss how K awardees can make the most of their awards and plan for a successful transition to research independence. Dr. Katz began the session with brief remarks. He noted that although we currently are in a time of unprecedented opportunity in biomedical research, recent research funding trends are a strain on all researchers. NIAMS, like many of the other NIH Institutes and Centers, has special programs and funding policies for new investigators. Despite some challenges, NIAMS still has over $500 million to invest in biomedical research each year and remains committed to funding meritorious investigator-initiated research.
Dr. Marie Mancini set the stage for the discussion by presenting some historical outcomes data on the NIH/NIAMS K08 and K23 awards. Some key messages were that K awardees are more likely to have subsequent research publications than comparable non-K awardees and are more likely to apply for subsequent NIH research awards. Collectively, researchers who had held K08 or K23 awards had a significantly higher R01 award success rate than the pool of individuals with no prior career development support. Individuals who received both foundation support and an NIH K award were more likely to apply for and receive R01 funding than those who had only the K award. Nevertheless, the transition period between the K and R01 award is a vulnerable period in scientists’ careers. Dr. Mancini also updated the group on the June 2014 NIH Physician-Scientist Workforce Working Group Report that was developed by the Advisory Committee to the NIH Director. The report presents recommendations to address the growing concern that, as physician-scientists exit the workforce, there won’t be enough new physician-scientists to replace them.
Focusing on the Present – How to Make the Most Out of Your K Career Development Award
Balancing research with patient care and other commitments
One of the major challenges cited was the difficulty of finding time for research while also attending to clinical responsibilities and other duties (e.g., committee assignments). Mentors and institutional leaders should be helping junior scientists to ensure that their research does not become secondary to other obligations. Junior researchers should carefully consider which committees to join. Suggested time management strategies were to set aside one consistent time block for clinical work, to formally schedule time for writing grants and doing research, and to hire a research coordinator, or at least a portion of a coordinator’s time.
Obtaining research resources
The participants also discussed challenges related to obtaining research resources. For those studying some rare diseases, accessing patient samples can be an issue. In such cases, it may be useful to partner with non-research clinicians who are often happy to contribute samples. There is a growing emphasis on team science, and partnerships with researchers at other institutions may provide access to additional materials. The K awardees were also encouraged to take advantage of services available through the NIH-sponsored Clinical and Translational Science Awards (CTSAs).
Some of the K awardees expressed an interest in conducting a clinical trial and wondered about funding sources. The NIAMS has developed a number of policies and funding mechanisms to support clinical trials. Some of the participants noted that many non-NIH organizations also have grant programs that could support the conduct of clinical trials.
Mentoring
The K award period is an excellent time to begin establishing and growing a network of mentors and collaborators. Although most K awardees have mentors at their own institution, it can be very rewarding and beneficial to work with senior researchers at other institutions, if possible. Some of the professional and voluntary organization meetings include “speed mentoring” sessions to help junior investigators identify mentors. Although having many mentors can be quite helpful, it can be difficult if mentors give conflicting advice. One strategy for managing a mentoring team would be to request that the mentors confer with each other and provide consensus recommendations, similar to what is done by a thesis committee. The group also talked about changes in mentorship, including strategies to maintain relationships when a researcher or mentor changes institutions.
Discussing authorship
Another challenge for junior investigators is negotiating authorship on publications. Researchers should discuss authorship early on, while acknowledging that agreements may change and evolve over the course of a project. For junior investigators who are navigating authorship issues, it may be helpful to confer with a senior person who is not involved with their research.
Advice from junior clinician scientists who have obtained independent funding
At the end of the discussion, participants who had recently transitioned from the clinical mentored K award to research independence provided some reflections on their experiences. They encouraged the K awardees to seek out every funding source possible and to keep applying until they get funded. They shared examples of hurdles that they had to overcome and advised the K awardees to be flexible and resilient. K awardees should be growing their network and reaching out to colleagues outside of their current institution. K awardees should also be expanding their clinical experience— being a specialist in an area with few other experts can be beneficial.
Planning a Successful Transition to the R01
Considering various NIH grant mechanisms
The group discussed the NIH R01 and other NIH award mechanisms. The NIH R03 and R21 awards are smaller than the R01, but may be useful either during or after the K award. NIH ICs use different ways to help “new investigators” to obtain R01s, including having a more lenient payline for them. Having obtained an R03 or R21 award does not cause an applicant to lose new investigator eligibility. The NIH Director’s New Innovator Award, funded through the NIH Common Fund, promotes high risk research. The award is for investigators who have never had an R01. It is a five year award that provides slightly more funding than an R01 award.
Writing grants and understanding the peer review process
Many of the senior participants noted that, in the current climate, everyone has grant applications that are rejected, so first and foremost, researchers have to keep trying. It is important to pay attention to reviewers’ comments to get a sense of how an application was received. Submitting an application to many organizations and reviewing feedback can help an applicant to identify and focus on correcting concerns that are shared by many reviewers. However, study sections are not intended to replace mentors. Mentors should be helping applicants to review and troubleshoot their grant applications. Before ever submitting a proposal, researchers should identify colleagues at their institution who will give them honest feedback about ways to improve the document. Many participants advised the K awardees not to start writing the full application until they’ve had many people look at their specific aims. Participants also suggested having someone outside the field look at the application, since not all reviewers will be very familiar with the applicant’s project or field.
Several of the K awardees wondered if they needed to have a certain number of publications before applying for an R01 award. While there is no formal requirement regarding the number of publications, study sections do consider an applicant’s publication record when assessing expertise and readiness for an independent research award. Not all of the publications have to be related to the R01 subject, but some of them should be.
