Resident Research News
University of Virginia Department of Pediatrics March 2005
Pediatric researchers don’t just work in the laboratory with pipettes and gels. Pediatric researchers work in university clinics, private offices, and government agencies investigating clinical medicine, health policy, medical education, and more. For this issue of the newsletter, Dr. Robert Chevalier has contributed an informative and inspiring discussion on “Careers in Pediatric Research.” Martha Hellems
UVa Children’s Hospital Research Symposium Call for abstracts – Deadline April 8, 2005.
The Research Symposium is a yearly event highlighting research devoted to the health of children from the clinics and laboratories of investigators at the University of Virginia. This year’s program will be held on May 19 and May 26. It is open to all those who conduct pediatric research at the University of Virginia, and provides a wonderful forum for the exchange of information about research focused on children. Dr. Peter Heymann has announced a call for abstracts for this conference. Instructions and a sample abstract are available at the Resident Research web-site http://www.healthsystem.virginia.edu/internet/pediatric s/peds_research/home.cfm .
In the News
Dr. Jonathan Swanson, PL-3 will be presenting the results of his research at the Pediatric Academic Societies’ Annual Meeting in Washington DC this May. His abstract, “Translation of the High Affinity Fc Receptor Is Driven by Apoptosis in Cultured Rat Ileal Epithelial Cells (IEC) and Is Blocked by Insulin-Like Growth Factor (IGF),” will be displayed in a poster session on Monday, 5/16/2005, 5:15 PM-6:45 PM. Congratulations Dr. Swanson!
New Format for Pediatric Research Forum
Dr. Allan Doctor has modified the format for the Pediatric Department Research Forum; there will be 23 invited faculty discussants asked to lead the Q & A following each presentation. Discussants will be from disciplines other than that of the presenter to ensure a discussion that will be of broad interest to the Department as a whole. This month: Phil Gordon, MD, “How can you be
Pediatric Academic Societies’ Annual Meeting
Consider attending the PAS Meeting, May 14-17 in Washington DC. This meeting is usually wellattending by UVa Pediatric faulty, residents, and fellows. And it’s nearby this year. The meeting agenda includes educational workshops, topic symposia, mini-courses, and presentation of original research in all areas of pediatrics. See their web-site at http://www.pas-meeting.org for more information.
sure when you’re right in research and does it really matter?” with Dr. Bill Clark and Dr. Gene
McGahren leading the Q&A. Mar 11, 1:00-2:00 7 East Conference Room Pizza and soft drinks will be served
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Careers in Pediatric Research Robert L. Chevalier, M.D. Professor and Chair Department of Pediatrics The University of Virginia
The thought of engaging in a research career is often daunting to the pediatric resident. Many residents have not been exposed to research either as undergraduates or in medical school. For those who have worked in a lab, or have participated in clinical research, their view of research may be narrowed or skewed by the particular project or site. Most medical students choosing a career in pediatrics think more of primary care than a fellowship as a goal following completion of their residency training. Nationally, fewer than 30% of pediatric residents choose to go on to fellowship training (about 50% at UVa). This is not surprising. Most of us went into pediatrics because of our love of children, an appreciation of growth and development, or the fact that children are more resilient than adults, and what we do for them has a lifetime impact. By the end of second year, we are beginning to feel we are competent physicians to children, and are anxious to “ply the trade” for which we are serving an apprenticeship. However, we cannot ignore the lure of understanding the mechanisms of disease processes, the frustrations of dealing with unsatisfactory therapy for some of our patients, the challenges of working within our current national health care system, and even the need for new ways to learn medicine and clinical practice. As with most influences in making career choices, our exposure to role models appears to carry the most weight. If we have worked with a pediatrician who derives pleasure and satisfaction from engaging in research, we become interested. The new resident research curriculum developed by Drs. Martha Hellems and Rich Stevenson now makes it even easier for our residents to be exposed to the joys of research. The biggest obstacles to
getting into research are picking a mentor and project, and learning the “nuts and bolts” of doing the work. Because of time constraints, the projects most often chosen by residents involve ongoing clinical studies, usually in the outpatient setting. However, a number of residents have chosen projects in the ICU’s or even basic laboratory research. Unfortunately, given the constraints of the residency curriculum (designed to train the physician to be competent in clinical pediatrics), most residents have little perspective on the career choices involving research. The usual path is to go on to fellowship in a subspecialty, during which two years of research training is the norm. This can involve basic science, clinical, translational, or outcomes research, and there is much more variation in fellowship training programs than among residency programs. Basic research is generally hypothesis-driven, and requires a “critical mass” of mentors and colleagues to acquire the skills needed. Interaction with basic scientists in addition to physician scientists is particularly important. The institution must have the necessary environment, including well-equipped laboratories, an effective animal care and use committee and core laboratory facilities. Clinical research can apply to either the generalist or subspecialist, the inpatient or outpatient venue, and can be hypothesisdriven or outcomes-based. There must be the availability of adequate numbers of patients and ideally a General Clinical Research Center (funded by NIH) and a clinical trials office. The institutional resources should include a staff of research nurses and biostatisticians, and an effective human investigation committee. Translational research can involve basic or clinical research (or combinations thereof), and requires a significant core of investigators, staff, and resources (such as genomic or proteomics facilities). Additional avenues for research include the role of informatics in health care, health policy, and educational research.
