2 nd Year Fellows Conference March 22 25, 2012 Scottsdale, AZ - - PDF document

2nd Year Fellows Conference March 22 – 25, 2012 Scottsdale, AZ

Supported by an educational grant from Abbott Nutrition

Learning objectives: To improve clinical competence and performance through:

• 1. Sessions on academic skills and professional development
• 2. Sessions on state of the art developments in the care of patients with pediatric digestive and nutrition

disorders

NASPGHAN-Abbott 2nd Year Fellows Conference Program 2012 March 22-25, 2012; Scottsdale, AZ

Thursday, March 22 3:15 – 4:00 pm Faculty Orientation Executive Lodge Boardroom 4:00 – 5:00 pm Fellow Orientation Ballroom C Kara Gross Margolis & Faculty 5:00 – 5:20 pm Academic Appointments and Promotions David Piccoli 5:20 – 5:40 pm A Career in Research Binita Kamath 5:40 – 6:00 pm Why Do I Like Private Practice Janet Harnsberger 6:00 – 6:30 pm Reception Cypress Court 6:30 – 8:30 pm Dinner in Groups Friday, March 23 8:00 – 8:30 am Breakfast Lobby Bar Foyer 8:30 – 8:50 am ABC’s of What NASPGHAN Can Do For You Ballroom C Kathleen Schwarz 8:50 – 9:10 am A Journey to the Liver, Bile, and Beyond Michael Narkewicz 9:10 – 9:30 am Motility: Why You Will Want to Be a Neurogastroenterologist Carlo DiLorenzo 9:30 – 9:50 am Feed Your Professional Soul: Careers in Nutrition Kevin Sztam 9:50 – 10:10 am Endoscopy as a Career Jenifer Lightdale

Friday, March 23 - Continued 10:10 – 10:30 am BREAK 10:30 – 10:50 am Being a Clinician-Educator: No Longer by Default Alan Leichtner 10:50 – 11:10 am How to Give a Great Talk Carlo DiLorenzo 11:10 am – 12:30 pm Lay Talk Breakout 12:30 – 2:00 pm Lay Talk Presentations with Lunch 2:00 – 2:20 pm Non NIH Funding for the Junior Faculty Member Mitchell Cohen 2:20 – 2:40 pm

NIH Early Career Funding Opportunities

Judith Podskalny 2:40 – 3:00 pm How to Write a Research Paper Mitchell Cohen 3:00 – 7:00 pm Activities on own 7:00 – 9:00 pm Dinner Cypress Court Saturday, March 24 7:30 – 8:00 am Breakfast Lobby Bar Foyer 8:00 – 8:30 am What is the Abbott Nutrition Health Institute Ballroom C Bob Dahms 8:30 – 8:50 am Industry Talk Gary Fanjiang 8:50 – 9:10 am International Research as a Pediatric Gastroenterologist and Nutritionist Kevin Sztam 9:10 – 9:30 am Moving From Mentee to Mentor Alan Leichtner 9:30 – 9:50 am Creating Your CV and Academic Portfolio Michael Narkewicz 9:50 – 10:10 am BREAK

Saturday, March 24 - Continued 10:10 – 10:30 am Interviewing and Negotiating for a Faculty Job Binita Kamath 10:30 – 10:50 am Running a Practice Janet Harnsberger 10:50 – 11:10 am Negotiating a Contract Kathleen Schwarz 11:10 – 11:30 am Academic Promotions David Piccoli 11:30 – 11:50 am How to Tell the NIH That You are Pregnant… Jenifer Lightdale 11: 50 – 1:30 pm Breakout Lunch in Groups Cypress Court 1:30 – 2:30 pm Panel Discussion Ballroom C 2:30 – 7:00 pm Activities on own 7:00 – 9:00 pm Dinner Garden Court Terrace Sunday, March 25 8:00 – 10:00 am Breakfast and Feedback Session Lobby Bar Foyer and Ballroom C

Faculty

Course Director:

Kara Gross Margolis, MD Columbia University 3959 Broadway 7th Floor, Dept Pediatric GI New York, NY 10032 P: 212-305-8167 kross_10022@yahoo.com Mitchell Cohen, MD Cincinnati Children's Hospital Medical Center Director, Division of Ped GI, Hepatology Cincinnati Children's Hospital Medical C 3333 Burnet Ave, MLC 2010 Cincinnati, OH 45229 P: 513-636-4953 mitchell.cohen@cchmc.org Carlo DiLorenzo, MD Nationwide Children's Hospital The Ohio State University 700 Children's Drive Columbus, OH 43205 P: 614-722-3450 carlo.dilorenzo@nationwidechildrens.org Janet Harnsberger, MD Cottonwood Med Tower 250 E 5770 S Ste 330 Salt Lake City, UT 84107 P: 801-277-6588 junglejt@hotmail.com Binita Kamath, MD The Hospital for Sick Children Division of GI, Hepatology and Nutrition 555 University Ave Toronto, ON M5G 1X8 Canada P: 416-813-7654 ext 28193 binita.kamath@sickkids.ca Alan Leichtner, MD Div of GI and Nutrition Children's Hospital 300 Longwood Ave Boston, MA 02115-5737 P: 617-735-2946 alan.leichtner@childrens.harvard.edu Jenifer Lightdale, MD, MPH Children's Hospital, GI Division Hunnewell Building, 300 Longwood Ave Boston, MA 02115 P: 617-355-6058 jenifer.lightdale@childrens.harvard.edu Michael Narkewicz, MD Children's Hospital Colorado, B290 13123 East 16th Avenue Aurora, CO 80045 P: 720-777-6669 michael.narkewicz@childrenscolorado.org David Piccoli, MD Division of GI, Hepatology & Nutrition Children's Hospital of Philadelphia 324 S. 34th St Philadelphia, PA 19104 P: 215-590-1678 piccoli@email.chop.edu Judith Podskalny, Jr., PhD Dr/Research Training & Career Develop Digestive Diseases & Nutrition, NIDDK 6707 Democracy Blvd, Rm 667, MSC 5450 Bethesda, MD 20892-5450 P: 301-594-8876 podskalnyj@extra.niddk.nih.gov Kathleen Schwarz, MD The Johns Hopkins Hospital Ped GI & Nutrition 600 N Wolfe St Brady 320 Baltimore, MD 21287 P: 410-955-8769 kschwarz@jhmi.edu

Kevin Sztam, MD, MPH Harvard Medical School-Children's Hospital Division of Ped GI/Nutrition 300 Longwood Ave, Hunnewell-Ground Boston, MA 02115 P: 617-355-5712 sztamke@hotmail.com NASPGHAN: Margaret Stallings Kate Ho Executive Director Associate Director PO Box 6 PO Box 6 Flourtown, PA 19031 Flourtown, PA 19031 P: 215-233-0808 P: 215-233-0808 mstallings@naspghan.org kho@naspghan.org Abbott Nutrition: Bob Dahms Manager, Professional Organizations- Pediatrics Abbott Nutrition Health Institute C: 203-912-2733 F: 614-737-9541 robert.dahms@abbott.com Ron DeVivo Manager.Professional Services-Northeast C: 516-382-0926 ronald.devivo@abbott.com Gary Fanjiang, MD Director of Medical Affairs P: 614-624-7331 gary.fanjiang@abbott.com

AAP 101 Academic Appointments and Promotions

David A. Piccoli, MD Biesecker Professor of Pediatrics at The Children’s Hospital of Philadelphia Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania

Faculty Ranks - The Possibilities

• Instructor
• Assistant Professor of Pediatrics

– Clinical Assistant Professor of Pediatrics – Assistant Professor of Clinical Pediatrics – Adjunct Assistant Professor of Pediatrics

• Associate Professor
• Professor

Hospital Positions - The Possibilities

• Attending physician
• Program (Center) Director
• Section Chief
• Co-Chief
• Division Chief
• Associate Chair / Vice Chair
• Department Chairman
• ? CEO / President

A career path is not ever a straight line Opportunities occur – obstacles impede

• Instructor
• Clinical Assistant Professor
• Assistant Professor – Tenure
• Assistant Professor – CE
• Associate Professor
• Professor

Resident – Chief Resident Fellow – Fellow Attending Liver lab Training director Section chief Interim chief Division Chief Associate Chairman for this Center Director Endowed Chair Associate Chairman for that

Four Questions

• What do I like, and what do I want to do?
• What do I do well?
• What is valuable to my division, department,

hospital and medical school?

• How will I be evaluated and promoted?

Academic Tracks (highly variable)

• Clinical track
• Academic Clinical track
• Clinician Educator track
• Tenure track
• Research track (PhD only)
• Hospital “track” – non-faculty
• Courtesy and other “appointments”

Roles and Responsibilities

• Clinical care
• Teaching
• Scholarly endeavors
• Extramural funding
• Service / advocacy
• Reputation

Goals: Roles and Responsibilities

• Great clinical care
• Teaching

– fellows – residents – medical students – nurses – others

• Scholarly endeavors

– publications – funding – leadership

Goals: Roles and Responsibilities

• Extramural funding
• Service

– local/regional – national/international

• Reputation

– Talks – Publications – Professional organizations – Other

Understand the Expectations

Research Clinical Teaching Service Clinician 0% 90% <5% <5% Academic Clinician <10% 80-90% <10% <10% Clinician Educator 20-80% ?? Funded 20-60% 10% 5-10% Tenure 80-90% Funded 10-20% <5% <5% Research 95% Funded 0% 5% 0%

Clinician Educator

First years Middle years Final years Clinical Advance clinical and technical skills. Establish interest/focus. Increase productivity and specialization. Expert / master status “Best doctor” Regional and natl. reputation. Research Establish focus. Increase productivity. Develop funding. Regional and national reputation Teaching Hospital and local Regional National meetings, courses Service Local, family support groups, education days Local, regional, national foundations Local, regional, national foundations

Tenure Track – Physician Scientist

First years Middle years Final years Clinical Consolidate clinical skills Developing expertise in field related to research National reputation Research Establish focus. Transition toward independence. Achieve steady progression of funding: K, R, foundation grants Continuous

• productivity. First

author papers with mentor, some last author papers. PI on R01 High impact papers. Series of peer- reviewed papers that show progression and tell a story. Stable independent funding (2 R01s) Teaching Hospital and local Regional and national National meetings, courses, visiting professor Service Local Local, regional, national foundations Local, regional, national foundations

Academic Clinician

• Excellence in Clinical Practice–Master Clinician

– Emphasis on quality and quantity of care – Innovation in delivery of care – Quality improvement – Regional reputation or recognition

• Excellence in Teaching – Master Teacher

– Didactic, bedside – Curriculum development, innovative teaching materials and methods – Mentoring

Timeline Considerations to Assistant

• How long is the course to Assistant Professor?
• What is the role of 4th yr fellowship or instructor

position?

• What are the implications of appointment?

– Clock is started – Salary may improve – Benefits may change (improve) – Research package may be available – Responsibilities may dramatically increase

Timeline and Evaluations

13-14 14-15 15-16 16-17 17-18 18-19 19-20 20-21 21-22 22-23 23-24 1 2 3 4 5 6 7 8 9 10

Instructor Assistant Professor Associate Professor Review 3 yr review 6 yr review Nomination Promotion 1 yr review Renew! On to Professor

GI Modern Family - Many Valuable Roles

2 4 6 8 10 12 14 16 18 Professor Associate Assistant Non-Faculty

Great Advice

• When you come to a fork in the road, ….
• It’s not the years, honey, …..
• When life gives you lemons, ….
• Good ideas are a dime ….
• Obstacles are the ……
• It’s never crowded on …..
• Il buono, il butto, …..
• You can do it !!!

A Career in Research

Binita M. Kamath MBBChir MRCP MTR March 2012

A Little About Me

• Clinician-Investigator
• 60% Translational Research

– Inherited cholestatic diseases, esp. Alagille syndrome

• 30% Clinical

– Hepatology (outpatient) and Liver Transplant (inpatient) and Procedures

What is a Research Career?

• Research-predominant profile
• >50% time devoted to research (“protected”)

– <40% seeing patients – Education, administration, leadership

• Basic science, clinical, translational

Why choose a research career?

PASSION for the question/area you are studying DESIRE to touch the lives of people you will never meet

What are you letting yourself in for?

• Flexibility

– The work is never finished

• Salary not tied to patient #s

– Dependent on grants

• Rejection
• Travel
• Public speaking

How to start a research career

• 1. Passion and an Inquiring mind
• 2. Pertinent question
• 3. Time
• 4. Money
• 5. Research team

Obremsky et al, J Orthop Trauma 2011;25:S124-127

How to start a research career #1

• Desire and passion
• Inquiring mind
• 90% perspiration, 10% inspiration
• Gladwell (“Outliers”): 10,000 hour rule

How to start a research career #2

• Pertinent question

– who cares?

• Testable

– feasible and ethical

• Find your niche – path to independence

How to start a research career #3-5

• Time (dedicated, not protected)
• Money
• Research team – research assistants,

students, statistician

• Negotiation

The Right Institution

• Mentor
• Division Chief
• Clinical colleagues
• Researchers in the Division – track record
• University

How to start a research career

• Find a mentor and project – First Year!
• Find your NICHE
• Strongly consider a Masters or PhD (if you

don’t already have one)

Currency for a Research Career

• Abstracts
• Publications (1st author)
• Chapters, reviews – THEMATIC
• Funding – institutional, foundation, NIH

Establishing your Research Career

• Define your expertise/skill set
• Network
• Collaborations
• Extend beyond your institution
• Consortia

Time Management

• Learn to say “No”
• Learn when to say “Yes”
• Be a good team player in your Division

Maintaining your Research Career

• Sketch out your career path regularly

– Research, clinical, administrative, education – Advisory committee

• Thematic

– Your CV must tell a story – White Board

Define Goals

• 3-5 years……….10 years
• Academic promotion
• Make an impact
• Division Chief, Section Chief, Research

Director

• Nobel prize

Strategies and attributes of highly productive scholars

• 94 highly productive scholars
• Short-answer survey: 5 questions re:

strategies in research writing

• 56% response rate

Journal of School Psychology 49 (2011) 691-720

Recommendations of highly productive scholars

• 1. Follow your bliss, be persistent and work

really hard

• 2. Collaborate
• 3. Manage your schedule wisely and prioritize

Journal of School Psychology 49 (2011) 691-720

Recommendations of highly productive scholars

• 4. Have protected time to write
• 5. Pursue a systematic line of research that

cultivates your expertise

• 6. Stay current in the literature and become a

reviewer

Journal of School Psychology 49 (2011) 691-720

Recommendations of highly productive scholars

• 7. Take peer reviews seriously without getting

defensive

• 8. Familiarize yourself with journals and select

the right outlet

• 9. Get a mentor and be a mentor

Journal of School Psychology 49 (2011) 691-720

JANET HARNSBERGER, M.D. SALT LAKE CITY

Why do I Like Private Practice?

I CAN DECIDE WHAT I WANT TO DO

• SCHEDULE
• PATIENT MIX
• OFFICE LOGISTICS
• STAFF
• INCOME

I CAN DECIDE WHERE I WANT TO LIVE

• WHERE MY SPOUSE LIVES
• WHERE MY CHILDRENS’ EDUCATION IS

GOOD

• WHERE I CAN ENJOY MY COLLEAGUES,

FAMILY, AND SOCIAL LIFE

• WHERE I CAN AFFORD A NICE HOME

MY PRACTICE IS PRIMARILY CLINICAL ON PURPOSE

• I CAN FOCUS ON PROVIDING MY FAVORITE

KIND OF PATIENT CARE WITHOUT WORRY THAT I AM NOT MEETING EXPECTATIONS FOR RESEARCH AND PUBLISHING

• I CAN DEVELOP MEDICAL ALLIANCES IN

THE COMMUNITY TO ENHANCE PATIENT CARE

I HAVE CONTROL OVER COSTS AND INCOME

• I CAN CHOOSE THE SIZE AND RENTAL

COSTS OF MY OFFICE

• I CAN WORK AS MANY HOURS AS I LIKE
• I CAN HIRE THE STAFF I NEED
• I CAN WORK WITH HEALTHCARE

TRANSFORMATION SYSTEMS TO FIGURE OUT HOW TO FIX THE OVERWHELMING FINANCIAL MESS OF MEDICINE

What’s it Like?

It is like another family

Needs nurtured Nurtures me

It is mostly sane and pretty quiet I can educate patients and staff

• 5:45 : wake up, get ready, have breakfast

with Ric, read the paper

• 7- 8:30: endoscopy
• 9- 10 : telephone hour for patients
• 10-2 : see patients in the office
• 2- 3 : dictate letters, manage the office,

couple phone calls

• 3- 5 : hospital rounds, extra procedures
• 7pm : exercise with hubby, kids, friends

Here is My Weekday Life

Is Private Practice Right for You?

• Depends on your expectations and what you

value

 It is BIG for me to take good care of patients  I find lots of ways to be a good citizen in my

professional and my regular life

 The relationships you build in your communities

will determine your long-term satisfaction

What to Look for in a Private Practice

• If you are joining an established practice, I

would think you would want to be sure the aura of the practice is right for you

 Type A ?  Profit oriented ?  Restrictive to future endeavors?  Who do they keep? Who do they fire?  Can you make an impact?  Time for ongoing education?

