care and feeding of physician neuroscientists training, career development, and independent research...

Care and feeding of Physician Neuroscientists

Training, career development, and independent research

AUPN, ANA and NINDS

Dennis M. D. Landis, M.D.

Professor and Chairman, Department of Neurology,

Case Western Reserve University.

Clinical training and research experience

• Recognition of basic science advances which could be pertinent to human disorders.

• Assisting basic scientists in the design of studies related to human illness.

• Communication with patients and patient advocacy groups about conduct and results of research.

• Educating physicians in the biological basis of clinical disorders.

• Opportunity to apply your ideas in a clinical context, involving patients.

• Personal satisfaction of caring for people and advancing the science and art of medicine

7/1/2004 7/1/2028

7/1/2004 - 6/30/2008College

7/1/2016 - 6/30/2019Residency

7/1/2008 - 7/1/2015Medical School

7/1/2010 - 6/30/2013PhD training

7/1/2019 - 6/30/2021Research Training

7/1/2015 - 6/30/2016Internship

7/1/2021 - 6/30/2026Career Development

7/1/2026 - 6/30/2028RO1

Two years

This timeline summarizes the most common career path for individuals who undertake MD/PhD training, and then clinical training prior to independent research

At first glance, it looks like an incredibly long process. Keep in mind that each phase has intrinsic awards and satisfaction. You should view this timeline diagram as an aid to planning. Anticipate what will be required at each phase, and things will go much more easily

• The mission of the National Institute of Neurological Disorders and Stroke is to reduce the burden of neurological disease.

• The principal strategy is to support research.• A supporting strategy is to guarantee the supply of future

researchers by supporting the training of especially promising individuals

7/1/2004 7/1/2028

7/1/2004 - 6/30/2008College

7/1/2016 - 6/30/2019Residency

7/1/2008 - 7/1/2015Medical School

7/1/2010 - 6/30/2013PhD training


7/1/2015 - 6/30/2016Internship


7/1/2026 - 6/30/2028RO1

Two years

Help From NINDS

Understanding science and physician scientists

• In general terms, the way in which your research is supported changes with your level of training and with evidence of your successful work.

• During research training, your work initially is directed by others.

• During career development, you develop your ideas and strategy with a mentor, and work with suggestions.

• An independent researcher devises his/her own plans, and figures out how to accomplish them.

7/1/2004 7/1/2028

7/1/2004 - 6/30/2008College

7/1/2016 - 6/30/2019Residency

7/1/2008 - 7/1/2015Medical School

7/1/2010 - 6/30/2013PhD training


7/1/2015 - 6/30/2016Internship


7/1/2026 - 6/30/2028RO1

Two years

Sequence of Support

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7/1/2004 - 6/30/2008College

7/1/2016 - 6/30/2019Residency

7/1/2008 - 7/1/2015Medical School

7/1/2010 - 6/30/2013PhD training


7/1/2015 - 6/30/2016Internship


7/1/2026 - 6/30/2028RO1

Two years

Most combined degree students are supported by a training grant to the institution, such as MSTP. It is also possible to obtain individual funding for MD/PhD training

Usually, those who have done research training during medical school will later elect to obtain further research training prior to applying for a career development award, or independent funding

– One approach is to break away from clinical training, obtain definitive research training, apply for independent investigator awards or career development awards during the third year of residency, and then go right to work.

– Restructuring of residency training is underway. The premises are that it is desirable to continue research, and that are certain classes of clinical education can be tailored to the individual needs of the resident.

7/1/2004 7/1/2028

7/1/2004 - 6/30/2008College

7/1/2016 - 6/30/2019Residency

7/1/2008 - 7/1/2015Medical School

7/1/2010 - 6/30/2013PhD training


7/1/2015 - 6/30/2016Internship


7/1/2026 - 6/30/2028RO1

Two years

Research Training During Residency

7/1/2013 6/30/2016

10/1/2013 1/1/2014 4/1/2014 7/1/2014 10/1/2014 1/1/2015 4/1/2015 7/1/2015 10/1/2015 1/1/2016 4/1/2016

7/1/2013 - 6/30/2014First Year

7/1/2014 - 6/30/2015Second Year

7/1/2015 - 6/30/2016Third Year

7/1/2013 - 12/31/2013Primary Neurological Care


10/1/2014 - 12/31/2014Pediatric

3/1/2015 - 3/31/2015Psychiatry

4/1/2014 - 6/30/2014Out-Patient

7/1/2015 - 9/30/2015Out-Patient

Current RRC requirements for Neurology:18 months of adult neurology, including six months of out-patient experience3 months of pediatric neurology1 month of psychiatry

