1 Pathways are not always direct! Medical school in Srilanka - - PDF document

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IBD research: A guide for fellows and Junior Faculty

• Subra Kugathasan MD

– Emory University – Prinicipal Investigator, CCFA Pediatric Risk Stratification Initiative

• Ying Lu MD

– North Shore Children’s Hospital

• Athos Bousvaros MD MPH

Children’s Hospital Boston – Children’s Hospital Boston – Chair, NAPSGHAN IBD Committee

• Sandra Kim MD

– University of North Carolina, Chapel Hill – Vice-chair, CCFA Pediatric Affairs Committee

• Michael Kappelman MD MPH

– University of North Carolina, Chapel Hill

• Marjorie Merrick, RN

– Research Director, Crohn’s and Colitis Foundation of America

Subra Kugathasan, M.D. Professor in Pediatrics & Human Genetics Emory University School of Medicine

Current Role and Responsibilities

• Division of effort

– 50% research – “40%” clinical (6 weeks of service, 3 ½ day clinics, ½ endoscopy) – 10% administration/program development % p g p

• Research

– Principle Investigator: Risk Stratification &

Identification of Immuno-genetic and Microbial Markers

• f Complicated Disease Course in Pediatric Crohn’s

Disease.

• 5.4 million, 20 center, 4 year study

– IBD genetics of African-Americans – Genomics (methylation) markers of IBD

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Pathways are not always direct!

• Medical school in Srilanka
• Pediatric training in the UK for 4 years
• Fellowship – Very first exposure to any

research research

• Mucosal immunology (Dr Fiocchi)
• Stayed in the lab for additional one year

(good investment yields dividends!)

My circuitous pathway

• First real job as an assistant professor (age-38

years)

• K23 award (40 years) – Mucosal T-cells in early

and late Crohn’s disease

• Switched gears – mucosal immunology was not

Pathways are not always direct!

Switched gears mucosal immunology was not going anywhere!!. While side-project – population based IBD epidemiology brought fame.

• Extended tentacles into genetics of the IBD.
• 5 years later – gene discovery leading to Nature

genetics publication.

How to get a clinical research started ! Look for a research question ! that interest you

There is no substitute for having a good question which is Answerable Important

START small, no project is small to start

Always have a ‘side-project’ Collaborate Create a formal plan for execution Time resources Utilize available resources Do not get turned off with negative feedback from divisional / department

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How to get started ? Create a formal plan & Time management

Work on your projects for at least 15

minutes – EVERY DAY ! Start your day with your research on your research days, half days ! Emails, letters, dictations …… CAN WAIT !

• f interest

Enteric flora

Immunology Genetics

IBD pathogenesis – how to invest, where to invest in 2010? Level o

1960 2010 2000 1980 1970 1990 …as time goes by…

Environment Infectious agents

IBD Research From a Recent Fellow’s Perspective p

Ying Lu, MD NASPGHAN 2009

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Timeline for flu study

Start recruitment Flu season End recruitment IRB and grant approved Idea for research Write IRB and grant Analyze data Submit manuscript Manuscript accepted Oct Flu season Dec Sept April May/ June Spring June Aug Second year Third year

Timeline for HPV study

Grant approved Start recruitment IRB approved Idea for research Write IRB and grant Still recruiting July Aug 2008 Sept April May/ June Present Second year Graduation Third year

Research project

• Feasible

– Resources

• money, assistant, statistician, GCRC, CRP

– Time – Patients – Patients

• Mentorship

– Expert in field – Experience with research, grants, publications – Will not fight for authorship – Looks out for your interest, not their own – Approachable, available, willing to help

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Ideal research project

• You’re interested in topic (not just others)
• Contribution to field
• Niche
• IRB approved funded and ready to go
• IRB approved, funded, and ready to go
• First author paper on original article by

graduation

• Disclaimer: Even the most simple study requires

a lot of work!

My personal track

• Clinical versus basic science research
• Clinical versus research track after

fellowship F t d

• Future endeavors

IBD from the perspective of the “research friendly clinician”

Athos Bousvaros MD MPH

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My career pathway

• Began fellowship in 1988, completed in 1991
• Three years in laboratory doing mucosal immunology

– Mentor became disenchanted with science, quit during my first research year. – Preferred patient care

• Returned to clinical medicine with strong interest in IBD,

and desire to apply what I had learned in the laboratory to patients.

• Spent the last 17 years doing just that.
• Approximately 70% of my time is patient care, the rest

being research

How can a clinician do research?

• Read the literature
• Further study

– Coursework, MPH

• Identify collaborators

– Epidemiologists – Epidemiologists – Clinical trials experts – Basic scientists – Statistician is essential

• Form a “team” to study IBD
• Participate in multicenter collaboratives

– CCFA and others

Epidemiology Pharmacology Microbiology Genetics Outcomes

“The wall” – physical separation, profit based medicine, research funding, ( )

The “Wall” vs. the “Web”

IBD Motility Hepatology Short Bowel GI allergy

regulatory (FDA and IRB), personal issues

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My research has reflected my collaborative teams

• Angiogenesis

– Judah Folkman – vascular biology lab

• Tacrolimus in UC

– Transplant group at Pittsburgh

• Probiotic studies

Jon Vanderhoof and Rose Young expertise in LGG – Jon Vanderhoof and Rose Young – expertise in LGG – Patricia Hibberd – clinical trials

• Vaccine studies

– Denise Jacobson

• Microbiome in IBD

– Broad Institute, Harvard, and MIT

• All my colleagues, both locally and nationally that help.