Will you Find What Your Want?

• Probably!
• As a group, physicians want the best for

those they watch over. This includes you.

Kathleen B. Schwarz, M.D. President Ross Conference 2012

 NIH  Roche/Genentech  BMS  Novartis  Vertex  Impro

rove ve qualit ity of care and healt lth h outcomes for child ldre ren n with h disord rders rs of the gastro roint intestina nal l tract and liver

• Supporting research that advances understanding
• Fostering translation of knowledge into practice
• Serving as effective voice for children, families, and

members of our profession

 Executive Council

• President, President-Elect, Past President,

Secretary-Treasurer, 7 Councilors – Canadian, North American, Mexican

 Committees:

• Advocacy, Clinical Care and Quality, Endoscopy,

Ethics, Education and Training, Fellows, Hepatology, IBD, International, Motility, MOC Task Force, Nutrition, Obesity Task Force, Practitioner’s Task Force, Publications, Professional Education, Professional Development, Public Education, Research, Technology

 National office:Margaret Stallings (Executive

Director); Kate Ho; Kim Rose

 ,

‘trusted intermediary who functions as your defender in your dealings, policies, standards, and procedures” Google

 Information for kids and parents  Digestive topics A – Z  Find a pediatric gastroenterologist  Featured resources – eg dangers of popular

magnets!

 Comic strip on how to prepare for a

colonoscopy – Bowel Prep NO Sweat!

 Image

ge of the Mont nth

 Edit

itoria rials ls

 Guid

ideli line nes

 Origina

inal article icles

• gastro

tro, hepato tology gy, nutriti rition

 Case report

rts/Sho hort rt communica unicatio ions ns

 Selec

lected summaries ries

 Letters

rs to the Edit itor/Notice ices

 Call for papers

rs – eg. Pediatric ric Gastro roent ntero rolo logy Around und the Globe

 K Ross, Course Director  Michael Narkewicz, T and E Committee  Margaret Stallings and Kate Ho,, NASPGHAN  Abbott Nutrition for  Bob Dahms

• Arch Curran
• Gary Fanjiang, MD

A Journey to the Liver Bile and Beyond

Michael Narkewicz MD Professor of Pediatrics Hewit-Andrews Chair in Pediatric Liver Disease University of Colorado SOM Children’s Hospital Colorado

A path to a career in hepatology

• Me

Medical Student

• 4th Year Rotation with Bill Balistreri
• Passion for knowledge and clarity
• Residency
• Arnold Silverman and Ronald Sokol
• Love and passion for GI and Liver and Patient Care
• Fellows

wship

• Pediatric Scientist Development Program NIH Funded
• Two years of bench research in Meudon France
• Centre de Recherches sur la Nutrition
• Developmental regulation of hepatic glucokinase in newborn

liver

• Foundation for hepatic metabolism interest

2

• First Faculty Position
• Colorado
• Given the opportunity i.e. Asked to participate in liver clinic
• Welcomed to the clinic by the whole team
• Research at the bench:
• Hepatic metabolism: partnered with local experts: Neonatology
• Clinical Research: Mentored by Ron Sokol
• Philosophy: we all participated: how else will you learn!
• Transplant:
• Confession: I never saw a transplant until I was an attending!
• I learned by apprenticeship: a great way to learn MENTOR KEY

3

Hepatology Research

• Progression:
• Found a niche or two
• Viral hepatitis: started with local experience:

leveraged adult expertise in HBV and HCV with early local treatment attempts that led to publications

• This led to participation in PEDS C and an

introduction to NIH staff

• SPLIT: PI for PTLD studies
• PALF
• BARC
• Finally I had to do my own work: Cystic Fibrosis

4

Hepatology Clinically

• Clinical interests drew

w patients

• Developed further expertise: ERCP, viral

hepatitis

• Took as mu

much transplant call as I could possibly do do

• Opportunity: I wo

would like you to be the director

• f the liver center
• Opportunity: Endowe

wed chair

• TAKE HOME

ME ME MESSAGE

• If you put the patient first, good things alwa

ways follow: w: for the patient and for you

5

What advice do I have?

• Keep your interest and skills in general GI
• Find the person wh

who does liver and follow w them m around like a puppy dog

• Look at every liver biopsy at your place by

yourself

• Find a niche expertise for yourself in liver
• Go to The Liver Me

Meeting and to the AASLD single topic conferences

6

What about that fellowship

• Certificate of Added Qualifications in Pediatric

Transplant Hepatology

• Began from a move in Internal Medicine to recognize the

expertise needed in transplant hepatology

• Pediatrics participated in parallel (ABP)
• Current requireme

ments

• Boarded in Pediatric GI and participating in MOC
• 1 year (12 months) of training in a program accredited for

training in transplant hepatology in US or Canada

7

Criteria for a Training Program

• Accredited by US or Canadian oversight
• UNOS

UNOS-approved center (for US trainees)

• Pediatric LT specialist and surgeon
• At least 6 mo

months on the IP liver service, we weekly continuity clinic for 12 mo months

• Other mo

months: hepatology or transplant-related experience, including transplant research

• direct involveme

ment in pre-, , peri-, and postoperative care of at least 10 pediatric LT patients

• direct involvement in OP management of ≥ 20

pediatric LT recipients

8

Ped ediat atric c Tran anspl splan ant Hep epat atology

• logy

≠ Ped Pediatric Hepatology

9

What I do know

• CAQ not required by UNOS to care for

transplant patients

• 500 pediatric transplants per year
• MA

MANY MA MANY MA MANY mo more patients wi with liver disease wh who do not need transplants

• If you wa

want to do hepatology:

• It is great
• It is rewarding
• It requires you to be interested and to be part of the community
• It has great research opportunities
• It has great clinical opportunities
• You will not make a lot of RVUs (Relative Value Units) from

hepatology procedures

10

• You wi

will ma make a lot of PVUs (Patient Value Units

• r Personal Value Units)
• Third Take Home

me Me Message

• Do Wh

What Ma Makes You Happy and Challenges You and You Wi Will Have a Great Career!

11

Motility: Why you will want to be a neurogastroenterologist!

Carlo Di Lorenzo, M.D.

Why does it matter to me?

Jay Pasricha, Gastroenterology, 2011, 140:1126-8

Reasons people dislike motility

• It is not about pus and blood (is it

the testing or the disease?)

• Too invasive
• “These squiggles do not mean

anything” (no controls, not predictive,

too many artifacts…)

• Not trained
• Booooooooring!

Why you should give motility and FGID some love…

• The most important job of the gut is to

“move” its contents from mouth to anus

• Looks are not everything
• Motility problems are common
• Lots of “new gadgets”
• CPT codes have been established
• Your market value increases (11/13 of last job

advertisements mentioned “motility”)

• Aren’t we all little squiggles on the face of the earth?

New gadgets

Gastrointest Endosc 2011;73:949-54

Motility disorder demonstrated in:

• Gastroesophageal reflux
• Achalasia
• Toddler’s diarrhea
• Functional abdominal pain
• Functional dyspepsia
• Functional constipation
• Intestinal pseudo-obstruction
• Hirschsprung’s disease
• Other g.i. neuromuscular disorders

“Motility disorders” are not just about disordered motility

Psychosocial factors Brain – Gut Interactions

Altered motility / secretion Gut – immune interactions Visceral hypersensitivity

Dogma: Motility disorders rarely have pain as the predominant symptom Fact: If you become a “motility expert”, you will be very popular among your more organically oriented “friends”, who will be more than happy to send to you all their pain predominant patients to rule out a motility disorder

Test!

B12 Courtesy of Hans Jurgen Ehrlein, DVM

Emesis Interrupts the ENS Postprandial Program and Initiates Power-Propulsion Program

B13

25

The Migrating Motor Complex (MMC)

Manometric recording ports on catheter 20 15 10 5 Time (min)

MMC phase-III activity front

P14

What do you want to be? “Motilist” vs “functionalist”

 Does pathophysiology matter?  Lab vs clinical work  Do you enjoy psychology?  Love to talk to “challenging” families?  Prefer to give drugs or being a placebo?

Great Role Models!

Michael Camilleri Douglas Drossman Michael Gershon

You will be never out of a job! Prevalence

IBS, constipation, diarrhea, dyspepsia, and GERS:

 All are common  62% report symptoms

If you are symptom-free, you are in the minority!

Thompson WG et al. Dig Dis Sci 2002; 47:225

USA 13% Italy 10%

Prevalence of Functional Abdominal Pain in Children

Finland 8% Germany 2.5% United Kingdom 12% Holland 3% Norway 6% Sweden 13%

Chitkara DK et al. Am J Gastroenterol 2005; 100:1868

Canada 5-10% Finland <5% Saudi Arabia 5-10% Japan 10-20% Brazil 10-20% USA 5-10% Turkey 10-15% UK 5-10% Greece 10-15% Italy 15-20% Hong Kong >20%

Prevalence of Pediatric Constipation

Australia 15-20%

van den Berg MM et al. Am J Gastroenterol 2006; 101:2401

Functional disorders have an image problem

Dalton CB, et al. Clin Gastroenterol Hepatol 2004;2:121-6.

% responding “a great deal” or “very”

Physician response (%) Patient response (%)

Survey question Organic Functional Organic Functional Problem was serious 35 3 * 60 78 Patient was disabled 36 6 * 45 69 * Request was reasonable 67 25 * 95 100 Doctor was helpful 58 41 91 85 Satisfied with 74 67 88 81 recommendation Liked doctor/patient 61 33 * 94 94

Physician and patient perceptions:

• rganic vs functional

*=p<0.05

Training!

 Train in a program that has a “Motility Center”  Do research in motility  ANMS training program  Extra year of training in motility (much like in transplant)

Participating programs:

• Cedars-Sinai Medical Center, Los Angeles,

CA

• Medical College of Wisconsin (Adult ) and

Children's Hospital of Wisconsin (Pediatrics), Milwaukee, WI

• Nationwide Children’s Hospital, Columbus,

OH (Pediatric)

• Penn State Milton S. Hershey Medical

Center, Hershey, PA

• Temple University, Philadelphia, PA
• Texas Tech University Health Sciences

Center, El Paso, TX

• University of Iowa, Iowa City, IA
• University of Michigan, Ann Arbor, MI
• University of North Carolina at Chapel Hill,

NC

• Wake Forest University School of Medicine,

Salem, NC http://www.motilitysociety.org/pdf/ANMS_CTP_ Brochure_9.23.10.pdf

Training in pediatric vs adults

 Better training in adults for anorectal manometry and biofeedback, HRM, SmartPill  Better training in pediatrics for colonic manometry, impedance, antroduodenal manometry  Many psychosocial differences between children and adults (role of family)

Develop special expertise!

 Upper vs lower  Epidemiology/QOL  Manometry vs transit  Pathophysiology  New diagnostic techniques  Traditional vs complementary medicine  PRO, outcome studies

Take home messages

• Become exposed to motility during

your training (give it a chance!)

• Find a good mentor
• Stick with it if you like it
• If you like it, it will pay off

(marketability, fame, “interesting” patients, love from colleagues)

Kevin Sztam, MD, MPH Children’s Hospital Boston

Pediatric GI and Nutrition hierarchy

• Training

–General pediatrics

• Pediatric GI and Nutrition

– IBD – Hepatology – Dysmotility – Transplant – Allergic disease – Short bowel – Malabsorption syndromes Nutrition

Nutritional Care

• Often secondary consideration
• Few admissions for purely nutritional

diagnoses

• GI disease often drives nutritional status
• Another team can manage it (dietitians,

nutritionists, ICU)

Why people don’t like it

• Everyone eats – who cares
• Uncommon cause of medical emergency
• Wide range of normal physiology

accommodating varied ranges of intake

• Measuring nutrient status can be challenging
• We know everything already – just give

enough

• Other teams do manage it

Why people like it

• Everyone eats – wide applicability of results
• Critical to many fields: GI, metabolism,

surgery, endocrinology, infectious disease, public health, international health, general pediatrics, adolescent medicine, cardiology, psychiatry, neurology, molecular biology, ICU

Why people like it

• Even if intake is adequate, may require
• ptimization
• Opportunity to utilize knowledge of basic

nutrient metabolism

• We really don’t know everything
• Comfortable with wide ranges of normal

physiology

Training varies in Pediatric GI, Nutrition and Hepatology

• Learning related to primary diagnosis
• Presence of trained dietitians (ie, nutritionists)
• Goal in fellowship

– Understand and treat most common nutritional problems – Know when to refer

• Wide range of capability among providers

So much more

• Few subspecialists are exposed to this

knowledge base

– Variety nutritional deficiencies and excess – Primary and secondary nutritional diagnoses – Treatment approaches

• This basic training can lead you to leadership

roles in different disciplines

Roles for Pediatric GI trained physicians - Clinical

• Depends on size and location of clinical program
• Role is usually team leader
• FTT

– Outpatient FTT clinic (multidisciplinary) – Co-morbid conditions requiring long term enteral nutrition

• Congenital cardiac disease
• Neurologic disease
• Metabolic disease
• Cystic fibrosis

Roles for Pediatric GI trained physicians - Clinical

• Parenteral nutrition service

– Outpatient (Home parenteral nutrition service)

• Coordination
• Outpatient clinic – nutrition specific

– Inpatient service – large center – Integrated intestinal failure and rehabilitation programs

Roles for Pediatric GI trained physicians - Clinical

• Children with non-GI primary diagnoses with

major nutritional effects

– Congenital heart disease, spastic quadriplegia, metabolic disease, cystic fibrosis

• Individual/small GI practice with nutrition niche

– Standard of care, alternative therapy, differences in approach

Roles for Pediatric GI trained physicians - Metabolism

• Nutritional assessment

– Indirect calorimetry – Body composition testing (dexa scans, bioelectric impedance analysis, air displacement plethysmography)

• Metabolic disease

Roles for Pediatric GI trained physicians - Obesity

• Increasingly important public health issue
• Pediatric origins of adult disease
• Prevention
• Management

– Behavioral – Therapeutic – Bariatric

• Nutritional issues aside from hyperlipidemia

Roles for Pediatric GI trained physicians - Public health

• Education – Departments of public health,

school-based nutrition programs

• National – national societies, nutrition

guidelines, U.S. DHHS, NIH

• Global health – malnutrition and chronic

diseases “of excess”

Roles for Pediatric GI trained physicians - Industry related

• Formula companies
• Food industry
• Supplement industry
• Part time – consultancy

Roles for Pediatric GI trained physicians - Government

• Food and Drug Administration

– Interacts with industry and investigators – Evaluate research, protocols, devices

• NIH

International program development in developing settings

• Assisting development of systems for

nutritional care

• Developing local industry/products to support

nutritional care

• Nutrition education

– Increase capacity to provide services – Share knowledge of systems

Roles for Pediatric GI trained physicians - Research

• Any and all disciplines
• Usually requires cross-discipline collaboration

– patients usually followed by service where primary diagnosis is categorized

• Increasing demand for experts trained in

research and quality improvement

Roles in Nutrition for the Pediatric Gastroenterologist and Nutritionist

• Not for everyone
• You could find yourself anywhere

Jenifer R. Lightdale, MD, MPH

ENDOSCOPY AS A CAREER

ENDOSCOPY IS…

• Cool…!
• Fun, active
• Attractive part of the “job doc” of a pediatric gastroenterologist
• Good for people who are “Good with their hands”
• Also, for those who enjoy the [fill in the blank] of doing procedures
• High tech
• New toys
• Satisfying way to help patients
• Basically safe

ENDOSCOPY IS ALSO…

• Intrinsically risky
• Takes practice
• Constantly evolving as a technology
• Different in kids from adults
• Practiced often in the absence of evidence…

NEED FOR EVIDENCE BASIS

• My personal primary motivation for pursuing endoscopy as a career
• Bonus for me: all the other factors still apply
• Lots of room for research
• Lines up well with clinical research/education
• From a quality perspective, provides a nice “lab”
• Engaging in thoughtful investigation of what you are

already doing on a daily basis

• THE key to a procedural career

BEST ENDOSCOPY CAREER GOALS

• Not just to be good at doing something…
• But to be known for advancing knowledge…
• So that everyone else can become better

THE BASICS *

• Upon completion of fellowship, all trainees should be prepared to:
• Appropriately recommend endoscopic procedures as indicated
• Have explicit understanding of indications, contraindications, as well as diagnostic

and/or therapeutic alternatives

• Perform procedures
• Safely
• Completely
• Expeditiously
• Correctly interpret endoscopic findings
• Understand how to mitigate risk…and manage complications
• Acknowledge limitations of procedures and/or skills…know when to request help!

*Principles of Training in Gastrointestinal Endoscopy, GIE, 1999.

ROLE OF YOUR TRAINING DIRECTOR:

• An expert endoscopist and teacher who should monitor
• n a regular basis
• Acquisition of skills
• Success in defined objective performance standards
• “Must be appropriately trained in the

SKILLS OF PATIENCE, TACTILE (!) and VERBAL INSTRUCTION that characterize effective teachers of endoscopy..”*

• Ideally be actively involved in research in the field of endoscopy
• Enhances the quality of the trainees
• verall learning involvement…”*

THE TRAINING PROCESS

• There is a natural progression as trainees accrue more technical expertise and

confidence.