Only 22 months of the 36 month residency are absolutely specified

Current Requirements for Neurology Residency Training

7/1/2013 6/30/2016

10/1/2013 1/1/2014 4/1/2014 7/1/2014 10/1/2014 1/1/2015 4/1/2015 7/1/2015 10/1/2015 1/1/2016 4/1/2016

7/1/2013 - 6/30/2014First Year

7/1/2014 - 6/30/2015Second Year

7/1/2015 - 6/30/2016Third Year



1/1/2014 - 6/30/2014Out-PatientResearch

50:50

7/1/2015 - 12/31/2015Out-PatientResearch

50:50



Residency Training Model: Laboratory-oriented research

This model requires elimination of the requirements for Pedatric Neurology and Psychiatry, butWould allow certification inMedical neurology.

7/1/2014 - 6/30/2015Research 80% effort

7/1/2013 6/30/2016

10/1/2013 1/1/2014 4/1/2014 7/1/2014 10/1/2014 1/1/2015 4/1/2015 7/1/2015 10/1/2015 1/1/2016 4/1/2016

7/1/2013 - 6/30/2014First Year

7/1/2014 - 6/30/2015Second Year

7/1/2015 - 6/30/2016Third Year



7/1/2014 - 12/31/2014Pediatric 50% effort

3/1/2015 - 3/31/2015Psychiatry

1/1/2014 - 6/30/2014Out-Patient 50% effort

7/1/2015 - 12/31/2015Out-Patient 50% effort



Partial Effort during Neurology Residency Training

This would meet baseline requirementsFor medical neurology, but would limitTime available for specialized topics such asEEG, EMG, and pediatric neurolgoy to about5 months.

7/1/2013 6/30/2016

10/1/2013 1/1/2014 4/1/2014 7/1/2014 10/1/2014 1/1/2015 4/1/2015 7/1/2015 10/1/2015 1/1/2016 4/1/2016

7/1/2013 - 6/30/2014First Year

7/1/2014 - 6/30/2015Second Year

7/1/2015 - 6/30/2016Third Year



1/1/2014 - 3/31/2014Pediatric

10/1/2015 - 10/31/2015Psychiatry

4/1/2014 - 6/30/2014Out-Patient

7/1/2015 - 9/30/2015Out-Patient



Neurology Residency Training for Clinical Investigation

7/1/2014 - 6/30/2015Didactic Training in Clinical Res.

In this pattern, an individual might seekCertification in medical neurology and Perhaps a Masters degree in public Health or clinical investigation..

• The interval between completion of residency training and obtaining definitive research support is fun and confusing.

• You’ll have to decide whether you want more specialized clinical training.

• You’ll learn to balance clinical activity and performing the research necessary to earn your own independent funding.

• You now have to give serious thought to the directions of your future work.

7/1/2004 7/1/2028

7/1/2004 - 6/30/2008College

7/1/2016 - 6/30/2019Residency

7/1/2008 - 7/1/2015Medical School

7/1/2010 - 6/30/2013PhD training


7/1/2015 - 6/30/2016Internship


7/1/2026 - 6/30/2028RO1

Two years

After Initial Clinical Training

• It may be necessary to re-enter research training for 1 or 2 years, even if one has not changed interests or techniques.

• Review for K08 and K23 awards seeks substantial preliminary evidence.

• The support mechanism during the gathering of preliminary evidence is usually a NRSA. The stipend is now comparable to a similar year of clinical training.

7/1/2004 7/1/2028

7/1/2004 - 6/30/2008College

7/1/2016 - 6/30/2019Residency

7/1/2008 - 7/1/2015Medical School

7/1/2010 - 6/30/2013PhD training


7/1/2015 - 6/30/2016Internship


7/1/2026 - 6/30/2028RO1

Two years

Research Training After Initial Clinical Training

7/1/2004 7/1/2028

7/1/2004 - 6/30/2008College

7/1/2016 - 6/30/2019Residency

7/1/2008 - 7/1/2015Medical School

7/1/2010 - 6/30/2013PhD training


7/1/2015 - 6/30/2016Internship


7/1/2026 - 6/30/2028RO1

Two years

• In addition to federal support of post-residency research training, you should be aware of grants from:– Professional organizations, such as the American Academy

of Neurology– Private Foundations– Health advocacy organizations, such as American Heart

Assoc., Muscular Dystrophy Assoc., Multiple Sclerosis Society, etc.