Establishing independence
Many K awardees wondered how to carve out a niche and demonstrate to reviewers that they are independent of their mentor. Many of the more senior investigators at the meeting noted that K awardees can include their former mentors as part of the R01 application (for example, as consultant or co-investigator) and still be considered independent. Having a senior person with a well-articulated role in a project can be an asset. Applicants do need to show, however, that they have their own “story” and preliminary data.
Finding additional resources
The group discussed several resources related to preparing grant applications and understanding the review process. Many NIH Institutes provide guides and tip sheets on their websites. The NIH Center for Scientific Review offers an early career reviewer program that allows emerging researchers to review grants as part of an NIH study section. The United States Bone and Joint Initiative offers a young investigators initiative grant mentoring program that focuses on grantsmanship and related skills. Many of the CTSAs offer grant writing courses. Thus, applicants are encouraged to seek out grant writing and other application resources through their own institution, relevant private foundations, and the NIH as well.
Closing remarks
At the end meeting, participants shared their reflections on the forum. Many of the senior participants noted that they’d been very impressed with the K awardees’ research presentations, and encouraged them to continue to focus on their research and keep applying for funding, including from non-NIH sources. Several K awardees noted that the meeting gave them a better understanding of the NIH’s activities and structure; many mentioned that they had particularly enjoyed the Round Robin sessions with NIAMS staff. They suggested extending the time for the Round Robin or even providing time for K awardees to meet individually with NIAMS staff. Dr. Katz and the NIAMS staff expressed their appreciation to the participants for taking time to attend the meeting and share their comments. NIAMS staff requested that the participants send any additional comments via e-mail.
Participants
*BARTELS, Christie, M.D., M.S., University of Wisconsin School of Medicine and Public Health
*CASTELINO, Flavia V., M.D., Massachusetts General Hospital/Harvard Medical School
*CHARLES, Julia F., M.D., Ph.D., Brigham and Women's Hospital/Harvard Medical School
*CHONG, Benjamin, M.D., MSCS, University of Texas Southwestern Medical Center
CWIK, Valerie, M.D., Muscular Dystrophy Association
*DANILA, Maria I., M.D., M.Sc., MSPH, University of Alabama at Birmingham
GARZA, Luis, M.D., Ph.D., Johns Hopkins School of Medicine
HANKENSON, Kurt D., D.V.M., Ph.D., Representing the Orthopaedic Research Society, Michigan State University/University of Pennsylvania
HEATWOLE, Chad R., M.D. MS-CI, University of Rochester Medical Center
HECKMAN, James D., M.D., Representing the Orthopaedic Research and Education Foundation, Dartmouth-Hitchcock Medical Center
KARLSON, Elizabeth W., M.D., Brigham and Women's Hospital/Harvard Medical School
KIEL, Douglas P., M.D., M.P.H., Representing the American Society for Bone and Mineral Research, Hebrew Rehabilitation Center/Harvard Medical School
*LATTERMANN, Christian, M.D., University of Kentucky
*LO, Grace, M.D., M.S., Baylor College of Medicine
*MACKENZIE, John D., M.D., UCSF Benioff Children's Hospitals, San Francisco
MARCHIOLO, Eryn, M.P.H., Representing the American College of Rheumatology, Rheumatology Research Foundation
MINNILLO, Rebecca, D.M., M.P.A., Society for Investigative Dermatology
NIEWOLD, Timothy B., M.D., Representing the Rheumatology Research Foundation, Mayo Clinic
NIGROVIC, Peter A., M.D., Boston Children's Hospital/Brigham and Women's Hospital/Harvard Medical School
RANKIN, Anthony, M.D., Representing the American Academy of Orthopaedic Surgeons, Howard University
*SCHNABEL, Lauren V., D.V.M., Ph.D., DACVS, North Carolina State University
*SHAH, Ami A., M.D., MHS, Johns Hopkins University School of Medicine
*SHARMA, Anjali, M.D., M.S., Albert Einstein College of Medicine
*STYNER, Maya, M.D., University of North Carolina School of Medicine
*WIXTED, John, M.D., University of Massachusetts Medical School
WU, Joy Y., M.D., Ph.D., Stanford University School of Medicine
*Indicates current NIAMS K08 or K23 awardees.
NIAMS
BOYCE, Amanda, Ph.D.
BURROWS, Stephanie Y., Ph.D.
BUSCHMAN, Justine, M.S.
CARTER, Robert, M.D.
DRUGAN, Jonelle K., Ph.D., M.P.H. GRAYSON, Peter, M.D.
KATZ, Stephen I., M.D., Ph.D.
KESTER, Mary Beth, M.S.
LANGER, Mark
LESTER, Gayle, Ph.D.
LIN, Helen, Ph.D.
LINDE, Anita M., M.P.P.
MA, Kan, Ph.D.
MANCINI, Marie, Ph.D.
MARRON, Kathryn, Ph.D.
MCGOWAN, Joan A., Ph.D.
MOEN, Laura K., Ph.D.
NELSON, Melinda
NICHOLSON, Anna, MSHS
REUSS, Reaya, M.S.
SALAITA, Kathy, Sc.D.
SERRATE-SZTEIN, Susana A., M.D.
SIEGEL, Richard M., M.D., Ph.D.
THACH, Yen
TSENG, Hung, Ph.D.
TYREE, Bernadette, Ph.D.
WANG, Fei, Ph.D.
WANG, Yan, M.D., Ph.D.
WANG, Runsheng, M.D.
WASHABAUGH, Charles H., Ph.D.
WITTER, James, M.D. Ph.D.
ZHENG, Ted, M.D., Ph.D.