• Observation
• Practicing the basics
• Recognizing normal AND abnormal endoscopic findings
• Learning manuevers/”tricks”
• Rate of skill acquisition known to vary
• Consistently – takes 100-150 procedures to be safe
• vs. competent
• Many more (i.e. >400 colonoscopies)* to be good

*Spier B, GIE, 2010.

HOW DO YOU KNOW WHEN YOU’RE COMPETENT

• Still a matter of HUGE controversy
• Recent development of valid measures
• GAGES*
• CAT (Pediatric Specific)

*Vassilou, Am J Surg, 2011

SCOPE NAVIGATION SCORE 

USE OF STRATEGIES SCORE 

ABILITY TO KEEP A CLEAR ENDOSCOPIC FIELD SCORE 

INSTRUMENTATION (if applicable; leave blank if not applicable) SCORE 

QUALITY OF EXAMINATION SCORE 

GAGES – COLONOSCOPY SCORESHEET GLOBAL ASSESSMENT OF GASTROINTESTINAL ENDOSCOPY SKILLS

WHAT ABOUT ADVANCED PROCEDURES?

• More complex and technically demanding
• Generally carry higher risk of complications
• Required less frequently than standard procedures
• Number of individuals trained to do them can be smaller
• Same rules about “numbers needed to be good” still apply
• By the guidelines*, training in advanced procedures
• Founded on a thorough mastery of standard procedures
• Requires year(s) of extra training beyond 3-year fellowship
• Requires adequate patient volume AND faculty expertise

*Principles of Training in Gastrointestinal Endoscopy, GIE, 1999.

ERCP EUS ACHALASIA Treatment Advanced hemostasis Manometry catheter placement Stricturoplasty Stent placement Endoscopic mucosal resection (EMR) Endoscopic submucosal dissection (ESD) Enteroscopy (single vs. double balloon) Endoscopic fundoplication POEM

WHAT ABOUT ADVANCED PROCEDURES?

• More complex and technically demanding
• Generally carry higher risk of complications
• Required less frequently than standard procedures
• Number of individuals trained to do them can be smaller
• Same rules about “numbers needed to be good” still apply
• By the guidelines*, training in advanced procedures
• Founded on a thorough mastery of standard procedures
• Requires year(s) of extra training beyond 3-year fellowship
• Requires adequate patient volume AND faculty expertise

*Principles of Training in Gastrointestinal Endoscopy, GIE, 1999.

OPTIONS FOR ADVANCED TRAINING

• Advanced/Therapeutic Fellowships
• i.e. MGH/BWH, Columbia, HUP, Mayo, Cleveland Clinic, etc.
• Generally aimed at adult fellows
• Some precedence for training pediatric fellows
• Offers high volume, structured training
• May also include training in statistics, epidemiology, study design
• Goal is to develop “academic” physicians
• Through a MATCH process as of this June 2012*

*http://www.asge.org/apps/aef/aef_main.aspx

OPTIONS FOR ADVANCED TRAINING

• Alliance with local adult colleagues
• Arrange for dedicated time to train
• Coordinate with adult fellows
• May require malpractice insurance adjustments
• Alliance with local pediatric expert
• Ad hoc fellow vs. junior faculty position
• Requires adequate patient volume to allow trainee

and trainor to practice skills

*http://www.asge.org/apps/aef/aef_main.aspx

OTHER OPPORTUNTIES FOR LEARNING

• “Hands-on” Pediatric Endoscopy Courses
• NASPGHAN
• NASPGHAN/ASGE at the IT&T Center
• ASGE
• CME
• International opportunities
• Simulation
• Nice to learn a technique BEFORE a patient needs you

to know it

• Computer-based
• Porcine
• Intense training for a few hours cannot substitute for repeated and persistent exposure…

ULTIMATELY

• Important to understand what skills you are going to need
• Align your expectations with those of the group you are joining
• Firm commitment from your Division Chief (or whoever is hiring you)
• Resources you will need
• Adequate “protection and support”
• Understand procedural environment
• Establish backup call options
• If joining a large group, need commitment for you to have the time
• Do procedures
• Learn new skills

PEARLS NO MATTER WHAT YOU DO

• To establish yourself as an endoscopist
• Identify a niche
• Thoughtfully (a priori design!) collect data on your procedures
• Submit abstracts to NASPGHAN and DDW
• Contribute to knowledge
• Make a name for yourself!
• Consider joining the NASPGHAN Endoscopy and Procedures Committee
• Reviews abstracts
• Develops guidelines
• Produces “Hands on” education
• Consider joining the American Society of Gastrointestinal Endoscopy
• Career Development Awards in Endoscopy

THANKS AND GOOD LUCK!

Being a Clinician-Educator: No Longer by Default

Alan Leichtner, MD Abbott Conference

Objectives

• Understand current options for academic

promotion as a clinician-educator

• Evaluate scholarship in education using

recognized criteria

• Access resources for obtaining training
• Be prepared for the future innovations in

medical education

Let’s Start with a Survey

• Clinical work
• Research
• Medical education

How to be Promoted: The Dilemma of the Clinician-Educator circa 1990:

History of Promotion at HMS

Researcher Researcher Researcher Teacher/Clinician Clinician Educator

New HMS criteria for promotion

“Extraordinary educators, clinicians and researchers”

BUSM’s Faculty Site Promotion Criteria at BUSM Tracks at BUSM

What Activities Support Promotion as an Educator? (HMS)

Categories Metrics Didactic Teaching Evaluation by learners or peers; increasing involvement and responsibility in courses or clinical rotations; Innovative methods that are adopted by others; Teaching about education Research Training and Mentorship Numbers of mentees; Publications with trainees; Feedback from mentees; Accomplishments of mentees Clinical Teaching and Mentorship Level of teaching activities; Evaluations from mentees; Leadership roles in education in professional societies; Direction

• f successful courses; Innovative teaching methods

Administrative Teaching Leadership Roles Success of programs led (popularity, evaluations, emulation) Recognition Invitations to speak; Contributions to professional organizations; Funding; Roles for educational journals; Awards; Role in creating guidelines and policies; Service on grant review committees; Service as a consultant Scholarship Development of educational materials; Publications; High impact educational research

Rank and Geographic Impact (HMS)

Rank Geographic Impact Assistant Professor Local to Regional Associate Professor Regional to National Professor National to International

http://academicaffairs.unca.edu/sites/academicaffairs.unca.edu/files/BoyersModel.pdf

Boyer’s Model of Scholarship

HOW DO YOU ASSESS SCHOLARSHIP IN MEDICAL EDUCATION?

Buzz Group or “Think, Pair, Share”

Assignment: Think about non-research scholarly activities in medical education, e.g. curriculum, evaluation tool, simulation workshop, etc. Take one minute and come up with 3 criteria for evaluating educational activities

List of Criteria for Evaluating Educational Scholarship Standards for Assessing Scholarship Glassick

Criteria Clarifying Questions

• 1. Clear Goals

Does the scholar state the basic purpose of his or her work clearly? Does the scholar define objectives that are realistic and achievable? Does the scholar identify important questions in the field?

• 2. Adequate

Preparation Does the scholar show an understanding of existing scholarship in the field? Does the scholar bring the necessary skills to his or her work? Does the scholar bring together the resources necessary to move the project forward?

• 3. Appropriate

Methods Does the scholar use methods appropriate to the goals? Does the scholar apply effectively the methods selected? Does the Scholar modify procedure in response to changing circumstances?

Standards for Assessing Scholarship Glassick

Criteria Clarifying Questions

• 4. Significant

Results Does the scholar achieve the goals? Does the scholar’s work add consequentially to the field? Does the scholar’s work open additional areas for further exploration?

• 5. Effective

Presentation Does the scholar use a suitable style and effective organization to present his or her work? Does the scholar use appropriate forums for communicating the work to its intended audiences? Does the scholar present his or her message with clarity and integrity?

• 6. Reflective

Critique Does the scholar critically evaluate his or her own work? Does the scholar bring an appropriate breadth of evidence to his or her critique? Does the scholar use evaluation to improve the quality of future work?

The Audience

UME GME UME

Inter- professional Patient and Family

Keep a Portfolio

• Lectures, clinical precepting, other educational

sessions, courses

– Audience, Evaluations, Impact – Participation, Direction

• Innovative tools for teaching and/or evaluation
• Mentoring
• Leadership roles – Rotation Director, Program

Director, Course Director

• Scholarship – Not just Research

Where to Publish

• Medical education journals
• Medical journals
• On-line sites

– MedEd Portal – ACGME Site

Training as an Educator

• Mentors
• Academies or Medical Educator Communities
• University Resources
• Courses, e.g. Harvard Macy Institute
• Fellowships
• Advanced Degree Programs

– Traditional – MEd, MMEd, MHPEd – On-line or Hybrid

Trends in Medical Education

• Simulation: Cognitive skills, procedures, team

training, systems design

• Endoscopic procedures: Simulators, live courses,

hands-on courses

• Project-based Learning
• Team training – Crisis Management, Patient

Safety and Quality

• Inter-Professional Education
• On-Line Resources

EXAMPLES OF NEW TECHNOLOGY IN MEDICAL EDUCATION

The Digital Revolution

Digital Native

• Born after 1980 (Mostly

Millenials)

• Native speakers of computers,

videogames, digital music, video cams, cell phones

• Prefer to receive information

quickly, from multiple sources

• Prefer to interact with content
• Constantly multitasking

Digital Immigrant

• Born before 1980
• Can speak digital, but have

an accent, e.g. print out emails, call someone to see if they received email, bring people into office to see a screen

• Don’t understand skills of

digital native

Digital Native and Immigrant coined by Marc Prensky Slide Modified from Curtis Whitehair Link to Khan Academy

Is the Lecture Dead or moving on-line? Khan Academy

Not Just Wikipedia: The Wiki in Medicine - GanFyd

Link to Ganfyd Link to Mediatrician

Medical Blogs: Ask the Mediatrician Beyond Simulation: Virtual Environments Second Life

Link to Second Life

Virtual Conference Room Virtual ICU Take Home Messages

• Yes, you can get promoted as a medical

educator

• Non-research contributions are valued, but

need to meet criteria for meaningful scholarship

• Get formal training – It is available
• Technology is going to disrupt education as we

know it

Journals Publishing Medical Education Articles

Medical Education Journals:

Medical Education (IF 2.639) Academic Medicine (IF 2.631) Medical Teacher (IF 1.494) Teaching and Learning in Medicine Advances in Health Science Education Theory & Practice Journal of Graduate Medical Education International Journal of Medical Education (On-line)

Specialty Education Journals:

Academic Psychiatry Journal of Surgical Education

Other Journals:

JAMA (IF 26.309) Family Medicine (IF 1.647) BMJ (IF 11.935) Lancet (IF 32.498) Journal of General Internal Medicine (IF 2.761) Journal of Family Practice

IF = Impact Factor

Carlo Di Lorenzo, M.D.

How to give a great talk

Why you should listen to this talk

• Listening is hard work!
• Simple things can make your next

talk better

• An expert teacher is more

successful than an expert who teaches

• Everyone benefits from a good talk
• Audience is happier
• You get invited back

Effective talk

• Communicate your ideas and evidence
• Persuade your audience that they are

true

• Be interesting and entertaining
• In summary, tell a story and make it a

good one, build an arc

• And do not worry: people do not learn

from talks!

Cardinal rules

• Tell them what you are going to tell them
• Tell them
• Tell them what you told them

Show enthusiasm

• Have a good attitude and smile
• Your audience is more likely to

remember your personal style than your content

• An enthusiastic speaker can make an

average talk good, and a good talk great

• Ok to be anxious (adrenaline is a great

drug!)

Do not apologize

• “I did not have time to prepare this

talk properly”

• “My computer broke down so I will

present only half of the data”

• “I do not have time to tell you about

this”

• “I do not feel qualified to address

this audience”

The beginning

You have two minutes to engage your audience:

• Why should I tune into this talk
• What is the problem?
• Why is it an interesting problem for

me?

The invitation

• What is the purpose of the meeting
• Who is the anticipated audience

(most important!)

• Respect your audience
• Format and time allowed
• Other presentations at the meeting

Preparation

• Teach them something they do not

know

• Very last minute information
• Be enthusiastic but balanced!
• Not everybody loves urea cycle

defects (or motility disorders)

What to put in

1) What you believe is important 2) What the audience will find interesting 3) There is no number 3 4) You do not have to tell them everything you know (even though it is sooooo important)!

Preparation

• Have something to say
• Use slides to illustrate your points, do

not decide what to say based on your slides

• The problem of hand-outs (including this
• ne)
• KISS: Keep It Short and Sweet
• Audience reads 3 times faster than you

can speak

• Slides are not a teleprompter

Being seen, being heard

• Speak to someone at the back of

the room, even if you have a microphone on

• Make eye contact; identify a

nodder, and speak to him or her (better still, more than one)

• Move!
• Watch audience for signs of fatigue

If you are beginning to lose the audience

• “Wake-up slide”
• Joke
• Question
• Interaction with the audience
• Skip complicated slides (not ideal!)

The jokes

Visual jokes

OK in every country Dilbert does not work in Argentina

Some jokes require time The mystery of the “Sphinxter”

“Do not tell bad, old or insensitive jokes; do not use jokes in front

• f small audiences”

(Di Lorenzo, 2012 )

How to make good slides Text

• Spelling and grammar

– Don’t rely on built-in fools – Get help

• Print the slides
• KILL (Keep it large and legible)
• Rule of fives (sixes, sevens)

– Five words per line – Five lines per slide

tools

Fonts - Bad

• If you use a small font, your audience won’t be able to read what you have

written

• CAPITALIZE ONLY WHEN
• NECESSARY. IT IS DIFFICULT TO

READ

• Don’t use a complicated font
• Be consistent

Slide Structure – Good

• Use 1-2 slides per minute of your

presentation

• Write in point form, not complete

sentences

• Include 4-5 points per slide
• Avoid wordiness: use key words

and phrases only

• Names the axes of all graphs

Slide Structure – Good

Show one point at a time:

– Will help audience concentrate on what you are saying – Will prevent audience from reading ahead – Will help you keep your presentation focused

Slide Structure – Good

• Make sure the slides show what they

are supposed to show (no “this slide doesn’t really show it but…”)

• And not more…
• Take time to explain
• Assume the audience is naive

Slide Structure - Bad

• Do not use distracting animation
• Do not go overboard with the

animation

• Be consistent with the animation

that you use

• Make sure your animation works

Distracting animations

CAN ≠ SHOULD

Color - Good

 Use a color of font that contrasts sharply with

the background

– Ex: blue font on white background

 Use color to reinforce the logic of your

structure

– Ex: light blue title and dark blue text

 Use color to emphasize a point

– But only use this occasionally

Color - Bad

 Using a font color that does not contrast with

the background color is hard to read

 Using color for decoration is distracting and

annoying.

 Using a different colour for each point is

unnecessary

– Using a different color for secondary points is also

unnecessary

 Trying to be creative can also be bad

Background – Bad

 Avoid backgrounds that are distracting or

difficult to read from

 Always be consistent with the background that

you use

32

WATCH THE DAY TURN TO NIGHT AS THE SUN SETS ON THE TOP OF THIS ONE!

Are you reading my very important point or are you looking at that stupid animation?!?.

Rehearse

• Check length, contents, flow
• By yourself and in front of audience

that can give honest and constructive feedback

• Print the slides and read them
• Do not have to accept every

suggestion (you know the topic better than anybody else)

Travel

• Bring back up
• E-mail it to yourself
• Do not check it in (same for good

clothes if the talk is same day or early AM on day after)

• Laptop allows very last minute

changes (experienced presenters)

Day of the presentation

• Be rested
• Dress up comfortably
• After you have given the presentation to

the organizers, review it one more time

• Check the room and the set-up
• Water
• Bathroom

Presentation

• Do not read
• Translators (allow them time to catch up)
• Timing of slide entrance (ok to keep a

copy of your slides at the podium)

• No fancy fade ins
• No really, don’t

The end

• Closing slide
• Closing comments (thank audience and

person for asking the question)

• Questions:
• When to repeat the question
• Uninterpretable (or stupid)

questions – escape routes

• When you do not know the answer
• Disconnect your microphone!

Mistakes to avoid

• DO NOT read your slides
• DO NOT stand behind the podium
• DO NOT dress casually
• DO NOT face the screen
• DO NOT use too many acronyms
• DO NOT shake the laser pointer (not a

lightsaber!)

• DO NOT use casual language (thing, stuff,

just, cool, you guys…)

Summary

• Be enthusiastic, clear and loud!
• Keep it simple
• Be consistent
• Practice
• Do NOT exceed the time limit
• Have fun!