Research Training After Initial Clinical Training

• The K08 and K23 career development awards provide salary support for a junior faculty member (not a postdoctoral fellow), money for research (but someone else will have to supplement this), and requires “institutional commitment”.

• The K08 mechanism supports any sort of research.• The K23 mechanism is designed to support clinical research.• A variety of Foundations provide awards similar to the K08 and

K23 mechanisms. These, too, can bridge the interval until R01 funding.

7/1/2004 7/1/2028

7/1/2004 - 6/30/2008College

7/1/2016 - 6/30/2019Residency

7/1/2008 - 7/1/2015Medical School

7/1/2010 - 6/30/2013PhD training


7/1/2015 - 6/30/2016Internship


7/1/2026 - 6/30/2028RO1

Two years

Career Development Awards

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7/1/2004 - 6/30/2008College

7/1/2013 - 6/30/2016Residency

7/1/2008 - 7/1/2012Medical School

7/1/2012 - 6/30/2013Internship


7/1/2018 - 6/30/2021Initial ResearchYour Institution

7/1/2004 7/1/2028

7/1/2004 - 6/30/2008College

7/1/2016 - 6/30/2019Residency

7/1/2008 - 7/1/2015Medical School

7/1/2010 - 6/30/2013PhD training


7/1/2015 - 6/30/2016Internship


7/1/2026 - 6/30/2028RO1

Two years

The K99/R00 mechanism is an alternative to the career development awards. One does 2 years of mentored research, and then has 3 years of funding for independent research in your own institution.

This diagram does not include PhD training

• The R01 mechanism supports investigator-initiated research. Funds may be used for salary support, technicians, equipment, travel, and supplies. The duration of the award is 2 to 5 years, which means regular and rigorous peer review of your progress and ideas. Usually, you can take the grant with you if you choose to move.

7/1/2004 7/1/2028

7/1/2004 - 6/30/2008College

7/1/2016 - 6/30/2019Residency

7/1/2008 - 7/1/2015Medical School

7/1/2010 - 6/30/2013PhD training


7/1/2015 - 6/30/2016Internship


7/1/2026 - 6/30/2028RO1

Two years

Independent Research Support

• Foundation support.• Participation in program project grants as a project

director.• Participation in multi-site NIH-supported clinical trials.• Participation in clinical trials supported by

pharmaceutical companies.• Employment in pharmaceutical or biotechnology

companies

7/1/2004 7/1/2028

7/1/2004 - 6/30/2008College

7/1/2016 - 6/30/2019Residency

7/1/2008 - 7/1/2015Medical School

7/1/2010 - 6/30/2013PhD training


7/1/2015 - 6/30/2016Internship


7/1/2026 - 6/30/2028RO1

Two years

Alternatives and Adjuncts to the RO1 Grant Mechanism

You will succeed

• In recent years, more than half of the R01 grants awarded to individuals with a MD degree have been awarded to MD/PhDs.

• Whole realms of research inquiry are open to you that your PhD colleagues cannot attempt.

• The number of physicians who choose to conduct basic and/or clinical investigation is inadequate.

• The number of elderly persons and the number of patients with disorders affecting the nervous system are increasing

Clinical Loan Repayment Program

• The NIH has addressed the pressing problem of academic debt. A program is in place to pay approximately $100,000 of academic debt, tax free. To qualify, an individual must have succeeded in obtaining grant support—federal (NRSA, K08, K23, R01, project on P50) or Foundation. The work must include clinical research.

What is clinical research?

• “clinical research means patient-oriented clinical research conducted with human subjects, or research on the causes and consequences of disease… involving material of human origin, … for which an investigator or colleague directly interacts with human subjects, …epidemiological, …outcomes, …developing new technologies, …therapeutic interventions, or …clinical trials”

Guiding principles

• Stay informed and plan ahead. The AUPN and ANA will help with more ideas during your K awards.

• Intramural and Extramural branches of NINDS are there to help at every phase, and want to work with you.

• There are funding mechanisms for virtually every research path.

• Choose your research on the basis of its importance and the satisfaction it provides you.

The path is long, but each step has its interest and rewards. Because ideas and interests change, and because fields progress, many of you will seek additional research training after completing clinical preparation and before beginning the mentored career development interval.

7/1/2004 7/1/2028

7/1/2004 - 6/30/2008College

7/1/2016 - 6/30/2019Residency

7/1/2008 - 7/1/2015Medical School

7/1/2010 - 6/30/2013PhD training


7/1/2015 - 6/30/2016Internship


7/1/2026 - 6/30/2028RO1

Two years

Combining Research and Clinical Training

care and feeding of physician neuroscientists training, career development, and independent research...

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