Self Management: What Do You Need to Provide to the Mix to Ensure Success

1. Self Management: What Do You Need to Provide to the Mix to Ensure Success John Chae, M.D. Association of Academic Physiatrist Daytona, FL, March, 2006

2. What is Success? • How is “Success” defined? • Personal versus professional • Definition of “Success” should always be PERSONAL

3. What is Success? Personal Nonprofessional Professional • How many of us in our death bed would be saying “I wish I spent more time in the lab, had more publications, had more grants….?” • You might be saying “I wish I spent more time with my wife, my children or grandchildren. I wish I invested more in people…” • We don’t want to climb the ladder of success to find out at the end that it’s leaning against the wrong wall.

4. Relational vs Terminal Thinking • Relational thinking: Making daily choices in light of long-range objectives. • Terminal thinking: Viewing each activity as an end in itself.

5. Why Set Objectives? • “If you aim at nothing, you hit it all the time.” • You are a limited resource • Not every “good” activity is valuable. Beware of “opportunities” that come your way • Well defined objectives become the filter through which you assess your activities • Relational thinking: All activities have short and long-term consequences

6. Objectives Faculty Med School Residency K12 K23 R01 “Independent Investigator” Tenure

7. Independent Investigator • Scientifically independent -A new/unique line of scientific inquiry -No longer dependent on a mentor for scientific input • Financially independent -Has own grant to fund salary, staff and lab -R01/Merit Review/NSF

8. Timeline for Independence Faculty yr 1 2 3 4 5 6 7 8 9 10 • Select mentor • K12 research • Write K23 • K23 research • Publish • Write R01/Merit Review • R01/Merit Review

9. Criteria for Tenure • Research: Grants and publications • Teaching: Medical students, residents, community • Service: Committees, board examiner, study section • National Reputation

10. Timeline for Establishing National Reputation Year: 0 1 2 3 4 5 6 7 • Professional Activity • Journal Articles • Join national organizations • Local & regional meeting presentations • National meeting presentations • Committee in national organizations • Review articles • Book chapters • Text books • Positions at other institutions

11. Case Study #1 Michael is a PGY-III resident who is participating in the RMSTP. He is enthusiastic about his project on a novel technique for motor relearning in hemiplegia. Upon returning from the annual AAP meeting, a faculty member in his program approaches him to join him as a coauthor on a chapter entitled “Physical Modalities” for the latest textbook in PM&R edited by DeLisa, Gans, Braddom and Frontera. Michael was incredibly intrigued by the offer. He has a great deal of respect for this faculty member and the new textbook by DeLisa, Gans, Braddom and Frontera was the talk of the meeting.

12. Case Study #1 • Why was Michael so intrigued by the offer? • What should he do and why? • Why shouldn’t he take the offer? -Book chapter takes an incredible amount of time -He will probably do most of the work -Future grant success is dependent on peer reviewed articles -Topic is not even related to his present project

13. Case Study #2 Chris has just started as an assistant professor. Chris’ mentor is the department chair, who is constantly providing opportunities for Chris. These include heavier teaching load than anyone in the department, several committees that are very time consuming, and administrative responsibility within the department. When Chris discusses these observations with the department chair, he is told that all these activities are important for promotion and tenure and that he should not worry

14. Case Study #2 • What’s wrong with this picture? • What will likely happen when he comes up for promotion and tenure? • What should he do now? Chris speaks to a senior professor in another department. This professor describes the fate of Chris’s predecessors, each of whom has been denied promotion and tenure due to lack of research/creative productivity. Chris and the senior professor meet with his department chair. The 3 of them develop a plan to decrease Chris’ teaching, committee and administrative responsibilities so that that Chris can devote more effort to research/creative activities.

15. Case Study #3 John Chae’s 6th pre-tenure year review, June 6, 2001 Research Dr. Chae began his work under the mentorship of Hunter Peckham but has been developing his own areas of expertise in stroke motor impairment and disabilities and upper limb neuroprosthesis in hemiplegia. He is currently PI on a FIRST award.. and an NIH R01 award. Dr. Chae’s publication record had been going well but recently has hit a snag. After publishing 3 first authored articles in 1998, he lists 5 articles as in-press with the Am J Phys Med Rehabil which, Dr. Murray informed the committee, were accepted 15 months ago.