Non NIH Funding for the Junior Faculty Member

Mitchell B. Cohen, MD Professor and Vice Chair of Pediatrics Director, Gastroenterology, Hepatology and Nutrition Cincinnati Children’s Hospital Medical Center

CCHMC Sources of External Funding Fiscal Year 2011

Federal 86% Other 6% Industry 7% State 1%

CCHMC Sources of Federal Funding Fiscal Year 2011

National Institutes of Health (NIH) 110,775,374 Agency for Healthcare Research and Quality(AHRQ) 13,604,616 Health Resources & Services Administration(HRSA) 5,133,213 Centers for Disease Control (CDC) 3,458,165 Department of Defense Army (DOD) 2,286,752 Substance Abuse & Mental Health Service Admin(SAMHSA) 686,229 Food & Drug Administration (FDA) 538,853 Administration on Developmental Disabilities(ADD) 502,327 Department of Education(DOED) 189,241 Department of Health and Human Services(DHHS) 157,626 Department of Labor(DOL) 94,190 National Science Foundation(NSF) 37,542 Total 137,464,128

CCHMC Sources of NIH Funding Fiscal Year 2011

National Heart Lung & Blood Institute (NHLBI) 27,194,368 Nat’l Inst. of Allergy and Infectious Disease (NIAID) 15,597,771 Nat’l Inst. of Diabetes and Digestive & Kidney Disease (NIDDK) 15,359,053 Nat’l Inst. of Child Health & Human Development (NICHD) 12,588,512 Nat’l Inst. of Neurological Diseases and Stroke (NINDS) 8,140,455 National Cancer Institute (NCI) 6,496,551 Nat’l Inst. Of Arthritis and Musculoskeletal and Skin Disease (NIAMS) 6,118,479 Nat’l Inst. of Environmental Health Sciences (NIEHS) 3,790,497 National Institute of Mental Health (NIMH) 3,520,469 Nat’l Inst. of General Medical Sciences (NIGMS) 2,723,720 National Center for Research Resources (NCRR) 2,621,625 Nat’l Inst. on Deafness & Other Communication Disorders (NIDCD) 2,418,618 National Eye Institute (NEI) 2,395,459 National Institute of Aging (NIA) 770,865 National Institute of Dental Research (NIDR) 526,481 National Library of Medicine (NLM) 268,600 National Institute of Nursing Research (NINR) 147,317 National Institute of Biomedical Imaging and Bioengineering (NIBIB) 96,534 Total 110,775,374

CCHMC Foundation and Other Agency Awards Fiscal Year 2011

Cystic Fibrosis Foundation 744,660 Charley’s Fund 664,148 American Heart Association 546,500 Hamilton County Public Health 459,088 March of Dimes 402,954 Crohn’s & Colitis Foundation of America 355,887 The Hospital for Sick Children 266,882 Robert Wood Johnson Foundation 265,299 American Cancer Society 230,000 The American Bd. of Med. Spec. Research & Educ. Fdn. 219,654 The Leukemia and Lymphoma Society 218,271 Cancer Free Kids 215,000 Miscellaneous Other (88) – average ~60K/award 5,193,270 Total 9,781,613

A personal funding journey: NIH funding

• Individual NRSA, NIDDK "E. coli heat-stable toxin:

Gastrointestinal receptor response." (DK 07790), July 1986- June 1988, $66,000

• Clinical Investigator Award, NIDDK "Regulation of ST

action: Human intestinal ST receptor." (DK 01908), July 1989- June 1994, 75% effort, $374,600

• NIH: Expression and function of the guanylin ligand family.

RO1 DK47318 1995-2011

• T32 DK07727, Program Director: MB Cohen, Training Program in Pediatric

Gastroenterology and Nutrition: 5% effort; 07/01/05 - 06/30/15 $2,009,290

• DK058701 Studies on intestine-enriched transcription factor, IKLF (20% effort) 09/01/2001
• 06/30/2006, MB Cohen, PI
• Regulation of gastrointestinal eosinophils (NIH: DK 45898-01), (P.I.: M. Rothenberg, MD,

Ph.D.) 09/01/99 - 08/30/04 $1,095,267, Co-investigator, 5% effort, 09/01/99 - 08/30/00 $207,366

• R24 DK 064403, Cincinnati DDRDC: Center for Growth and Development (CGD),

04/01/03-03/31/08, MB Cohen, PI (15% effort)

• NIH:P30 DK 0789392 07/01/07-05/31/12 Role: Program Director (7/1/07-5/31/09),

Associate Director 6/1/09-05/31/12) Digestive Health Center: Bench to Bedside Research in Pediatric Digestive Disease

• NIH: Test kit to quantify fat absorption in cystic fibrosis. (R42 DK 48537), (M.

Janghorbani, PI), $388,817; Co-investigator, 15% effort, 11/01/96-10/30/98 (subcontract $120,503)

• NIH: Biomedical Research Support Grant (RR 05535) Enteroaggregative Escherichia coli

heat stable toxin, May 1991 - March 1992, $11,000

• NIH: Biomedical Research Support Grant (RR 05535): Localization of guanylin and the E.

coli heat stable enterotoxin receptor by in situ hybridization, December 1992 - September 1993, $7,500.

• NIH: Test kits for measuring malabsorption in cystic fibrosis. (R41 DK 48537), (M.

Janghorbani, PI), 5% effort, $100,000, subcontract, 9/30/94-9/29/95, $30,350.

• NIH: Development of accurate test kits for malabsorption. (R43 DK 48190), (M.

Janghorbani, PI), 7% effort, $79,324, subcontract, 9/30/94-3/31/95, $10,000.

• Borderline pancreatic function in cystic fibrosis. (R43DK55924-01A1), (M. Janghorbani, PI),

$91,415; Co-investigator, 5% effort, 06/01/00-05/31/01 (subcontract $30,000)

• NIAID-DMID-94-29: N01-A145252: Evaluation of control measures against human

infectious diseases other than AIDS. Co-investigator. (GM Schiff, PI.), MB Cohen Coinvestigator: 25% effort, 1994-2002, $11,374,000

• DMID Protocol # 07-0052 A Randomized, Double-blind, Placebo-controlled Dose

Escalation, Inpatient Phase I Study to Determine the Safety and Immunogenicity of a Single Oral Dose of a Combined Enterotoxigenic E. Coli (ETEC)-Cholera Vaccine (Peru 15 pCTB) in Healthy Adult Subjects, 30% effort, 11/1/07-5/30/10

• NIH: NIAID-DMID-N01-AI-25459: Evaluation of control measures against human

infectious diseases other than AIDS. Co-investigator. (David Bernstein, PI.), MB Cohen PI

• f Enteric Vaccine: 30% effort, 6/1/02-5/31/07; 10% effort 11/1/07-10/31/12.
• DMID Protocol 09-0066; Phase I Study to Determine the Safety and Efficacy of an Oral

ETEC Candidate Vaccine, Attenuated, Recombinant Double Mutant Heat- Labile Toxin (dmLT) from Enterotoxigenic Escherichia coli, 20% effort

Non-NIH funding

• American Gastroenterological Association

– Supplemental Research Training Award, July 1985- June 1986, $7,500 – Industry (Glaxo) Scholar Award, "Regulation of ST-induced intestinal secretion," July 1988- June 1991, $75,000 – Research Preceptorship, Michelle R. Ritter, Summer Student, May 1989- August 1989, $1,500 – Mentor, AGA Senior Fellowship Research Award to Dr. Glen Lewis, July 1993-June 1994, $7,500. – AGA Summer Undergraduate Research Fellowship to Noeet Elitsur, ($4000), 2003 – Sponsor/Mentor: Praveen Goday 1999-2001 ($72,000) – Sponsor/Mentor: Jeffrey Rudolph, MD 2000-2002 ($72,000)

• ALF:

– Mentor, American Liver Foundation Award to Dr. Jane Balint, July 1994-June 1995, $7,500.

• AstraZeneca

– Unrestricted Educational Grant 1999, $3,995

• Avant Immunotherapeutics

– Choleragard planning grant, MB Cohen PI $10,000 07/01/06-06/30/07

• Bristol-Myers

– "Intestinal receptor for E. coli heat-stable enterotoxin: Increased receptor density and potential role as a receptor for an intestinally active growth factor in perinatal life," July 1989- June 1990, $9,000. – Principal Investigator: Safety and Efficacy of Rice Based Oral Rehydration Solution. January 1990- March 1993, $111,120

• CCHMC

– Regulation of STa-induced intestinal secretion.“ Trustee Award, July 1988-June 1991, $92,000 – Translational Research Initiative, $3,000 DDRC Retreat, 2002

• Cystic Fibrosis Foundation

– Expression and function of the guanylin ligand family (P978), July 1, 1995-July 1, 1996. $32,493. – First Year Clinical Fellowship Sponsor (Jeffrey Rudolph), (Rudolp97B0), 1997-98 ($30,500) – Fellowship Sponsor (Stephen Guthery), (GUTHER99B0), 1999-01 ($76,000) – Fellowship Sponsor (Valerie McLin (MCLIN01B0) 2001-3 ($84,500) – Clinical Fellowship to Nissa Erickson (ERICKS03B0)July 1, 2003-June 30, 2004 $42,000 – First Year Fellowship Award (Pasternak PASTER05B0) 7/1/05-6/30/06) 7/1/05-6/30/06 $42,000

• Marion Merrell Dow Foundation

– Transgenic models of cardiovascular disease: Guanylin overexpression in transgenic mice, 1994, $2,000 – Transgenic models of cardiovascular disease: Targeting of the guanylin gene, 1996 ($4600) – Transgenic models of cardiovascular disease: Targeting of the uroguanylin gene, 1997 ($4600)

• Mead Johnson Nutritional Group

– Development of accurate test kits for malabsorption. Project 8538. September 1994-September 1995. $24,000

• Miles Pharmaceutical Company:

– Prospective, controlled double blind randomized comparison of ciprofloxacin vs trimethoprim/sulfamethoxazole vs placebo for prevention of traveler's diarrhea. Jeff Heck, Principal Investigator; Responsible for Component III:Escherichia coli pathogen assays, February 1990- May 1992, 5% effort, $79,100 – Prospective, double-blind, randomized comparison of Ciprofloxacin 500 mg daily for 3 days vs. trimethoprim- sulfamethoxazole 160/800mg twice daily for 5 days for the empiric therapy of traveler's diarrhea. (Jeff Heck, Principal Investigator), Responsible for Component III, Escherichia coli pathogen assays, October 1992- April, 1993, 5% effort, $26,259.

• Procter and Gamble Company

– Escherichia coli pathogen assays. February 1993-February 1994. $80,000. – Efficacy of bismuth subsalicylate in decreasing stool output in children with short bowel syndrome or intestinal

• aganglionosis. September 1994- September 1995, $25,000

– Fellowship Research and Education, 1997-1998, $5,000 – Unrestricted Educational Grant, 1998, $2,400 – Bifido 624 in Prevention of Day Care Diarrhea, MB Cohen, PI 06/15/02-10/15/03 $367,000

• Ross Laboratories

– Unrestricted educational grant: Infants with rectal bleeding: Defining allergic colitis and the role of eosinophils., (P.I.:

• J. Schwimmer MD (Fellow)), Faculty Investigator, %Effort: no salary support, 09/01/99-08/31/00 Direct $15,000
• Salix

– 7/1/05-12/1/05 Susceptibility of diarrheagenic E. coli from US subjects to rifaximin $3000

• Solvay Pharmaceuticals

– Fellowship Research and Education, 1997-1999. $25,000 – Unrestricted Educational Grant, 1999, $2,956

• Synsorb Biotech

– Title: SYNSORB Pk for the Prevention of HUS in Children (PK001) and A Nested Study of the Efficacy and Safety

• f SYNSORB Pk in the Treatment of Uncomplicated VTEC Gastroenteritis in Children (PK001A), 08/12/99 -

08/11/00 $73,430

May need help to stand on your own Why apply for non-NIH Funding?

• Gets YOU on the playing field

– Provides more targeted award – written for YOU

• Career development – time limited opportunity
• Focused area – more specific to your research

– Designed to help you get NIH funding and/or leverage your NIH money (additional trainees, specific supplies, etc) – Offers better pay line (not always) – Bolsters institutional confidence (and yours) in the initial investment – Gets you known by those in the field – Gives practice at organizing (thoughts and administrative details) for NIH grant – Not everyone plans (wants) to get an NIH grant

“Negatives”

• Usually smaller grants – less ROI
• Usually less indirect costs
• Sometimes cannot keep all or some of the award with

NIH award

• Not always easier to get than NIH award
• Round peg – square hole (does a colleague agree it is

written for YOU)

• If professional society – usually need to be a member.
• Bottom line, be aware of limitations but NON-NIH

funding SHOULD be part of your portfolio.

Non-NIH Sources of Funding: Federal

• Office of Orphan Products Development

– Clinical development of products for use in rare diseases or

• conditions. The products can be drugs, biologics, medical devices, or

medical foods. – http://www.fda.gov/ForIndustry/DevelopingProductsforRareDiseases Conditions/WhomtoContactaboutOrphanProductDevelopment/default .htm

• DOD- Department of Defense

– Focus varies by congressional mandate (congressionally directed medical research programs), e.g, genetics of food allergy – http://cdmrp.army.mil/funding/default.shtml

– http://www.darpa.mil

• CDC-Centers for Disease Control and Prevention

– May have separate set asides, e.g, IBD – http://www.grants.gov/

• AHRQ - Agency for Healthcare Research and Quality

– Comparative Effectiveness – Prevention and Care Management – Health Information Technology – Patient Safety – Innovations/Emerging Issues – Can use local QI or national QI networks as springboard for grant applications – http://www.ahrq.gov/fund/ragendix.htm

• HRSA -Health Resources and Services

Administration

– HRSA makes grants to organizations to improve and expand health care services for underserved people. – http://www.hrsa.gov/grants/apply/index.html

Foundation

• NASPGHAN Foundation

– http://www.naspghan.org/wmspage.cfm?parm1=664

• NASPGHAN Foundation in Office Member Grant for

Development of Patient Education Prototypes Patient education in practice settings. The Foundation will award up to two grants, each ranging from $500 - $2000. NASPGHAN Foundation Young Investigator Development Awards $75,000 per year for two years; 70% protected time to conduct the proposed work.

• 1. NASPGHAN Foundation/George Ferry YIA
• 2. NASPGHAN Foundation/Nestlé Nutrition YIA
• 3. NASPGHAN Foundation/Crohn’s and Colitis Foundation
• f America YIA
• NASPGHAN Foundation Fellow to Faculty Transition

Award in Inflammatory Bowel Disease Senior pediatric gastroenterology fellows -additional clinical and research expertise in pediatric IBD.

• NASPGHAN Foundation/TAKEDA Pharmaceuticals

North America Research Innovation Award Two-year grant for innovative, high-impact research in pediatric gastroenterology, hepatology and

• nutrition. Applicants at any career level may apply.
• NASPGHAN Foundation/ASTRAZENECA Research

Award In Peptic Ulcer Diseases (offered in even numbered years) Epidemiology, pathogenesis, natural history, genetics, diagnosis and management of peptic diseases affecting children.

AGA/AGA Foundation/FDHN

http://www.gastro.org/aga-foundation/grants

2012-13 AGA Research Foundation Awards - At a Glance Award Name Eligible Category Award Amount Term # of Awards Application Deadline Start Date AGA-Takeda Research Scholar Award in Gastroesophageal Reflux Disease Career Development $120,000 2 years 1 Extended to 1/13/2012 7/1 Research Scholar Award (RSA) Career Development $120,000 2 years * TBD 9/7/2012 7/1

• R. Robert and Sally Funderburg Research

Award in Gastric Cancer Established Investigators $100,000 2 years 1 8/31/2012 1/1 AGA- Emmet B. Keeffe Award in Translational or Clinical Research in Liver Disease Career Development Junior Faculty $70,000 1 year 1 2/3/2012 7/1 Elsevier Pilot Research Award Career Development Established Investigators $25,000 1 year 1 1/13/2012 7/1 June & Donald O. Castell, MD Esophageal Clinical Research Award Career Development $25,000 1 year 1 1/20/2012 7/1 AGA/AGA-Broad Foundation Student Research Fellowship Awards Student Award $2,500 1 year 10** 24*** 3/23/2012 7/1 AGA - Horizon Pharma Fellow Abstract Prizes Travel $1,000 DDW Travel 3 3/09/2012 7/1 AGA - Horizon Pharma Student Abstract Prizes Student Award Travel Award $500 DDW Travel 8 2/24/2012 7/1 $1,000 3 Moti L. and Kamla Rustgi International Travel Awards Travel Award $500 DDW Travel 2 3/09/2012 7/1

We are the 10%. Research Scholar Awards

• Gates Foundation

http://www.gatesfoundation.org/grantseeker/Pages/d efault.aspx

• Thrasher Foundation - pediatric medical research

– Al Thrasher Awards: 3yrs, up to $400,000. Median award is $230,000, with most between $150,000-$300,000. – Early Career Awards are limited to a maximum of $25,000 in direct costs, plus up to 7% indirect costs. 2 years. – http://www.thrasherresearch.org/

• ACG Institute - http://gi.org/acg-institute/

– Junior Faculty Development Grant $225,000 ($75,000 per year for each of three years) is to assist promising clinical researchers to develop research and careers that have a direct bearing on clinical gastrointestinal practice

– Clinical Research Award – Clinical Research Award Pilot Projects – Smaller Programs Clinical Research Award

• CF Foundation- http://www.cff.org/

– Basic and clinical research grants, Fellowships

• CCFA http://www.ccfa.org/

– Career Development Awards: – Up to $90,000 per year, 1-3 years

• Research Fellowship Awards
• Scientific Conferences and Workshops
• Senior Research Awards
• Student Research Fellowship Awards
• March of Dimes –

http://www.marchofdimes.com/professionals/grants.html

– Basil O'Connor

• Junior faculty who do not yet have an R01. K08 is OK. Award is

$150,000 over 2 years ($75,000 annually).

