Mentoring Clinician Scientists and Scientists in Clinical Departments

1. Mentoring Clinician Scientistsand Scientists in Clinical Departments Thomas K. Henthorn, M.D. University of Colorado Health Sciences Center

2. Mentor Qualities • Mentor was the name of the close friend to whom Homer’s Odysseus, during a protracted absence, entrusted his children • Educate • Tutor • Prepare for succession • Protect trust Protect

3. Developing the Young Academic Surgeon Kevin Staveley-O’Carroll M.D., Ph.D., et al. Journal of Surgical Research, October 2005 • Physician-Scientists need mentorship in 3 areas: • - academic, scientific, clinical • - usually means 3 different mentors • Academic mentor • - senior faculty with ‘milestones’ • - organizing time • - balance between research and clinical • Scientific mentor • - learning ‘science’, methods, technologies, etc • - writing, grantsmanship, presenting results, etc. • Clinical mentor • - cannot be ignored • - ‘credibility’ in a clinical department depends on clinical prowess • - can help ensure critical protected time is available; share time

4. Developing the Young Academic Surgeon Kevin Staveley-O’Carroll M.D., Ph.D., et al. Journal of Surgical Research, October 2005   Strategic Milestones in Transition to Scientific Independence

6. Mentoring Faculty in Academic Medicine, A New Paradigm? Pololi L, Knight S. J Gen Int Med 20:866 2005 • 33-50% of faculty report being mentored • Informal vs formal? • How long? • "Where have all the mentors gone?" (Dunnington GL. Am J Surg. 1996) • Gone with the recent changes in medicine • Potential mentors need training • Result is a decline in junior faculty prepared as clinician-scientists

7. Mentoring Faculty in Academic Medicine, A New Paradigm? Pololi L, Knight S. J Gen Int Med 20:866 2005 • In GIM only 11% are now Professors and 58% are Assistant Professors • Unlikely that all junior faculty can be assigned a senior faculty mentor • Conflict of interest between senior ‘protector’ of the division/department and a junior faculty member’s professional aspirations • Although informal mentoring provides a more effective mentoring model the recognition that many faculty lack mentors has led institutions to increasingly implement formal mentoring programs.

8. Mentor Qualities • Today, there is no agreed upon definition of a ‘Mentor’ • This is an increasing issue recognized by the leadership in Biomedical Science • Part of the problem of the country’s lagging efforts in training the next generation of clinical scientists • How do we fix this?

9. NIH Roadmap for Medical ResearchInstitutional Clinical and Translational Science Awards (CTSA)Building an Academic HomeOctober 17, 2005

10. Industry Other Institutions NIH CTSA Awards: A Home for Clinical and Translational Science Clinical Research Ethics Trial Design Advanced Degree-Granting Programs Biomedical Informatics CTSA HOME Participant & Community Involvement Clinical Resources Biostatistics Regulatory Support

11. NIH Efforts • NIH conference to specify the new RFA requirements for CTSAs (Clinical Translational Science Awards) T-32 } K-12 + $6 million = CTSA K-30 GCRC

12. NIH Efforts T-32 } K-12 + $6 million = CTSA K-30 GCRC  New emphasis on ‘mentoring’ for institutional training (T32 K12 and K30).  New requirement for a graduate school accredited to award degrees in clinical research.  New emphasis translational science, systems biology, bioinformatics and ‘industry’ studies (GCRC).

13. Mentor Qualities • "Mentors are: • advisors, people with career experience willing to share their knowledge • supporters, people who give emotional and moral encouragement • tutors, people who give specific feedback on one's performance • masters, in the sense of employers to whom one is apprenticed • sponsors, sources of information about and aid in obtaining opportunities • models, of identity, of the kind of person one should be to be an academic." The Council of Graduate Schools (1995), Morris Zelditch

14. Enhancing the Discipline of Clinical and Translational Sciences Meeting, May 23, 2005 • Clinical and Translational Science Program Descriptions 16 Programs were presented and discussed

15. Colorado Clinical Science Program: Laurie Shroyer, Ph.D.

16. Colorado Clinical Science Program: Ronald Sokol, M.D. Young Investigators’ Guide to Research Mentoring Protocol Writing and Submission Meet With Your Mentor About The Nature of Clinical Research: Plan to spend sufficient time with your mentor to discuss clinical research….. BOOKS: Principles and Practice of Clinical Research, Ed. John I. Gallin, Academy Press, 2002, ISBN 0-12-274065 Ethical and Regulatory Aspects of Clinical Research: Readings and Commentary, Ed. Ezekiel J. Emanuel et al, The John’s Hopkins University Press, 2003, ISBN 0-8018-7813-6 ON-LINE RESOURCES: St. Jude’s Children’s Research Hospitalhttp://www.cure4kids.org/ums/home/courses/detail/content.php?courses_id=10 Registration and use of resources is free. NIH Clinical Center; Training and Education, http://www.cc.nih.gov/ Colorado Pediatric General Clinical Research Center, electronic application, http://www.uchsc.edu/pedsgcrc/ Public Health Service Form 398,http://grants.nih.gov/grants/funding/phs398/phs398.html Colorado Multiple Institutional Review Boards,http://comirbweb.uchsc.edu/