16. Dr. Chae has published only one other research article, as a middle author, in the past three years. The Committee took note of Dr. Chae’s 3 review articles published in 2000, but until the 5 in press articles appear, it must consider Dr. Chae’s publication record problematic.The committee encouraged Dr. Murray to discuss with Dr. Chae consideration of placing research articles in journals with broader audience, suggesting the journals Stroke and Neurology. A national and international reputation is indicated by membership since 1998 on the NIH SBIR/STRR, Rehabilitation Study Section, on a Dutch Grant Review Council, service as an American Board of PM&R oral examiner, membership on the K12 Advisory Board, and by 2 international presentations made during 2000.

17. Teaching Dr. Chae is an active and much valued teacher. He runs the stroke rehabilitation curriculum for the residents. Between 1995 and May 2000, he was an active participant in the Core Physician Development Program, teaching between 40 and 100 hrs annually. He accepts a large number of trainees in his laboratory and has hosted a visiting Ph.D. scholar as well. He has offered a Type A elective seminar each year since 1995, often more than once each year and has maintained a steady medical student enrollment. He has served on a biomedical engineering and FES committe, and made other teaching contributions. The Committee is pleased to see that Dr. Chae has maintained the range of his teaching contributions in the three years since his third pretenure year review.

18. Service Dr. Chae makes an important service contribution at the department level by serving actively on its graduate medical education committee. His local service is highlighted by serving on the Board of Trustees of the NE Ohio chapter of the National Stroke Association and the Program and Education Committee of the NE Ohio affiliate of the American Heart Association. He makes no University service contribution or national service contribution on professional societies, an important omission from his record.

19. Summary Dr. Chae’s teaching contributions have been quite good. The committee notes that he has cut back on some contributions and, given his past teaching strengths, continued contributions, and the need to focus on research publication, the Committee believes this is the correct course. Dr. Chae’s funding support record is also on track, but the key to his promotion and tenure candidacies appears to be his publication record. The committee hopes that Dr. Chae’s in-press articles appear and that he is able to publish as first or senior author in a greater variety of journals of wider appeal. Such publications could enhance the likelihood of future R01 awards, another important aspect of promotion and tenure. Publication of the already submitted articles and additional articles in journals with a broader readership will also increase the likelihood of a favorable decision concerning promotion and tenure. The Committee recognizes that Dr. Chae is a very valuable member of the department, but the clinical and teaching demands on his time may make it difficult for his research program to reach the required fruition within the pre-tenure period permitted.

20. Case Study #3 • What was JC’s typical day during 3 yrs since his 3rd pre-tenure yr review? -Into work by 7am and home by 7-8pm. -Full inpatient service (12-16 patients), 6 mo/yr -Half day of clinic per week -Director of Stroke Rehabilitation -Medical student teaching: 2hrs/wk + coordinator for an elective -Resident teaching -R29 for 50% effort; an R01 at 25% effort

21. Case Study #3 • What’s wrong with this picture? • What should JC do? -Discussed the review with his mentor -He leveraged the discouraging pre-tenure review to: -Reduces inpatient load to ½ inpatient service 3x/yr -Reduce clinics to 1 half day per month -Eliminate medical student teaching -Relinquish administrative role -Cranked out papers -Joined the AAP research committee -Chaired the AAP Council of Researchers

22. Important Principles and Questions • Become an excellent doctor! • Do not get deceived by flattery. Beware of “opportunities” • Constantly ask “How does the activity contribute to the overall goal?” • Learn to say “no” • When in doubt consult your mentor

23. Success & RMSTP • How do we measure success in the RMSTP program? -Successfully become an independent investigator • How do we ensure that you become an independent investigator? -Work with your mentor -Learn the science -Do the research -Publish results -Say “no” to all other activities that distract you from this goal