– Prematurity Grant Program

• Burroughs Wellcome Career Award for Medical

Scientists

– http://www.bwfund.org/pages/52/Grant-Programs/ – Career Awards for Medical Scientists – open to MDs and MD/PhDs. People should have 3-5

• papers. Award is $700,000 over 5 years.
• Broad - http://broadmedical.org/

– Strong potential of clinical applicability for IBD in the foreseeable future. Rolling deadline.

• Industry

– Investigator initiated – Sponsor initiated

• Directly related to your area of focus (or emerging focus)
• Budget adequate to cover your costs without risk
• ?Profit to help pay for unfunded research
• Is it doable – can you enroll the patients?
• Will it compete with other demands for your time?
• Is it scientifically worthwhile?
• Will it bring an opportunity to your patients/your center?

Think Local

• Local

– Your institution

• Trustee
• Procter Scholar
• K12
• CTSA PF
• Digestive Health Center PF
• Other Center PF

NIH Early Career Funding

Judith Podskalny, Ph.D. Division of Digestive Diseases and Nutrition, NIDDK NIH

2nd Yr Pediatric GI Fellows , 2012

Medical School Residency Independent Investigator

Fellowships Career Awards R-series * Loan Repayment

Postdoc

• Jr. Faculty

Specialty Graduate School

Predoc Fellowships

2nd Yr Pediatric GI Fellows , 2012

Mentored Career Development Awards (Ks)

• K01 – Mentored Research Scientist

Development Award

• K08 – Mentored Clinical Scientist Development

Award

• K23 – Mentored Patient-oriented Research

Career Development Award

• K25 – Mentored Quantitative Research Career

Development Award

• K99/R00 – Pathway to Independence Award

(NIDDK uses for PhDs)

2nd Yr Pediatric GI Fellows , 2012

BEFORE submitting a K-application:

• Have a position at an institution that allows

you to apply

• Pick appropriate mentors
• Publish at least 1-2 papers
• Generate your own preliminary data
• Identify the correct FOA
• Be a U.S. citizen, permanent resident, OR

have applied for permanent residency

Funding Opportunity Announcement

2nd Yr Pediatric GI Fellows , 2012

for all mentored Ks:

• U.S. institutions only
• 3 – 5 yrs, not renewable
• Minimum 9 calendar months (75% effort)

required

2nd Yr Pediatric GI Fellows , 2012

K99/R00 is exception:

• Does not require citizenship/perm. res.
• Cannot have a faculty appointment and must

have no more than 5 yrs research experience

• To move to R00 phase, must have a

‘tenured’ faculty position (R00 is not guaranteed)

• K99 = 1 – 2 years
• R00 = 2 – 3 years

‘Pathway to Independence Award’:

2nd Yr Pediatric GI Fellows , 2012

…refer to the ‘parent announcement’ website for current FOAs for all Ks:

http://grants.nih.gov/grants/guide/parent_announcements.htm

…refer to the NIH K awards table for salary information:

http://grants.nih.gov/training/careerdevelopmentawards.htm

K award includes:

• Salary, with additional fringe benefits

(NIDDK = $90,000 plus fringe at institution’s rate)

• Research support for tech support, supplies,

travel, courses, animals, patient costs, etc. (NIDDK = $25,000 for K01, K08; $50,000 for K23 if justified)

• average 5 yr award, at $150,000/yr =

$750,000

2nd Yr Pediatric GI Fellows , 2012

Elements evaluated in a K application:

• Candidate = Principal Investigator
• Career Development Plan/Career Goals &

Objectives

• Research Plan
• Mentor(s), Co-mentor(s), Consultant(s),

Collaborator(s)

• Environment & Institutional Commitment to

the candidate

2nd Yr Pediatric GI Fellows , 2012

Elements evaluated in a K application:

• Candidate
• Career Development Plan/Career Goals &

Objectives

• Research Plan
• Mentor(s), Co-mentor(s), Consultant(s),

Collaborator(s)

• Environment & Institutional Commitment to

the candidate

Using letters of recommendation, Biosketch, candidate’s statement, reviewers evaluate potential to become independent investigator and leader in proposed area of research

2nd Yr Pediatric GI Fellows , 2012

Elements evaluated in a K application:

• Candidate
• Career Development Plan/Career Goals &

Objectives

• Research Plan
• Mentor(s), Co-mentor(s), Consultant(s),

Collaborator(s)

• Environment & Institutional Commitment to

the candidate

Reviewers look at plans to evaluate progress towards independence, additional specialized training, faculty development, grant writing workshops, etc.

2nd Yr Pediatric GI Fellows , 2012

Elements evaluated in a K application:

• Candidate
• Career Development Plan/Career Goals &

Objectives

• Research Strategy
• Mentor(s), Co-mentor(s), Consultant(s),

Collaborator(s)

• Environment & Institutional Commitment to

the candidate

..appropriate to applicant’s background and level of expertise; hypothesis driven with preliminary data; merit of research question; design and methodology

• Significance
• Innovation
• Approach

2nd Yr Pediatric GI Fellows , 2012

Elements evaluated in a K application:

• Candidate
• Career Development Plan/Career Goals &

Objectives

• Research Plan
• Mentor(s), Co-mentor(s), Consultant(s),

Collaborator(s)

• Environment & Institutional Commitment to

the candidate

previous mentoring experience, expertise in area of research, productivity, relevance of mentor’s statement/plan to candidate’s strengths and areas to develop

2nd Yr Pediatric GI Fellows , 2012

Elements evaluated in a K application:

• Candidate
• Career Development Plan/Career Goals &

Objectives

• Research Plan
• Mentor(s), Co-mentor(s), Consultant(s),

Collaborator(s)

• Environment & Institutional Commitment to

the candidate

protected time, space, opportunities for collaboration, intention to integrate candidate into research program, position NOT contingent on getting K-award

2nd Yr Pediatric GI Fellows , 2012

Common problems with K- applications:

• Unclear or missing hypothesis
• Overly ambitious
• Unclear future plans (i.e. where will the research lead)
• Inadequate career development plan
• Poorly written
• Inadequate grasp of the literature
• Technical issues (incorrect model/cell line, not using best

methods, “technique in search of a project”, etc.)

• No power analysis for sample size
• Mentors lack correct expertise
• “Pedestrian”

2nd Yr Pediatric GI Fellows , 2012

2011 NIH K Awards* :

Applications New Awards (Success Rate) Total Awards

K08

489 143 (29%) 929

K23

648 174 (27%) 967

K99

878 151 (17%) 305

* approx., not finalized for FY11

Loan repayment programs..

2nd Yr Pediatric GI Fellows , 2012

Loan Repayment Programs

Five different LRPs – must pick ONE

• Clinical Research LRP
• Clinical Research LRP for Individuals from

disadvantaged backgrounds

• Pediatric Research LRP
• Health Disparities Research LRP
• Contraception and Infertility Research LRP
• Clinical Research LRP
• Pediatric Research LRP

2nd Yr Pediatric GI Fellows , 2012

$45 $16

$- $10 $20 $30 $40 $50 $60 $70 $80

Dollars (in millions)

NIH Loan Repayment Allocations FY 2010 [TOTAL = $75.5 million]

Clinical/Disadvantaged Bkgd. Contraception/Infertility Health Disparities Pediatric Clinical

2nd Yr Pediatric GI Fellows , 2012

LRP ‘features’:

• Provides up to $35,000 per year for 2 years

towards repayment of educational loans

• NIH pays the taxes on this amount directly to

the IRS

• May re-compete (i.e., get 4 or even 6 years)

2nd Yr Pediatric GI Fellows , 2012

Eligibility:

• US citizen or permanent resident
• Owe more than 20% of yearly salary
• as bona-fide educational debt
• Perform 2 years of research --
• concurrent with loan repayment period

2nd Yr Pediatric GI Fellows , 2012

LRP – Time-line for 2013 cycle

• Sept. 1 – November 15, 2012 – applications

accepted

• Feb - April, 2013 – applications reviewed by ICs

and funding plan prepared

• May – July, 2013 – LRP office verifies financial

information

• July, 2013– contracts issued

THEREFORE – be very clear how you will be supported for the period July 2013 through Aug. 2015

2nd Yr Pediatric GI Fellows , 2012

Finally… the NIH budget is BIG….

2nd Yr Pediatric GI Fellows , 2012

National Institutes of Health (’11)

>$30,000,000,000

2nd Yr Pediatric GI Fellows , 2012

Also REMEMBER --

• NIH staff want to help you succeed – contact

us with your questions

• Unless you apply, you’ll never know if you

will be funded

Judith Podskalny, Ph.D. 301 594-8876 jp53s@nih.gov

2nd Yr Pediatric GI Fellows , 2012

Training contacts:

• NCI: Dr. Ming Lei

leim@mail.nih.gov

• NIAID: Dr. Katrin Eichelberg

keichelberg@mail.nih.gov

• NICHD: Dr. Dennis Twombly

dtwombly@mail.nih.gov

How to write a research paper

Mitchell B. Cohen, MD Professor and Vice Chair of Pediatrics Director, Gastroenterology, Hepatology and Nutrition Cincinnati Children’s Hospital Medical Center

• Real success in academic medicine requires a

mentor, an important project, perseverance, and

• patience. Fame does not come overnight. All

things cometh to him/her who waiteth, if he/she works like hell while he/she waiteth.

– Delbert A Fisher, MD Harbor-UCLA Medical Center, Torrance CA

Who dunnit?

• Original peer reviewed manuscript published?
• Original peer reviewed manuscript submitted?
• Original peer reviewed manuscript “in preparation”?

Why publish:

• Publications expose data to critical review and benefit

society/medicine/children by your work product.

• If project was worth an abstract, probably worth writing

a manuscript

• Publication is the gold standard for academic

currency.

• Publications demonstrate career development and are

used to measure impact. Real impact measured by effect on society. Surrogates are impact factor and H index.

H-index

• A scholar with an index of h has published h papers each of

which has been cited in other papers at least h times. The h- index reflects both the number of publications and the number of citations per publication.

• The h-index grows as citations accumulate and thus it

depends on the 'academic age' of a researcher.

• Hirsch suggested (with large error bars) that, for physicists,

an h index of 12 might be typical for advancement to tenure (associate professor). A value of 18 = full professorship, and 45 or higher could mean membership in the National Academy of Sciences.

Why publish this paper? What is unique?

• Write the first draft in a limited number of sittings.
• Drips and drabs are an inefficient way to write and you

can lose your focus

• Make your thoughts concrete, worry about polishing later
• “Just get it down on paper, and then we’ll see what to do

with it.”

– Maxwell Perkins, editor for Ernest Hemingway, F. Scott Fitzgerald and Thomas Wolfe, advice to Marcia Davenport (1927)

Focus

• Make a list of your major hypotheses
• Create a path or story. Have a conversation with the
• reader. The reader wants to know what you set out

to discover (hypothesis), how it was done (method) what was found (results) and how you came to your conclusions/what are the limitations of your study (discussion).

• Don’t meander.

“I didn't have time to write a short letter, so I wrote a long one instead.” Blaise Pascal

Organize

• Collect references. READ them.
• Decide which references relate to each hypothesis.

Put them in folders (paper or electronic).

• Summarize all the points relating to hypothesis 1 on
• ne folder, hypothesis 2 in a second folder….

Write

• You need not begin writing with the introduction.
• Put your data together and then write your results.

– Generally say it once, e.g., graph, OR table, OR text

• This section is the easiest and the core of the paper.
• Fill in the methods based on your data.
• Then go back and write the introduction which should

frame your results; next move to the discussion.

Review, Revise, Circulate to co-authors and internal reviewers:

• Don’t let the manuscript age on your

desk/computer. It is not a fine wine. Academics does not reward hibernation.

Time line: How much time does this take?

Plan experiments, IRB, IAUCUC approvals Perform research, report abstract Write manuscript; submit for publication

Aim High TITLE

• Make your title specific enough to describe the

contents of the paper, but not so technical that only specialists will understand.

• The title usually describes the subject matter of the

article: Effect of Height on Academic Performance

• Sometimes a title that summarizes the results is

more effective: Short Pediatric Gastroenterologists Are Promoted Faster.

ABSTRACT

• A "preview" of what's to come. Often structured. May be the
• nly thing that is read!
• If not structured, summarizes the purpose, methods, results

and conclusions of the paper.

• It is not easy to include all this information in just a few
• words. Start by writing a summary that includes whatever

you think is important, and then gradually prune it down to size by removing unnecessary words, while still retaining the necessary concepts.

• Don't use abbreviations or citations in the abstract. It should

be able to stand alone without any footnotes.

Introduction

• What questions did you ask in your experiments?

Why is it interesting? What is already known - the introduction summarizes the relevant literature so that the reader will understand why you were interested in the question you asked.

• One to four paragraphs (1 page or so) should be

enough.

• End with a sentence explaining the specific

question you asked in this experiment.

MATERIALS AND METHODS

• How did you answer this question? There should be

enough information here to allow another scientist to repeat your experiment. Look at other papers that have been published in your field to get some idea of what is included in this section.

• If you had a complicated protocol, it may helpful to

include a diagram, table or flowchart to explain the methods you used.

• Explain the power calculation.
• Do not put results in this section. You may,

however, include preliminary results that were used to design the main experiment. "In a preliminary study, we observed a circadian rhythm of guanylin levels so we performed all of our experiments between 9-11am.”

• Mention relevant ethical considerations. If you used

human subjects, did they consent to participate. If you used animals, what measures did you take to minimize pain? IRB and IACUC approval.

Results

• This is where you present the results you've gotten.

Use graphs and tables if appropriate, but also summarize your main findings in the text. Do NOT discuss the results or speculate as to why something happened; that goes in the Discussion.

• Use appropriate methods of showing data. Don't try

to manipulate the data to make it look like you did more than you actually did.

• "The drug cured 1/3 of the infected mice, another

1/3 were not affected, and the third mouse got away.” Use appropriate statistics.

Don’t fight with the editor DISCUSSION

• Highlight the most significant results, but don't just repeat

what you've written in the Results section. How do these results relate to the original question? Do the data support your hypothesis? Are your results consistent with what other investigators have reported? If your results were unexpected, try to explain why. Is there another way to interpret your results? What further research would be necessary to answer the questions raised by your results? How do your results fit into the big picture?

• End with a one-sentence summary of your conclusion,

emphasizing why it is relevant.

Authorship

• Authorship credit should be based on

– 1) substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; – 2) drafting the article or revising it critically for important intellectual content; and – 3) final approval of the version to be published. Authors should meet conditions 1, 2, and 3.

Authorship

• Acquisition of funding, collection of data, or general

supervision of the research group alone does not constitute authorship.

• All persons designated as authors should qualify for

authorship, and all those who qualify should be listed.

• Each author should have participated sufficiently in the work

to take public responsibility for appropriate portions of the content.

Old CW – First (or last) is best

• Author, First
• Author, Middle
• Author, Last
• New CW
• It takes a village.

What is the Abbott Nutrition Health Institute? Abbott Nutrition Health Institute is a global

• rganization devoted to:
• Educating health care professionals throughout the world on the

importance of nutrition as therapy to improve patient care and

• utcomes
• Advocating the role of science-based nutritional approaches in

enhancing overall health

• Collaborating with a community of partners around the world to

advance science-based nutrition and address major issues facing today’s health care professionals

Visit www.ANHI.org to:

• Gain access to knowledge and information concerning nutritional

solutions that improve patient outcomes

• Learn how science-based nutrition as therapy can improve patient

care and overall health

• Become part of a community dedicated to advancing care

and bettering lives through science-based nutritional solutions

• Stay informed about international conferences, where researchers

and health care professionals exchange valuable ideas

Visit the Learning Center for Continuing Education.

• Online Independent Study
• Clinical Courses in the areas of Pediatric

and Adult Therapeutic Nutrition

• Accredited CE courses for Nurses and Dietitians
• Professional Development
• Clinical Information in the Resource Library

Abbott Nutrition Research and Development advances science-based nutrition

• Leading scientists share their wealth of

knowledge and key insights

• Learn about Abbott Nutrition R&D
• Find proceedings from the Abbott Nutrition

Research Conferences

ANHI Web-Site Learning Center Self-Study CE and CME Links

International Research as a Pediatric Gastroenterologist and Nutritionist

Kevin Sztam, MD, MPH Children’s Hospital Boston Harvard Medical School Affiliated with Columbia University ICAP - International Center for AIDS Care and Treatment Programs

How in the world did I end up here?