Advice

• There is no one pathway to success.
• All aspects of academic medicine are important.

“Community of Excellence”

– Patient care – Clinical research – Basic research Basic research – Teaching – locally, nationally – Preparation of educational materials – Community service – Advocacy

• Go and seek out collaborators, and get them interested in

IBD.

• Become actively involved in NASPGHAN and CCFA
• WRITE, WRITE, WRITE

Epidemiology and

• utcomes research

Michael Kappelman, MD, MPH Assistant Professor U i it f N th C li t Ch l Hill University of North Carolina at Chapel Hill

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Current Role and Responsibilities

• Division of effort

– 75% research – 20% clinical – 5% teaching

• Research

– Health services research and clinical epidemiology related to IBD (Variation in care and outcomes, descriptive epidemiology, costs, pharmaco-epi) – Initial funding via institutional K12 award – Currently in process of applying for individual career development awards (NASPGHAN, CCFA, NIDDK)

Current Role and Responsibilities

• Clinical work

– 6 weeks a year “on service” – ½ day of clinic every other week – ½ day of endoscopy per month – Countless “add-on’s” as needed

• Teaching

– Small group preceptor—med school clinical epidemiology course – Teaching of residents and students rotating through inpatient and outpatient rotations

My circuitous pathway

• Psychology major as undergraduate
• Research assistant for a study of erectile

dysfunction

• Entered medical school with an interest in psych
• Favorite 1st year course was molecular biology
• Spent 1st summer in basic science laboratory
• Additional year of basic science research

between med school and residency

• Applied for and began fellowship, initial interest

in IBD genetics

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My circuitous pathway

• An article in the New Yorker changed my career

pathway

“The Bell Curve” by Atul Gawande

• Epiphany: Why not apply the same principles

used by CF for years to measure and improve used by CF for years to measure and improve IBD care and outcomes?

• Switched gears again sometime in the middle of

my 1st year of fellowship

• Good advice from Athos:

– Go outside the field of pediatric GI and identify a mentor and academic plan to learn new skills and techniques which you will bring back to the specialty

Fellowship Training

• Primary mentor (methods):

– Jonathan Finkelstein: general pediatrician with expertise in QI and health services research, mostly in asthma and abx overuse

• Secondary mentors (content):

y ( )

– Richard Grand and Athos Bousvaros

• Formal training

– MPH in clinical effectiveness

• Research projects:

– Epidemiological study design and analysis of large databases

Job Search

• Personal happiness matters most (family,

friends, support, etc)

• Mentor
• Negotiations

Worked with division chief/department plan to – Worked with division chief/department plan to determine a career pathway (mutually beneficial to me and the program) – Identified necessary resources (protected time, clinical and/or research supplies, equipment, access to patients, etc.) – Past and prior mentors very helpful

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Most valuable lessons I’ve learned

• Keep an open mind trust your gut instincts —

remain receptive to all sources of inspiration

• During fellowship, learn a new technique or skill
• utside of your narrow clinical area of interest.

y

• Job:

– Mentor – clear expectations of how you will spend your effort and dedicated resources to achieve success – access to patients for clinical research (multi-center if joining a smaller program)

CCFA Research Programs

Presented by: Marjorie Merrick Vice President of Research & Scientific Programs

CCFA’s Mission

To cure Crohn's disease and ulcerative colitis, and to improve the quality of life of children and adults affected by these diseases.

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Research Program Strategies

• Identify and fund the best peer-reviewed research in

IBD.

• Provide “seed money” to allow investigators to

generate enough preliminary data to be competitive at the NIH level.

• Encourage outstanding young investigators to

choose a career in IBD research.

• Identify and support emerging areas of research.
• Insure that all applications recommended for funding

are closely aligned with CCFA’s scientific priorities as outlined in Challenges in IBD Research and Challenges in Pediatric IBD Research.

Training Awards: Career Development and Research Fellowship Awards

• Mentored awards
• International candidates are eligible, but must be employed by an

institution within the United States

• Career Development Awards: $90,000/year for up to 3 years
• Award includes salary support, fringe benefits, supply/tuition

funds

• Basic and clinical research tracks
• MD, PhD or equivalent
• Have at least 2 years documented experience in IBD basic or

clinical research

• Research Fellowship Awards: $58,250/year for up to 3 years
• Award includes salary support, fringe benefits and travel funds
• MD, PhD or equivalent
• Has at least 1 year documented IBD research experience

Application and Review Process

• Letters of intent to apply due November 1 and

May 1

• Grant applications accepted January 14 and July

1 (online submission)

• Applications reviewed by the Research Training

Awards Committee a ds Co ttee

• Review criteria:

– Relevance to IBD and scientific merit – Candidate’s qualifications and commitment to IBD – Strength of the mentor and training environment

• Successful applications begin funding on the July

1 or January 1 following submission.

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CCFA’s Spectacular Success in Training New Investigators

• Current funding rate: 40-50% of applications
• Since 1967 the CCFA has supported the

training of 218 Research Fellows and 122 g Career Development Awards

• The vast majority of these trainees have

stayed in the field, made substantial contributions to understanding and treating IBD, obtained NIH grants, and trained their

• wn fellows and mentored junior faculty

CCFA’s Research Program Continues to Grow

Number of new Senior and Training Grants since 1967: 1967-1970 7 1970-1980 77 1980-1990 158 1990-2000 272 2001-2006 516 2007 59 2008 51 2009 40 TOTAL GRANTS AWARDED: 1,180