The Training Page

Career Advice for NIH Clinical Fellows

BY ERIC BOCK, CC

Persevere, learn from your mistakes, and work with collaborators, NIH Director Francis Collins told attendees at the first annual NIH Clinical Fellows Day, held on Friday, October 25, 2013. “Science doesn’t work as a lonely enterprise,” he said. “Make friends, seek out mentors, and look for the chance to team up with others.”

Throughout the day, several other successful NIH physician-researchers offered career advice, too, including Susan Leitman (CC); Marston Linehan (NCI); Elaine Jaffe (NCI); Electron Kebebew (NCI); Steven Holland (NIAID); Anthony Fauci (NIAID); H. Clifford Lane (NIAID); and Henry Masur (CC). Below is an edited compilation of what they had to say:

What is rewarding about performing both research and patient care at the NIH Clinical Center?

• Leitman: A love of science motivates us. At NIH, we’re pushing the envelope and are on the leading edge of discovery. The rewards of combining research and patient care are that we move the field forward and are always learning. The ability to collaborate is another benefit of academic medicine.
• Linehan: There’s nothing more honorable than taking care of patients. Having the opportunity to pursue ideas and take care of patients enabled us to make the progress we’ve made. If you are in an environment where you can collaborate, that’s what medical science should be.
• Jaffe: You have to do what you enjoy and what excites you. You have the opportunity to learn and grow from your patients. There’s a unique opportunity with every patient to learn something to advance science.
• Kebebew: What I enjoy about my work is I get to follow my nose. I wanted to make a significant impact on peoples’ lives. At NIH, every patient you take care of is on a protocol that studies an important question. There’s no better place than NIH to be exposed to the cutting edge of science.
• Holland: People joke that “NIH” stands for “Not in a Hurry” or “Nerds in Heaven.” Ask yourself if you are the right nerd for this heaven.

What were the biggest obstacles in transitioning from a trainee to an independent physician? Any advice?

• Leitman: I would have liked to have had training in statistics, time management, and leadership, but NIH didn’t offer courses in those when I first came here (1980s). NIH offers such courses now and I recommend taking advantage of them. It’s also important to learn to delegate with grace, to devise a scheme to distribute [tasks] among fellows and support staff.
• Linehan: The biggest step was deciding whether I was going to tackle a question that was substantive. Another obstacle was deciding how to focus. People were skeptical of our decision to pursue the gene for kidney cancer, and it was initially difficult to find the right collaborators. But I persisted because my patients were dying and I didn’t know of a better way to help them. It took me awhile to find my niche.
• Jaffe: For women, balancing family with work was a challenge (in the 1970s), but today family demands are more equally shared. The biggest obstacle at NIH is that there’s so much happening that it’s tempting to go in 10 directions at once and not finish anything. Use your time wisely and don’t get distracted. Don’t start something new until you’ve finished what you’ve already begun.
• Kebebew: Define your career goals and make sure they are in line with whichever institution you’re transferring to. Take on challenges and start early to look for funding opportunities. Apply for eight to 10 grants to get a decent career-development award.
• Holland: You’re moving into an arena where the field is vast. You’ve got to define the problem you are going to explore and understand that you won’t be able to master it in two years.
• Fauci: Science is more complicated today. The resources are constrained, but the opportunities are unlimited. Since you cannot do it all, pick out a research question that is relevant and answerable.
• Lane: The challenge is being able to identify the question that is relevant and [that] you can address. Maintain focus and don’t get distracted by issues you can’t control (such as furloughs or Continuing Resolutions).
• Masur: Debt and attaining grants are big obstacles. Develop a passion, and stick with it as an investigator. Keep your clinical skills up-to-date so you can understand relevant questions.

The majority of research projects will fail. How do you not take that personally?

• Kebebew: Trying to answer an important question is not a failure. The initial hypothesis may be incorrect, but you’re still on the path to figuring it out. Sometimes, there’s not always an answer. It’s not a failure if you can’t answer your original question.

Publishing case reports vs. primary research: How do you apportion your time?

• Fauci: You should be doing your research. A case report is a sidebar. It’s okay to sprinkle case reports in your CV as long as there is a theme and you are connecting the dots.

How can you tactfully switch from one lab and/or mentor to another?

• Fauci: The most important thing is doing what you are comfortable with. You should not have to apologize for trying to change something that you are not comfortable with. If that means changing your lab or mentor, so be it.
• Lane: Every so often it doesn’t work out. It’s important to recognize when a situation is not going to work out so you change it. Realize it’s no one’s fault.
• Masur: This is your career. Have the confidence to go to the leadership when things aren’t working out. Don’t waste your time with a bad fit. You need to engage with your mentor.

Any recommendations for how to structure a mentorship?

• Fauci: You may need several different type of mentors for both science and life. Take your time in making a choice. The chemistry between you needs to be right.
• Masur: Sometimes younger people are reluctant to approach people for advice. Don’t be afraid. If you don’t approach them, you’ll never find out. Don’t wait for the world to come to you.

What advice do you have for transitioning from intramural to extramural research?

• Fauci: You need a theme and a question you can articulate. It shows you have a vision and are asking relevant questions.
• Lane: While here at NIH you can meet with program officers and learn what they see as successful; investigators at NIH don’t have the experience.

Have you ever considered leaving NIH and going to academia?

• Fauci: I never seriously considered leaving NIH because I love it. Choose an environment where you can do what you love to do. An academic title is meaningless; do what you want to do.

How did you apportion your research time?

• Holland: The risk is in not getting your research finished. Choose what you’re able to do and follow it. Set your eye on why, and you can’t go far wrong. If you focus and keep working, it’s hard to fail.
• Linehan: The most important thing is to understand that what you learn about science during training is more important to you than what you work on. You’re learning how to think about and do science. And read, read, read. Be the most critical person you can be. The most important person you don’t want to fool is yourself.

Advice in transitioning to extramural: How do you get a chair to invest in you so you can do research and still see patients?

• Kebebew: You have to be a great salesperson. You need to answer and address important questions. The value system has to be in line with what you’re trying to accomplish.
• Linehan: For any position, you need to remember that you do what your boss values. The ideal environment is one in which scholarship and scientific progress is valued. You have to be practical in what you can do, that is you need personal, intellectual, and facilities support to pursue substantive work as a physician scientist.

The NIH Clinical Fellows Day was hosted by the NIH Clinical Center’s Office of Clinical Research Training and Medical Education and by the Foundation for the Advancement of Sciences.