• University – molecular immunology lab
• Industry – molecular biology (Merck, Wyeth)
• Human rights monitoring project in a refugee

resettlement in Guatemala

• NJMS 1997: goal to work in international health
• HIV and HCV prevention in injection drug users

in Newark, NJ

• Led medical delegations – Guatemala, Cuba
• Master’s in Public Health – International Health

and exposed to Peds GI and Nutrition

• Residency, Fellowship at Columbia

Fellowship

• Receive good general GI training
• Complete a research project

– Pursue a smaller project – Pursue a dream project

• Super interesting
• Something to build a career on

Kevin’s Dream Team

• Pediatric GI and Nutrition mentor (Dr.

Richard Deckelbaum)

• Pediatrician with HIV and nutrition

research experience

• Director for 14-country international

HIV care and treatment program

• Kenyan PhD nutritionist at Columbia Earth

Institute (development organization)

• Kenya HIV program directors

Nutritional status with antiretroviral therapy (ART)

• Even with ART poor nutritional status is

predictive of mortality

• ART itself is a nutritional therapy
• ART increases BMI 5–20% up to 6 months
• Supplementing with macronutrients did not

necessarily lead to weight or improve mortality

• Rationale for supplementation, but effectiveness

not proven

• Few data on locally-available supplements

Swaminathan 2010; Ahoua 2011; USAID 2009; Schwenk 1999

Study

• A Macronutrient Supplementation Program

for Patients Initiating Antiretroviral Therapy in Central Kenya

• Identified grant opportunity (2nd yr fellow)

– Doris Duke Operations Research for AIDS Care and Treatment in Africa

• Award in 2006
• 2nd yr fellow

Study Goals

• Choose an approach that is locally accessible,

acceptable, possibly sustainable

• Test safety of local standardized supplement
• Preliminary effectiveness data for macronutrient

supplementation

• Costing
• Practical operational issues
• Feasibility within large HIV treatment program
• Began enrollment end of 2008

Study Outcomes

• Feasibility – operational and safety
• Cost
• Anthropometrics
• BMI at 24 weeks*, and 48 weeks
• MUAC and TSF at 0, 24, 48 weeks
• Questionnaires
• Dietary Intake at 0, 24, 48 weeks
• Food Security at 0, 24, 48 weeks
• Quality of Life at 0, 24, 48 weeks
• Clinical Status at 0, 24, 48 weeks
• Household food inventory at 12, 36 weeks
• Laboratory
• CD4 Count at 0, 24, 48 weeks
• Complete Blood Count at 0, 24, 48 weeks

Intervention

• Experimental intervention

– Macronutrient supplementation for 24 wks with 50% of energy requirement for family of 5 – Monthly: Maize (30 kg), beans (15 kg), vegetable oil (2.25 Kg), porridge mix (8.25 kg) – Nutrition counseling (both sites) – Multiple micronutrient supplement (Multivitamins) – Aflatoxin surveillance (Maize, porridge, peanuts)

Pilot Study Design

Comparison Site n=100 Intervention Site n=100

Ambulatory, starting ART BMI <20 Treat with ART and MMS Nutrition Counseling Treat with ART and MMS Nutrition Counseling

PLUS

Treat with 24 wks Macronutrient Supplement (Maize, beans, oil, porridge) 24 and 48 wk Follow Up Home Visit at 12, 36 wks 24 and 48 wk Follow Up Home Visit at 12, 36 wks Ambulatory, starting ART BMI <20

Anthropometrics

Site A n=100 Site B n=100 p Anthropometrics Body Mass Index, Kg/m2, median 17.96 17.39 0.04 Weight, Kg, median 47.85 46.65 0.29 Height, cm, median 162.65 164.0 0.86 BMI over 18.5 36 28 0.23 Mid-upper arm circumference, cm 22.0 21.35 0.007 Triceps skinfold thickness, mm 10 9 0.003

Clinical and Immunologic Status

Site A Site B p Tuberculosis, No. 31 18 0.03 Hospitalized in past 6 mos, No. 25 13 0.03 Acute diarrhea, No. 10 19 0.07 Chronic diarrhea, No. 7 26 0.0003 Cough in past month 46 41 0.48 Fever in past month 34 51 0.02 Headache in past month 37 43 0.39 Loss of appetite or change in taste in past month 34 56 0.002

Time to the first severe adverse event

Log rank p = 0.39 No statistical difference in time to 1st SAE

Our team

• Muhsin Sheriff (ICAP), Mark Hawken (ICAP), Juma Rashid (KEMRI)
• Murugi Ndirangu (GSU), Stephen Arpadi (CU), Richard Deckelbaum (CU)
• Geoffrey Nyamongo, Stanley Njuguna, Albino Luciano
• Gideon Chulele, John Kennedy Muthiru
• Mathew Kimani (Kenya), Ashley Bogosian (NYC)
• Study staff: Martin Kumbe, George Mutembei, Isaac Wachira, Rosemary

Nyowera, Kezia Wanjiru, Rosemary Chedeye, Alex Wacharia

• KEMRI National Reference Laboratory
• Wafaa El-Sadr (PI, CU)
• Hongyu Jiang (Children’s Hospital Boston)
• Christopher Duggan (Children’s Hospital Boston)
• District and Hospital Directors, lab and pharmacy staff
• Our participants in Central Province, Kenya

Things I’ve learned

• Study from start to finish

– Conceptualization, building team, grant, hiring staff, training, selecting sites, lab set up, budgeting, QA, database construction, multi- country and multi-institution collaboration, lead a diverse team across time zones – Food growing and grain processing, political interactions, facility renovation

New studies in Tanzania

• Tanzania with Harvard HIV group
• Trial of novel energy dense macronutrient

supplement for adults

• Observational study of Plumpy’Nut

(Nutriset, France) in HIV-infected children

• Programmatic studies of nutritional care

for HIV-infected adults

Why you might like or dislike this type of work

• Work on a major global epidemic disease
• Interface with HIV programs, NGOs, govts
• Attempt to perform research in challenging

environments

• High mortality
• Integrate knowledge of nutrition to improve

nutritional care for HIV-infected people

• Balance clinical duties and family with

research demands

Major international public health issues for Peds GI & Nutrition

• Chronic disease

– obesity, hypertension, hypercholesterolemia

• HCV
• Malnutrition
• Diarrheal disease and mucosal immunology

Follow your dream

• Challenging but possible

– Right mentor, some funding

• Spend time to create your opportunities

Moving from Mentee to Mentor

Alan Leichtner, MD Abbott Conference

Objectives

• Appreciate the characteristics of good

mentors

• Understand the actions mentors perform
• Apply tips for being a good mentor
• Create a developmental network for

mentoring

• Understand identify barriers for mentoring

and seek strategies to overcome them

Why Mentoring Goes Wrong

• No Mentoring

– Constant need to reinvent the wheel – No efficiency gained from collaboration – Slower progress on projects – Slower career development

• Bad Mentoring

Bad Mentors

• The Users – use the mentee’s work solely for

their own development

• The Avoiders – never have enough time to

devote to their mentee

• The Criticizers – believe mentoring is a license

for criticizing

Modified from Ed Benz

WHAT ARE THE DESIRED CHARACTERISTICS OF A MENTOR?

Buzz Group or “Think, Pair, Share” Assignment: Think about your experiences being mentored and providing mentorship Take one minute and come up with 3 of the most important characteristics for a mentor

Who says there is no science behind mentoring?

Sambunjak D, Straus SE, Marusic A. A systematic review of qualitative research on the meaning and characteristics of mentoring in academic medicine. JGIM 2009; Qualitative meta-analysis 8,487 citations from bibliographic search 9 articles met inclusion criteria

List of Most Important Characteristics

• f a Mentor

Desired Characteristics of Mentors

• Personal

– Altruistic – Understanding – Patient – Honest – Responsive – Trustworthy – Nonjudgmental – Reliable – Active Listener – Motivator

Sambunjak, et al

Desired Characteristics of Mentors

• Relational

– Accessible – Dedicated to developing relationship with mentee – Want to offer help in mentee’s best interest – Able to identify mentee’s strengths – Able to help define and reach goals – High standards for achievements – Compatible practice style, vision, personality

• Professional

– Senior and well-respected in the field – Knowledgeable and experienced [More junior mentors who are well-connected may be as effective]

Sambunjak, et al

What Trainees/Junior Faculty Want

• Career counseling, including help with CV

preparation

• Project oversight
• Scholarship help
• Time-management and work/life balance
• Teaching skills, curriculum development,

teaching portfolios

Modified from Community of Mentors OFD Children’s Hospital Boston

What Trainees/Junior Faculty Want

• Clinical practice strategies, quality

improvement methodologies

• Advocacy
• Enhancing professional visibility, locally and

nationally

• Joining professional societies
• Understanding the organizational culture

Modified from Community of Mentors OFD Children’s Hospital Boston

Multiple Types of Mentoring

• Dyadic mentoring
• Team mentoring, e.g. SOCs
• Collaborative peer mentoring
• Project-based mentoring
• E-mentoring

Actions of a Good Mentor: 20 Tips

• 1. Set expectations early and adjust as necessary
• ver time
• 2. Be explicit about credit
• 3. Plan for a long-term relationship
• 4. Help your mentee determine what he/she really

wants to do, but challenge them to expand goals and seek new opportunities and be flexible

• 5. Help match ideas and resources
• 6. Help mentee establish connections with

collaborators and network

Modified from Klibanski

Actions of a Good Mentor: 20 Tips

• 7. Follow-through on specific commitments you

make to your mentee(s)

• 8. Monitor progress
• 9. Respect individuality and show appreciation for

mentee’s abilities 10.Give feedback, foster self-reflection and performance improvement 11.Provide moral support to cope with stresses and build motivation 12.Help mentee with project/career/life balance

Modified from Klibanski

Actions of a Good Mentor: 20 Tips

13.Role model good mentorship 14.Understand co-dependence issues 15.Keep appropriate distance 16.Understand your limits and acknowledge and encourage mentee’s need for other mentors 17.Be willing to terminate dysfunctional mentoring relationships

Modified from Klibanski

Actions of a Good Mentor: 20 Tips

18.Teach the “rules of the game” and how to navigate political situations 19.Build independence 20.Plan early for separations

Modified from Klibanski

Age of Mentors:

Old vs. Young

• Advantages

– Fewer commitments – More understanding of current generational issues – Enthusiastic, bold

• Disadvantages

– Less seniority, authority, clout – Less secure – Less developed network – Less experienced as a mentor

• Advantages

– Seniority, authority, clout – More extensive network – Perspective – “seen it all” – Experienced as mentor

• Disadvantages

– Less time – Less understanding of current generational issues – Fatigue

Start early in your career !

Modified from Ed Benz

Benefits of Being a Mentor

• Help in achieving academic goals, e.g.

progress in a research area

• Credit towards academic promotion – part of

educational portfolio – expected in senior level professors

• Developmental of a legacy in a field

MENTOR

GENERATIONS OF MENTEES

1500 Pediatric Gastroenterologists in Society 500 Vote in Election 145 PGPAC Members (100 fellows and 45 faculty)

The Developmental Network

• Unusual to find one mentor who can provide

everything a mentee needs

• A better solution is to devise a network to

meet all mentee needs – like a cabinet

• Model developed by Kathy Dram, Monica

Higgins, and David Thomas and modified for use by Jean Emans

• 3 roles required of network

Getting Job Done

Career Personal Support

Barriers to Effective Mentoring

• Mentor

– Lack of time – Insufficient mentoring skills – Lack of flexibility – Lack of specific knowledge

• f mentee’s career

– No benefits for mentoring

Barriers to Effective Mentoring

• Mentee

– Unable to make effective changes – Misreading of events – Inability to develop network because of scant resources

• Relationship

– Lack of fit – racial, ethnic, gender, or generational issues – Lack of continuity – Competition between mentor and mentee, or abuse of mentee

Strategies to Improve Mentoring

• Personal

– Improve mentoring skills – Make sure you understand generational issues – Make regular meetings/contacts – Partnership agreement/contract may be advisable – Progress reports and set deadlines – Assist in creation of a developmental network

Strategies to Improve Mentoring

• Institutional

– Faculty development – workshops, coaching program – Programs for mentees on mentorship – Give incentives to mentors – Foster concept of networks of mentors, each fulfilling a different role – Monitor outcomes

Take Home Points

• Mentoring is a critical part of effective career

development

• Effective mentoring is multidimensional and takes

preparation

• Triple threat mentors are rare, and more and

more developmental networks are taking their place

• Mentoring has its benefits, but is still

underappreciated

• Start early (you have probably done this already)

“When you see a turtle on the top of a fence post, remember that he didn’t get there by himself.”

Alex Haley

Checklist for Mentors

Preparation

• Introduce yourself by phone, brief letter, or email
• Give mentee ample opportunity to propose agenda for first meeting
• Ask for updated CV/resume
• Ask mentee to think about short- and long-term goals

First Meeting

• Express interest in mentee’s career
• Ask open-ended questions; be an active listener and help mentee reflect on plans
• Review the mentee’s CV/resume with him or her
• Review the most recent career conference the mentee has had with his/her chief
• Help formulate short- and long-term goals
• Ask about the Development Network
• Set up mutual expectations and responsibilities
• Decide on frequency of meetings

Additional topics for discussion at first or early meetings

• Research: Details of intended project, ownership, available resources, skill

development, grant opportunities, timeline

• Promotion: Elements, timeline
• Balance: Family, day care, pace, negotiations with

chief/supervisor Follow-up Meetings

• Meet according to agreed upon plan
• Track progress carefully
• Give honest feedback about accomplishments
• Continue to suggest additional resources
• Continue relationship for a minimum of one year

Checklist for Mentors

• 1. Balmer D, D'Alessandro D, Risko W, Gusic ME. How mentoring relationships

evolve: a longitudinal study of academic pediatricians in a physician educator faculty development program. J Contin Educ Health Prof 2011;31:81-6.

• 2. Carey EC, Weissman DE. Understanding and finding mentorship: a review for

junior faculty. J Palliat Med 2010;13:1373-9.

• 3. Detsky AS, Baerlocher MO. Academic mentoring--how to give it and how to get
• it. Jama 2007;297:2134-6.
• 4. Feldman MD, Huang L, Guglielmo BJ, et al. Training the next generation of

research mentors: the University of California, San Francisco, Clinical & Translational Science Institute Mentor Development Program. Clin Transl Sci 2009;2:216-21.

• 5. Geraci SA, Kovach RA, Babbott SF, et al. AAIM Report on Master Teachers and

Clinician Educators Part 2: faculty development and training. Am J Med 2010;123:869-72 e6.

• 6. Gusic ME, Zenni EA, Ludwig S, First LR. Strategies to design an effective

mentoring program. J Pediatr 2010;156:173-4 e1. d 2010;85:1067-72.

References

• 7. Johnson MO, Subak LL, Brown JS, Lee KA, Feldman MD. An innovative

program to train health sciences researchers to be effective clinical and translational research mentors. Acad Med 2010;85:484-9.

• 8. Kiefer JC. Tips for success: fostering a good mentoring relationship. Dev

Dyn 2010;239:2136-9.

• 9. Ogunyemi D, Solnik MJ, Alexander C, Fong A, Azziz R. Promoting residents'

professional development and academic productivity using a structured faculty mentoring program. Teach Learn Med 2010;22:93-6.

• 10. Sambunjak D, Straus SE, Marusic A. A systematic review of qualitative

research on the meaning and characteristics of mentoring in academic

• medicine. J Gen Intern Med 2010;25:72-8.
• 11. Santoro N, McGinn AP, Cohen HW, et al. In it for the long-term: defining

the mentor-protege relationship in a clinical research training program. Acad Med 2010;85:1067-72.

References

Creating your CV and Academic Portfolio

Michael Narkewicz MD Professor of Pediatrics Hewit-Andrews Chair in Pediatric Liver Disease Associate Dean for Clinical Affairs University of Colorado SOM, Children’s Hospital Colorado

Disclosures

• No Funding Conflict
• Some

me slides borrowe wed from m Mi Miriam m Vos

• Other data borrowe

wed from m the University of Colorado SOM M we website

• http://www

www.ucdenver.edu/academics/colleges/m edicalschool/facultyAffairs/Appointme mentsPromo mot ions/Pages/Promo motionsTenure.aspx

• 2

Curriculum Vitae

• Latin: course of (one's) life
• First Known

wn Use: 1902

• Webster: “a short account of one's career and

qualifications prepared typically by an applicant for a position”

• Overview

w of your professional accomp mplishme

• ments. In the US, used almo

most exclusively by those pursuing an academi mic or me medical career.

• Typically a "living docume

ment" wh which wi will reflect the developme ments in a professional's career, and thus should be updated frequently.