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The advantages of an academic position include the environment of bright and stimulating colleagues and access to students, residents, and fellows. There are also opportunities to join professional organizations to network with investigators in regional, national, and international groups. The primary challenge in pursuing research in academic medicine is the allocation of time to do the work. Fortunately, for those committed to a career in research, there are many positions in academic pediatrics with job descriptions assuring the time and resources to launch a career as an independent investigator. Although the pediatric fellow is expected to learn the process and techniques of research, additional time beyond the fellowship is required to become an independent investigator. For this reason, the first academic job following completion of fellowship is extremely important. There should be a formal plan for the mentorship of junior faculty, preferably with financial support to assure “protection” from other competing missions of the department (such as clinical care, teaching, or administration). For some, earning an additional degree may be important in research career development. Examples are a Masters in Public Health, or a Master’s in Health Evaluation Sciences. The academic research career involves the gradual expansion of a skill set that includes the creative process of designing experiments, mastering a variety of techniques, supervising staff, writing grants and papers, and networking with colleagues. It generally involves significant “multitasking”: managing a number of projects at varying states of completion, and with a range of probability for success. The best research portfolio includes “safe” projects with a high probability of publishable results, and “risky” projects that have the highest potential impact. It is difficult to predict the likely point at which an investigator’s career is at its zenith. This may occur early (as for gymnasts), in midlife (as for opera singers), or later in life (as for conductors or authors). The beauty of a career in research is the opportunity to shift from independent investigation to mentoring others, or to bring the knowledge gained to clinical practice.
Not all academic physicians pursue careers as independent investigators. Research in the 21st century is becoming more and more collaborative, and serving as a member of one or more research teams or groups may be highly satisfying. This can be particularly attractive to faculty who wish to devote a greater fraction of effort to other missions (clinical care, teaching or administration), or who have part-time positions. There are also opportunities for research careers in governmental agencies, such as the National Institutes of Health, and the Centers for Disease Control. In these settings, the entire job consists of research (and possibly administration), with no clinical practice other than that associated with patient-oriented research. Governmental positions offer an opportunity to work with large multidisciplinary teams, including junior and senior investigators, postdocs, and support staff. While there is little expectation for teaching, there is also a relative lack of exposure to medical students and residents. Some governmental jobs offer an opportunity to make a broad impact on the health of children. Residents with strong people skills should consider such positions. The range of careers in child health services is particularly broad, and encompasses the entire scope of pediatrics, from genomics to societal issues. The development of the child requires an understanding of changing norms of health, illness, and disability, as well as outcome measures that relate to each stage of development. As the biomedical industry expands, there are increasing opportunities for research positions in the “private sector”. The advantages of working in this arena include excellent resources and environment, and allocation of time to complete the research tasks. The disadvantages include the expectation of working on assigned projects, with little independence or initiative (at least at the junior level). There is, however, a broad range of jobs, ranging from the development of a strictly commercial product to significant
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intellectual freedom investigator).
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Finally, we need to remember that many pediatricians in the private practice setting have contributed significantly to research in outpatient pediatric primary care. All that is needed is a desire to generate new knowledge, and the willingness to carve out time to devote to the research. Although the rewards may include academic advancement for pediatricians with non salaried academic appointments, even those not affiliated with an academic health center derive enormous satisfaction from publishing and disseminating original contributions to the pediatric literature. Types of research include outcomes studies, informatics, and health policy research. The American Academy of Pediatrics has an organization, Pediatric Research in Office Settings (PROS), that currently involves nearly 2,000 pediatric practitioners teamed with research staff at the Academy. In summary, there are enormous opportunities for careers in pediatric research. The completion of the first phase of the Human Genome Project, the explosion of bioinformatics, and increasing recognition of the dependence of the child on his or her social environment make the 21st century the most exciting and promising time of all. We have only to look back at the extraordinary strides made in the last century in preventing or treating infectious disease, disorders of preterm infants, and childhood cancer. We must recognize, however, that such advances have generated new challenges that will require additional intensive research. Examples include new malignancies arising in children undergoing organ transplantation or treatment of primary malignancies, cognitive impairment in very low birth weight infants, or long-term morbidities of children undergoing correction of complex congenital cardiac malformations. The opportunity to make the
future brighter for children, while incorporating the latest scientific advances and working with stimulating colleagues, makes a career in pediatric research one of the richest in the world. [1-8] Reference List 1. Linearity versus cross-talk: Biological models and the role of the Society for Pediatric Research in the 21st century. Pediatr Res 56:177-183, 2004 2. Chesney RW, Dungy CI, Gillman MW et al.: Promoting education, mentorship, and support for pediatric research. Pediatrics 107:1447-1450, 2001 3. Chevalier RL: Research exposure and academic pediatric careers. J Pediatr 143:547-548, 2003 4. Collins FS, McKusick VA: Implications of the Human Genome Project for medical science. JAMA 285:540-544, 2001 5. Cull WL, Yudkowsky BK, Schonfeld DJ et al.: Research exposure during pediatric residency: Influence on career expectations. J Pediatr 143:564-569, 2003 6. Forrest CBSL, Clancy C: Child health services research: Challenges and opportunities. JAMA 277:1787-1793, 1997 7. Kahn CR: Picking a research problem. New Engl J Med 330:1530-1533, 1994 8. Simpson L: Lost in translation? Reflections on the role of research in improving health care for children. Health Affairs 23:125-130, 2004
Resident Research Web-Site
http://www.healthsystem.virginia.edu/internet/pediatrics/peds_research/home.cfm
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