17. Colorado Clinical Science Program: Ronald Sokol, M.D. Young Investigators’ Guide to Research Mentoring Protocol Writing and Submission Meet With Your Mentor To Review And Critique Protocol Draft: Have a draft of your protocol to your mentor 5-7 days before the scheduled Draft Meeting time …. The Protocol Draft Meeting: - Your mentor will want to know answers to questions like “What issues arose while writing the Methods section?”. He/she is looking for evidence that you are growing…. - The result of this meeting should be a clear understanding, preferably articulated by you regarding modifications… - Once the essential components of the scientific portion of the protocol are at least in rudimentary form it is time for you to seek additional expertise; biostatistics, human subject issues, bioinformatics, regulatory, etc…. - Whatever your research, data will be collected and must be stored. Expert assistance in setting up databases and data collection advice … - Set a time to meet again with your mentor for the purpose of reviewing and discussing the full best-possible draft of your protocol …

18. Colorado Clinical Science Program: Ronald Sokol, M.D. Mentoring the Young Investigator (YI) Protocol Writing and Submission □Meet With YI About The Nature of Clinical Research; review research-treatment … □Meet With YI About His/Her Research Idea; purpose, design issues, background, significance, … □Provide YI With Protocol Writing Resources; on-line resources (NIH, PHS), names of local experts… □Meet With YI To Review And Critique Protocol Draft; examine and discuss all sections… □Provide YI With Information about Additional Resources and Expertise; contact info for experts … □Meet With YI to Review And Critique The Full Protocol Draft; examine and discuss each section… □Instruct YI To Personally Contact GCRC Core Managers □Meet With YI Post-GCRC Pre-Review; based upon readiness for submission, advise YI to proceed or delay. □Meet With YI Prior To The Review Meeting; Discuss the review process, what to expect from reviewers… □Attend Review Meeting With YI; This is required by the GCRC. □Meet With YI Post-Review Meeting; debrief and discuss YI’s experience of the review process … □Meet With YI To Review And Assess Adequacy of Responses to Reviewers; advise YI to proceed or delay. □Protocol Approval or Disapproval; Proceed to protocol initiation, or regroup.

19. PENN Training Program in Translational ResearchEmma Meagher, MD • Identification of the lead mentor at the outset is a critical feature for a successful training experience. • In consultation with the lead mentor, and with the approval of the MTR Advisory Committee, the candidate selects from the PENN faculty an individualized candidate MTR mentoring committee. • This three person committee functions as an ongoing monitoring group for the candidate’s progress. • The committee meets on a trimester basis to review progress reports submitted by the trainee. Thus the student’s MTR Program Committee functions analogously to a graduate student’s thesis committee.

20. Vanderbilt Physician-Scientist Development ProgramJeff Balser, M.D., Ph.D. • Program is fully integrated with the coursework, seminars, and mentoring infrastructure of our K-30 supported Masters in Clinical Investigation and Masters in Public Health programs. • A key feature of the VPSD is that participants are closely monitored (at 6 month intervals) by the VPSD Advisory Committee, which actively seeks input from both the awardee and the research mentor on progress. • The program director directly engages the awardee, mentor, and clinical department chair when problems are identified. • 47% of VPSD K-awardees are successfully converting to R-awards, more than twice the national average. • Recognizing the value of the central monitoring and organization this program provides, they are developing plans to expand the oversight of the VPSD beyond the 2 year initial period, into years 3-7, to include the K-award support period that almost always follows VPSD program participation.

21. Department of Anesthesiology – What we do now. • Every Physician-Scientist or Basic Scientist (anyone with a lab and a ‘start-up package’): • - must have a senior mentor outside of the Department • - key (strategically) to extending our reach and our value • - key (tactically) to the academic development of the individual • - must have a mentor within the Department • - key to developing within the specialty • - key to maximizing the benefit of the research to the Department • - key to developing ‘citizenship’ within the Department • - increasingly, looking for mentorship outside the institution

22. Mentoring through professional organizations • FAER – Academy of Anesthesia Mentors : Established in 2004 • - Objective is to recognize those individuals who, through their activities as mentors, have contributed importantly to the development and advancement of academic anesthesiologists in the areas of research and education. • - Additionally, the Academy seeks to promote the activities of mentoring among others in anesthesiology to increase academic activities in research and education as well as promoting the academic image of anesthesiology. • IARS Mentorship Initiative • - Effort to provide interdepartmental mentoring

23. Department of Anesthesiology – What we need to do • Every Physician-Scientist or Basic Scientist: • - must be part of a structured mentoring program run centerwide • - key to getting best chance at a productive mentoring team • - key to holding all parties accountable • - key to getting long term success Laurie Shroyer, the Graduate School Dean, and myself have applied to the President’s Fund for a grant to launch such a program at Colorado - we can learn from pediatrics and internal medicine - but they are in a world of their own - anesthesiology is one of the larger small departments - what we develop is suitable for export to the smaller departments

24. The End

25. National Shortage of Mentoring • Science to lead Anesthesiology into the future

26. Mentoring Session Record Mentor _______________________________________ Date ___________ Mentee ______________________________________Session ___________ Topics Covered at Present Session Present Issues: Current Actions: Future Agendas: Other Subjects: Topics for Later Reference