3

• CV

CV - longer, mo more detailed synopsis of your education, background, teaching and research experience, publications, presentations, awa wards, honors, affiliations, etc

• “A forma

mal record of your progress up the academic ladder.” (K. Barrett, JPGN 2002)

4

CV and Promotion

• The CV is a key comp

mponent of the promo motion process

• Know what is expected at your institution!
• Use the promo

motions and CV guidelines at your institution

• Follow the rules and guidelines
• Me

Meet wi with Academi mic Affairs Person at your institution

• Get an examp

mple of a we well presented CV

5 6

Key Components - 1

• Personal history or biographical sketch
• Begin with “Current Position” --- include title(s) and

professional address (with email and FAX)

• Do NOT include birth date or Social Security Number
• Education
• In chronologic order, list institutions attended dates and

degrees (Begin with college or university)

• Include internship, residency, fellowships, post-doctoral

training

• Ex: University of Colorado SOM Denver, CO: Fellowship, Pediatric

Gastroenterology July 1, 1986 – June 30 1989

• Fellow: Centre de Recherche sur la Nutrition Paris France:

Pediatric Scientist Development Fellow July 1, 1987-June 30, 1989

7

Don’t Include all education!

8

Key Components - 2

• Academi

mic appointme ments

• List these chronologically (including dates)
• Include full-time and adjunct faculty positions
• Ex: Associate Professor 2001-2007
• Hospital, governme

ment or other professional positions

• List positions chronologically
• May divide into sections (hospital, government, etc.):
• I do University, Hospital, National
• Ex: Medical Director Liver Transplantation

9

Key Components - 3

• Honors, special recognitions and awa

wards

• Graduate school honors and distinctions
• Clinical, teaching, research or service awards
• Elected and honorary society memberships
• Honorary fellowships
• Ex: Resident Teaching Award
• Society for Pediatric Research (have to be nominated and elected)
• Me

Memb mbership in professional organizations

• List organizations (and dates)
• Include offices held and other leadership positions
• Ex: Member Research Committee NASPGHAN 1997-2000

10

Key Components - 4

• Ma

Major Commi mmittee and Service Responsibilities

• Group (as appropriate) under headings: Departmental, SOM,

university and hospital

• Include state and national committees, tasks forces, boards

and commissions

• List important community service or public health activities
• Note leadership positions, key responsibilities
• Ex: Medical Board 1997-2009 (President 2006-2008)
• Licensure and board certification
• Include dates of state certification, board certification and

recertification (participation in MOC)

• Do NOT list medical license numbers

11

Key Components - 5

• Inventions, intellectual property and patents held
• r pending
• Review

w and referee wo work

• Service on editorial board (Include dates)
• Grant review committees and study sections
• Service as ad hoc reviewer for journals professional societies or

scientific meetings (State dates, journals, meetings)

• Invited extramu

mural lectures, presentations and visiting professorships (numb mber: eases counting)

• As list lengthens, may divide into headings: Local, regional,

national, international

12

Key Components - 6

• Teaching record
• In separate sections, list major presentations to medical (or
• ther undergraduate) students, graduate students, house
• fficers
• List course numbers and dates
• State ward/clinic attending duties (e.g., “2000-03: Supervision

and bedside teaching of residents, high-risk hypertension clinic - 6 hours/week”)

• Key administrative positions (course or training program

director) and dates

• List specific accomplishments (course development,

innovative syllabus, etc)

• Supporting details should be provided in

separate teacher’s portfolio

13

Key Components - 7

• Grant support
• Can introduce research focus:
• Primary research foci: Developmental Amino Acid Metabolism,

Biomarkers in CF liver disease and ALF, Clinical trials in viral hepatitis

• List all grants awarded; list active grants first
• Include your role (e.g., principal investigator, co-investigator),

funding source (and grant number), dates, percent effort, and total direct costs

• Divide into headings as appropriate (current and prior funding,

whether competitive, by type of funding agency, etc)

14

Key Components - 8

• Bibliography
• Check all bibliographic citations for accuracy
• Number all publications (beginning with the earliest) and list in
• rder of publication
• Underline your name as it appears in author list
• Include, in separate sections, the following items:
• Papers published in peer-reviewed journals (may include in-

press and accepted articles)

• Books and monographs
• Book chapters, invited articles & reviews in non peer-reviewed

journals

• Other publications, non-published documents, reports,

research or policy papers, lay press articles (must be complete and available for review)

15

Key Components - 9

• Bibliography – 2
• Other “products of scholarship” (software, CD’s, case

simulations, videos, etc.)

• Letters to the Editor
• Scientific abstracts published or presented at scientific

meetings

• List meeting, journal reference and type of abstract (plenary, oral
• r poster)
• Divide into headings (Competitive, non-competitive)
• Do not list manuscripts that have been submitted or that are “in

preparation” Debatable, helpful to keep track

16

What to do

• Start it when you get back (if you haven’t

already done this

• Back up
• Systema

matically update:

• Every paper accepted
• Every abstract
• Each time you lecture
• Review

w Mo Monthly:

• Update committees etc (end dates)
• Teaching

17

Teaching Portfolio

18

Teaching Portfolio: Beyond CV

• Teaching is increasingly recognized as key in

the academi mic environme ment

• Docume

mentation is key to successful recognition

19

Descriptions of Teaching Activity

• Teacher’s Statement
• Cl

Classroom m instructional activities (courses, lectures)

• Cl

Clinical instructional activities (bedside rounds, ad hoc talks)

• Other didactic activities (invited lectures, CF

CF team m talk)

• Te

Teaching leadership and admi ministration (course director)

• Cu

Curriculum m Innovation and Sc Scholarship (developed simu mulation)

• Mentorship (whom

m have you me mentored)

• Outside educational efforts (eleme

mentary school talk)

• Se

Self St Study and Imp mproveme ment (workshops attended)

• Te

Teaching Awa Awards

20

Documentation of Teaching Effectiveness

• Evaluations of Didactic Teaching Activities
• Ask if there will be an evaluation and will you get some form of

feedback.

• If not: Have a form and distribute and collect
• Evaluations of Clinical Teaching Activities
• Almost all rotations ask residents/students for evaluations
• Ask for summaries after time on service
• Solicit feedback
• Me

Mentorship

• Letters of Support

21

Let’s Get It Started

22

Binita M. Kamath, MBBChir MRCP MTR

INTERVIEWING AND NEGOTIATING FOR A FACULTY JOB

WHAT IS OUT THERE

• Job announcement letters sent to Department
• Announcements in scientific journals
• Websites of academic institutions
• Mail list servers
• Informal sources

PREPARATION

• Know your needs
• Know your strengths
• Most candidates underestimate themselves
• Know your weaknesses
• Ask your mentor
• Negotiate appropriately

PREPARATION

• Do you need to be working at a top-rated institution,
• r would a less-intense atmosphere be preferable?
• What is your ideal combination of research, teaching

and clinical practice?

• Do you want/need to be in a particular area of the

country?

• Will your partner’s professional needs set limits on

your search?

INITIAL CONTACT

• CV + cover letter
• Telephone call
• Informal meeting e.g. NASPGHAN annual meeting
• Set up the 1st interview
• Clarify reimbursement
• Get schedule ahead of time

GOALS OF THE INTERVIEW

• Convince the department that your work is exciting

and that you will be a leader in your field

• Convince each member of the department that you

will be a good colleague

• Find out if the institution and the department are right

for you

THE INTERVIEW

• Demanding and exhausting experience
• You are on display at ALL stages of the visit (even

before you arrive!)

• Be nice to admin staff
• Find out about the academic interests of the people

you are likely to meet

• Be ready to ask them about their work/interests
• Learn about the institution and the surrounding area

THE INTERVIEW

• Dress code
• Job talk
• Focus on your work
• Make the future directions clear
• Be dynamic

AFTER THE FIRST VISIT

• If not interested, promptly call the Chief
• If interested – call/email those you met with
• 2nd visit (take partner)
• Request particular people to meet with
• Salary and start-up negotiation
• Housing
• Schools

SALARY/COMPENSATION

• Financial analysis of compensation data (2007)
• Compared returns to General Pediatrics
• Pursuing fellowship in GI is a negative financial

decision

• NASPGHAN Workforce Salary Survey (2003-4)
• Assistant Professor $139K (135)
• Private Practice $226 (207)
• 0-5 Years from Fellowship $155 (138)

Rochlin and Simon, Pediatrics 2011

NEGOTIATION - SALARY

• Try to talk to a friendly insider
• You can (almost) never negotiate up from the start
• Understand the incentive process completely
• Consider the whole package

NEGOTIATION – START-UP

• How much and for how long?
• Usually 3 years guaranteed
• Source
• Space
• Equipment
• Animals
• Research technician or assistant

NEGOTIATION – OTHER BENEFITS

• Health insurance
• Life and disability insurance
• Retirement benefit
• Faculty tuition benefit
• Housing benefit / mortgage assistance
• Professional liability insurance
• Vacation
• Relocation expenses

AFTER THE SECOND VISIT

• Wait for the verbal job offer
• Can also occur after the 1st visit
• Timeline is idiosyncratic
• Unlike fellowship, residency

THE JOB OFFER LETTER

▪ Start date ▪ Faculty title and track ▪ Salary and benefits, including incentive compensation ▪ Effort distribution (% time for research, clinical and teaching) for at least the first 3 years ▪ Office and research space ▪ Basic office supplies (including computer)

THE JOB OFFER LETTER

▪ Administrative support

▪ Academic $ support (travel, subscriptions, membership fees) ▪ Specific items of research support - equipment, supplies, personnel ▪ Other special considerations that were verbally agreed upon

• Lawyer?

STAYING AT THE SAME INSTITUTION

• Sometimes explicit and clear
• More often, awkward
• Mentor vs. Division Chief
• Can be difficult to negotiate
• Must still interview elsewhere

SUMMARY

• Do your homework
• Be dynamic
• Aim to be in a position to weigh up more than 1 offer
• Negotiate appropriately, but don’t underestimate

yourself

• You must like your future colleagues
• Your partner must be happy
• It does not have to be forever

RUNNING A PRACTICE

Janet Harnsberger MD Salt Lake City

What Was I Thinking?

“I ain’t gonna work on Maggie’s farm no more”

Bob Dylan

The Vision

 A Private Practice with

 Personalized care for children  On time service  Wonderful esprit de corps  Versatile working hours  Strong community camaraderie

I Was Threatened

 You will lose your skills  Your fund of knowledge will be antiquated  You will not have any referrals  You can’t use the endoscopy suite  You are GENERALLY A BAD PERSON

Starting a Private Practice

 It is really easy

 It takes a maximum of two week’s work

 Almost every community needs you  You can figure it out so that you are not on

call all the time

 It is incredibly fulfilling and rewarding

Starting a Private Practice

 The bank will loan you the money you need

for equipping an office, malpractice insurance, and a few month’s of salaries

 Choose an office preferably in a building or

neighborhood with lots of Pediatricians and Family Practitioners

 Hire your office manager

 Es agradable a hablar Espanol !

Starting….

 Bond with the office manager by deciding

together on office décor, stationery, chart- keeping plans, ancillary staff

 Meet with the Hospital Administrators

 The administrators will buy the endoscopy

equipment you need and set up Grand Rounds and other introductions

 The administrators will send out notice of your

practice to the newspaper and the hospital staff

Starting….

 Be maximally available to the medical

community (at first)

 Set up lunches with potential referring groups-

make use of your pharmaceutical reps!

 Be on the wards and in the physician lounge in

the mornings, noon, and at afternoon rounds

 Drop a pile of your cards in all the ERs

 Communicate  Join community clubs

My Logistics

 Joe and Bill offered me space in their office  The bank loaned me $25,000  Chris and Dick’s built short exam tables  I hired my whole staff (one person) from

medical records

 I gave conferences everywhere  Julia designed my award-winning stationary

Credentialing

 Plan on a minimum of 2 months for this to

be accomplished once you have provided the required information

 Write “pending” on license and malpractice

coverage so as not to delay the credentialing process

Credentialing

 Start compiling lists now for applications

 Have you met training criteria for the procedures

and “level of care” credentials that you are requesting?

 Continuing medical education  Malpractice history  Criminal investigations (be forthcoming..)

Malpractice

 You will need to submit the same information to

• btain malpractice coverage as you sent for

credentialing

 For the first three years, your costs are on a

sliding scale (up)

 The expense is not bad as you start

 Give the process 2 months, apply with multiple

companies (the rates change ephemerally)

Is Private Practice a “Dead End?”

 Of course not

Now the Practice is Up and Running!

 You need to keep track of things

 Get QuickBooks – its an easy way to pay your

bills and track your expenses over the years

 Get Paychex – they will do your payroll and ALL

• f your taxes for a minimal fee

 Hire a medical billing company

 Once you have your feet under you it is more

efficient to buy a billing system and bill in-house

Your Expenses

 Rent, utilities, telephones and cleaning  Malpractice  Hospital and NASPGHAN Dues  Salaries  Office supplies

I wrote 14 checks in January 2009 – you just do not need a business manager for this

Maintaining Your Office Staff and Reputation

 BE SUPPORTIVE to the opinions of your

referring physicians

 BE SUPPORTIVE to your office staff

 Ask them what is not going well

 BE SUPPORTIVE to your patients and their

parents

 TRY NEVER TO WASTE ANYONE’S TIME

Maintaining Your Office Staff and Reputation

 Be honest and straightforward  Educate and learn from your office staff  Psychiatrize with the staff  Be predictable  You will be offered opportunities to engage

in alternative ventures. This generally does not come out well.

How Did it Work Out for Me?

 Utah Woman of the Year in 2000  I received the only national Best Practices

Award for a private medical practice

 Teacher of the Year awards from the

Department of Pediatrics – four times

 Horizonte Community Service Award

Will it Work Out for You?

• Enjoy the process, you have worked for

this all of your life

• You will find the best situation if you are

true to yourself

• It is easy to change and you haven’t lost

much if you find you want a different direction for your career

Kathleen B. Schwarz, M.D. President, NASPGHAN 2nd year fellows Ross Conference 2012

Outline

 What you can do for them  When they can do for you  Body language and other tips  Sensitive issues  The bigger picture for your family  The bigger picture for you

What you can do for them

 Clinical Service – how much, how long is the day?  Clinics – near and far – how many patients?  Procedures – how many? What kind?  Weekend call – how many? (with or without a fellow?)  Teach – what level? how much?  Hospital committees – how many? What happens if you

say no?

What are the employer’s expectations?

 How many RVU’s are you expected to contribute?

 Medicare uses a physician fee schedule to determine

payments for over 7,000 physician services. The fee for each service depends on its relative value units (RVUs), which rank on a common scale the resources used to provide each

• service. These resources include the physician’s work, the

expenses of the physician’s practice, and professional liability insurance.  Physician work RVUs account for the time, technical skill and effort, mental effort and judgment, and stress to provide a service.

RVU’s for Selected Services 2008

 Service (HCPCScode) Total MD P M  Intermdiate Office Visit (99214) 2.53 1.42 1.06 0.05  Diagnostic Colonoscopy (45378) 5.64 3.69 1.65 0.30  Total Hip Replacement (27130) 37.66 21.61 12.54 3.51  www.nhpf.org T H E B A S I C S Relative Value Units (RVUs)

What they can do for you

 Provide nursing and nutritionist assistance  Provide up to date endoscopy equirment  Provide research assistance – lab, technician, biomedical

statistics and the protected time to do it

 Provide secretarial assistance  Provide an office  Provide benefits – especially health insurance  Provide a grievance structure  Provide an efficient billing service

Pay you

Basic salary Incentives CME Malpractice/medical licenses Opportunities for advancement References AAP salary scale per region and rank NASPGHAN Practitioner’s Database

Body language and other tips

 Let the interviewer talk first  They will ask you questions about your background  They will try to figure out who you are  Try to figure out what they want  Tailor your response about yourself to fit what they want but don’t fabricate a story  Get the employer hooked on you!

Sensitive issues

 Pregnancy  Malpractice suit against you  Mental health issues  Drug or alcohol dependence  Gay/lesbian/biseual  HIV  Prison history  Child abuse  Tell them all the good news first but transparency is key despite privacy legislation (my opinion)

The bigger picture for your family

 Opportunities for your SO  Housing prices  Day care  Schools – public or private  Transportation

The bigger picture for you

 Try to figure out if they are the right employer for you  What kind of feedback will you get and from whom?  How is your potential employer regarded by the community?  What is the competition?  What do you want to be doing in 10 years?

Trust your instincts!!!

AP 102 Academic Promotions

David A. Piccoli, MD Biesecker Professor of Pediatrics at The Children’s Hospital of Philadelphia Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania

Timeline and Evaluations

13-14 14-15 15-16 16-17 17-18 18-19 19-20 20-21 21-22 22-23 23-24 1 2 3 4 5 6 7 8 9 10

Instructor Assistant Professor Associate Professor Review 3 yr review 6 yr review Nomination Promotion 1 yr review Renew! On to Professor

On Track – For Promotion

• Understand the process
• Obtain, maintain the documentation
• Ongoing mentoring
• Ongoing feedback

Timeline Considerations of an Assistant

• How long is the course to Associate Professor?
• What is required in my track?
• What resources are available at this stage?

– Start up package – Salary support – Research environment – Clinical mentor – Research mentor

• COAP guidance and feedback

Timeline and Evaluations – Research

13-14 14-15 15-16 16-17 17-18 18-19 19-20 20-21 21-22 22-23 23-24 1 2 3 4 5 6 7 8 9 10

Instructor Assistant Professor Associate Professor Review 3 yr review 6 yr review Nomination Promotion 1 yr review Renew! On to Professor Research Startup Funds K grant – mentored scientist award R01 award – sustained funding, and more Mentor for MDs, PhDs, students Independent Laboratory space Supplemental grants

Timeline and Evaluations

13-14 14-15 15-16 16-17 17-18 18-19 19-20 20-21 21-22 22-23 23-24 1 2 3 4 5 6 7 8 9 10

Instructor Assistant Professor Associate Professor Review 3 yr review 6 yr review Nomination Promotion 1 yr review Renew! On to Professor Paper Paper Paper Paper Paper Paper Paper Paper Paper Paper Paper Paper Paper Paper Paper Paper Paper Paper Paper Paper, ……….

Timeline and Evaluations

13-14 14-15 15-16 16-17 17-18 18-19 19-20 20-21 21-22 22-23 23-24 1 2 3 4 5 6 7 8 9 10

Instructor Assistant Professor Associate Professor Review 3 yr review 6 yr review Nomination Promotion 1 yr review Renew! On to Professor Establish Clinical Expertise in focused area Clinical or translational research Regional and national reputation Leadership – New programs or initiatives Funding, Development, advocacy Papers, chapters and reviews, ……….

CE Track – Papers & Chapters Tenure Track - Papers

Materials to Maintain

• Lectures given
• Evaluations at all levels

– Attending on service – Lectures – Solicit evaluations if not provided – Review faculty evaluations – Mentees / students who might write a letter

The Process

Provost / Dean Promotion Committee

Medical School Committee Departmental Committee Division Chief

Reappointment Process

• Formal dossier prepared at years 1, 3, 6
• Evaluate rate of progress and productivity

– Scholarship (CV) – Clinical productivity and excellence – Teaching quality and quantity (EDB) – Roles and responsibilities (Academic plan)

• Identify strengths and address deficiencies

Documentation - Reappointment

• Division chief letter of recommendation
• Department Education Officer letter
• Academic plan
• Candidate CV
• Candidate Educational Database
• Clinical roles and productivity

Academic Plan

ACADEMIC PLAN FOR ______________________, Degree ____ Proposed Start Date: ______________________ Mentor: _______________________ Breakdown of duties: % Research % Clinical Service % Teaching % Administration 100% Research: Clinical Services: Teaching: Administration: Approved: Candidate ____________________________________ (date)___ Chief ________________ Division of ______________ (date) ___ Chair________________ Department of ____________(date)___

Educational Database

• CV
• Personal statement
• Teaching activities
• Administrative teaching
• Teaching evaluations
• Departmental teaching review
• Other letters

Evaluations

• Thou shalt give, and thou shalt receive
• Maintain these in an ongoing fashion
• Learn from them, learn to give them
• HAMSTER – (house officer and medical student

evaluation record)

• Oasis
• Individual letters
• Course reviews
• Educational officer letter (Departmental letter)

HAMSTER Evaluations

Non-Clinical Lectures Labs < 3.5 Does not meet expectations Does not meet expectations ≥ 3.5 - ≤ 4.2 Meets expectations Meets expectations ≥ 4.2 Exceeds expectations Exceeds expectations Clinical GME UME < 3.9 Does not meet expectations Does not meet expectations ≥ 3.9 - ≤ 4.8 Meets expectations Meets expectations ≥ 4.8 Exceeds expectations Exceeds expectations

Promotion Process

• Same as for reappointment
• Same documentation requirements
• Review and support by internal consultants
• Review and support by external consultants
• Review by each level of Promotions Committees
• Review and evaluation of candidate by the Dean

and/or Provost

Letters of Support

• Extramural consultants

– List supplied by chair, candidate or both – Solicitation comes from committee – Full package is sent to consultants

• Intramural consultants
• Other recommendation letters
• Teaching letters

Academic Clinician Specific Criteria

• Medical knowledge, clinical judgment, clinical

skills, technical skills

• Communication with other health professionals
• Compassion and respect for and communication

with patients

• Dedication and enthusiasm for patient care
• Professionalism and respect for colleagues,

trainees, and allied health professionals

• Overall performance

Academic Clinician Documentation

• Letters from colleagues and referring physicians
• Evaluations / letters from former trainees and

house staff

• Evaluations / letters from allied health

professionals

Institutional Goals

• Recruitment
• Promotion
• Retention
• Faculty success
• Faculty happiness
• Faculty!!
• It is in the institution’s best interest to make this

straightforward, and successful.

Special Situations and Policies

• Extension of probationary period

– Birth or adoption of a child – Serious medical condition (faculty, family, partner) – Catastrophic event

• Reduction in duties
• Back up care program
• Moving to another track

With thanks, and encouragement !

Thanks to all the people in Mentoring, COAP, Faculty Affairs, TAC, The Division, The Department, and the Dean’s office that support young faculty in achieving their goals.

How to Tell the NIH You are Pregnant…

And other lessons (to date) on growing your career and family.

Jenifer R. Lightdale, MD, MPH Children’s Hospital Boston

Introduction

 Initiate discussion @ initial years of

academic medical careers

 Challenges  Realities  Strategies

 Individual and unique experience  Collective wisdom  No hard and fast rules

And Disclaimer Background

 Jenifer R. Lightdale, MD, MPH

 Residency UCSF  Fellowship Boston  On staff in Boston since 2001  HSR Research Fellowship 2001  KO8 AHRQ “Pediatric Sedation and Patient

Safety” (exp 2007)

 Wear several “hats” at CHB and HMS  GI – Director of Quality and Patient Safety  CRC - Director of Clinical Research Education  Hospital – Executive Sedation Committee, BEST

Labs, PRUDENT Project, COC

• 2

Promotion Buy a house

Background

JL’s original 5-year plan…

Fellowship

Start MPH End MPH

Apply for K

Baby

Work on K

Publish, publish, publish

Promotion

Marriage

Fellowship

Start MPH End MPH

Apply for K

Baby # 1

Work on K

Publish, publish, publish

Promotion

Marriage

K gets funded

Baby # 2

JL’s reality check…

Background

 Work-life balance

 An issue for all physicians

 Unique and particular challenges

 Young academic physicians  Modern era of medicine

 JL’s Anagram

 Strategies

balance

JL’s Anagram…

B A L A N C E

JL’s Anagram…

B A L A N C ENJOY OY

MD Career Satisfaction

 1973 – 86% of 2700 MDs: “no

doubt at all” about career choice 1

 1990 – only 60% reported:

“would enter medical school again” 2

 2000 – more than 37% surveyed:

“less satisfied than 5 years prior” 3

 2009 – U. Chicago (NORC) MDs with less

job satisfaction than clergy and physician assistants 4

1. Hadley, Acad Med, 1992. 2. Harvey, AMA, 1990. 3. Chan, Radiology, 1995. 4. NORC, 2009.

Physician Attitudes

 Perceived stress 2  Collegial environment 3  Frequent, small pleasures 3  Laughter, humor,

lighthearted interactions 4  Affected by more than just long work

hours 1

1. McCranie, Behav Med, 1988. 2. Ramirez, Lancet, 1996. 3. Larsen, JPSP , 2002. 4.Sotile, 2002.

JL as “Living Proof”

 New dx: “New age guilt”

 “It’s okay to love work!”

 Antidote – “I love going home.”  Enjoy it all

 As much of the time as possible. MN , KG and rest of faculty!!

JL’s Anagram…

B A L A N ChoiCE iCE E

Choices in early career/family

 Work

 Academic vs.Private Practice  Primary care vs. Fellowship  Research vs. Clinical  Part time vs. Full time  Take on administrative function  Stay or Move

 Home

 Move or Stay  Rent vs. Buy  ARM vs. Fixed rate mortgage  Children  Public vs. Private school

Making good choices

 Recognize that choice is stressful 1  Maintain sense of control  Value self-protective choices  Take a mid-term view  Embrace “cognitive-dissonance” 2  Recognize when you’ve made the

wrong choice

1. Sotile, 2002. 2. Roese, 2005

JL’s Anagram…

B A L A NICHE HE C E

Developing a niche

 Extremely important to success  Concept that many fail to master  Early years of career (residency

through early faculty)

 Smorgasbord approach 1  Variety of projects  Based primarily on availability

1. Stead et al, Acad Emerg Med, 2005

Important to find your niche:

 Develop a subject (research) area:

 Emphasize strengths  Feel challenged  Passion for topic  STAY FOCUSED!  Take ownership  Talk it up  Publish your data

Niche

 National recognition

 Invited reviews  Chapters in reference texts  Moderate sessions  Invited faculty

 Promotion

JL’s Anagram…

B A L ALLOC LOCATE E TIM IME N C E

Principals of time management

 Schedule “appointments” to get tasks

done1

 Day, week, month  Plan in advance  Establish priorities

 Emphasize flexibility  Take “time out”

 Increase efficiency

• 1. Brunicardi and Hobson, 1996.

Major obstacles to `managing time well:

 Procrastination  Interruptions  Email 1

 “Do it”  “Delegate it”  “Defer it”  “Delete it”

• 1. Allen, “Getting Things Done” 2001.

Allocate time at work:

• 1. AAAS Survey, Science, 2001.

Allocate work vs. home time…

Work Home

• Try to alternate spheres… emphasizing

flexibility as priorities change.

Allocate work vs. home time…

Work Home

• Try to alternate spheres… emphasizing

flexibility as priorities change.

Allocate work vs. home time…

Work Home

• Try to alternate spheres… emphasizing

flexibility as priorities change.

JL’s Anagram…

B A LEARN RN to SAY NO A N C E

Limit setting

 Limit call-time, and afterhours work 1  Set reasonable limits on your

availability to patients/ colleagues

 Use your gut to determine if you are

• verwhelmed

 “Template” responses to say “no” to

both colleagues and patients and learn to use them…

1. Sotile, 2002.

To your colleagues:

 “I would love to, but my plate is full.”  “That sounds great, but I’m

swamped.”

 “I’m honored, but I’m now focusing

• n other areas.”

 “I’m sorry, but that’s out of the

• question. I’ve just been out of the
• ffice and I’m trying to dig out here.”
• 1. Babitsky and Mangraviti, 1998.

To your patients:

 “I am so sorry that you’re having

• difficulty. I’m not available, but

someone I know and trust is. Please let me refer you.”

 “I’m really concerned about you. I’m

sorry that I don’t have more time today to discuss this. Can we schedule a follow-up appointment for us to sit down and explore this further?”

• 1. Babitsky and Mangraviti, 1998.

JL’s Anagram…

B ADJUS JUST L A N C E

Adjust constantly

 Moment-to-moment

balancing act 1

 Day to day  Year to year

 Accept change in plans come with the

territory

 Be confident that you will maintain

priorities

• 1. Allen, “Getting Things Done” 2001.

Promotion Buy a house

Background

JL’s original 5-year plan…

fellowship

Start MPH End MPH

Apply for K

Baby

Work on K

Publish, publish, publish

Promotion

Marriage

fellowship

Start MPH End MPH

Apply for K

Baby # 1

Work on K

Publish, publish, publish Marriage

K gets funded

Baby # 2

JL’s reality check…

JL’s Anagram…

BUY HELP LP A L A N C E

Advantages of Growing UP

 Clinical job

 Administrative Assistance  Nursing assistance

 Grants

 Salary support  Research Assistance/ Technical

support

 Home

 Help with maintenance  Childcare

At work:1

 Identify your resources

 NPs/ RNs  Fellows  AAs  Techs/ RAs  Students

 Delegate wisely

 Think upstream as well as

down…

 Handoff (e.g. Email)  Follow-up  Avoid micromanaging

• 1. Allen, “Getting Things Done” 2001.

At home:

 Identify your resources

 Housecleaning  Home/ yard work  Cooking  Childcare providers  Family

 Delegate wisely  Follow-up  Avoid micromanaging

Conclusion

Question: How do you tell the NI H you are pregnant? Answer: You don’t necessarily need to…

Conclusion:

BUY HELP LP ADJUS JUST LEARN RN to SAY NO ALLOCA LOCATE E TIM IME NICH CHE CHOICE ICES ENJOY OY

Best of Luck!! Thank you for your attention!

2012 2nd Year Fellows Conference Evaluation Form

1 = Poor 2 = Fair 3 = Good 4 = Excellent Comments

• 1. Fellow Orientation – Kara Gross Margolis

Usefulness 1 2 3 4 _________________________________________ Overall 1 2 3 4 _________________________________________

• 2. Academic Appointments and Promotions – David Piccoli

Usefulness 1 2 3 4 _________________________________________ Overall 1 2 3 4 _________________________________________

• 3. A Career in Research – Binita Kamath

Usefulness 1 2 3 4 _________________________________________ Overall 1 2 3 4 _________________________________________

• 4. Why Do I Like Private Practice – Janet Harnsberger

Usefulness 1 2 3 4 _________________________________________ Overall 1 2 3 4 _________________________________________

• 5. ABC’s of What NASPGHAN Can Do For You – Kathleen Schwarz

Usefulness 1 2 3 4 _________________________________________ Overall 1 2 3 4 _________________________________________

• 6. A Journey to the Liver, Bile, and Beyond – Michael Narkewicz

Usefulness 1 2 3 4 _________________________________________ Overall 1 2 3 4 _________________________________________

• 7. Motility: Why You Will Want to Be a Neurogastroenterologist – Carlo DiLorenzo

Usefulness 1 2 3 4 _________________________________________ Overall 1 2 3 4 _________________________________________

• 8. Feed Your Professional Soul: Careers in Nutrition – Kevin Sztam

Usefulness 1 2 3 4 _________________________________________ Overall 1 2 3 4 _________________________________________

• 9. Endoscopy as a Career – Jenifer Lightdale

Usefulness 1 2 3 4 _________________________________________ Overall 1 2 3 4 _________________________________________

• 10. Being a Clinician-Educator: No Longer by Default – Alan Leichtner

Usefulness 1 2 3 4 _________________________________________ Overall 1 2 3 4 _________________________________________

• 11. How to Give a Great Talk – Carlo DiLorenzo

Usefulness 1 2 3 4 _________________________________________ Overall 1 2 3 4 _________________________________________

• 12. Non NIH Funding for the Junior Faculty Member – Mitchell Cohen

Usefulness 1 2 3 4 _________________________________________ Overall 1 2 3 4 _________________________________________

• 13. NIH Early Career Funding Opportunities – Judith Podskalny

Usefulness 1 2 3 4 _________________________________________ Overall 1 2 3 4 _________________________________________

2012 2nd Year Fellows Conference Evaluation Form

1 = Poor 2 = Fair 3 = Good 4 = Excellent Comments

• 14. How to Write a Research Paper – Mitchell Cohen

Usefulness 1 2 3 4 _________________________________________ Overall 1 2 3 4 _________________________________________

• 15. What is the Abbott Nutrition Health Institute – Bob Dahms

Usefulness 1 2 3 4 _________________________________________ Overall 1 2 3 4 _________________________________________

• 16. Industry Talk – Gary Fanjiang

Usefulness 1 2 3 4 _________________________________________ Overall 1 2 3 4 _________________________________________

• 17. International Research as a Pediatric Gastroenterologist and Nutritionist – Kevin Sztam

Usefulness 1 2 3 4 _________________________________________ Overall 1 2 3 4 _________________________________________

• 18. Moving From Mentee to Mentor – Alan Leichtner

Usefulness 1 2 3 4 _________________________________________ Overall 1 2 3 4 _________________________________________

• 19. Creating Your CV and Academic Portfolio – Michael Narkewicz

Usefulness 1 2 3 4 _________________________________________ Overall 1 2 3 4 _________________________________________

• 20. Interviewing and Negotiating for a Faculty Job – Binita Kamath

Usefulness 1 2 3 4 _________________________________________ Overall 1 2 3 4 _________________________________________

• 21. Running a Practice – Janet Harnsberger

Usefulness 1 2 3 4 _________________________________________ Overall 1 2 3 4 _________________________________________

• 22. Negotiating a Contract – Kathleen Schwarz

Usefulness 1 2 3 4 _________________________________________ Overall 1 2 3 4 _________________________________________

• 23. Academic Promotions – David Piccoli

Usefulness 1 2 3 4 _________________________________________ Overall 1 2 3 4 _________________________________________

• 24. How to Tell the NIH You are Pregnant… – Jenifer Lightdale

Usefulness 1 2 3 4 _________________________________________ Overall 1 2 3 4 _________________________________________

• 25. Panel Discussion

Usefulness 1 2 3 4 _________________________________________ Overall 1 2 3 4 _________________________________________

• 26. Conference Overall

Usefulness 1 2 3 4 _________________________________________ Overall 1 2 3 4 _________________________________________

2012 2nd Year Fellows Conference Evaluation Form

1 = Poor 2 = Fair 3 = Good 4 = Excellent Comments My favorite talk(s) was: They could have left this talk(s) out of the program: I wish there had been a talk(s) on: Suggestions/Comments: (what would improve the conference for future years?)