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

IBD research: A guide for fellows and Junior Faculty • Subra Kugathasan MD – Emory University – Prinicipal Investigator, CCFA Pediatric Risk Stratification Initiative • Ying Lu MD – North Shore Children’s Hospital • Athos Bousvaros MD MPH – Children’s Hospital Boston Children’s Hospital Boston – Chair, NAPSGHAN IBD Committee • Sandra Kim MD – University of North Carolina, Chapel Hill – Vice-chair, CCFA Pediatric Affairs Committee • Michael Kappelman MD MPH – University of North Carolina, Chapel Hill • Marjorie Merrick, RN – Research Director, Crohn’s and Colitis Foundation of America Subra Kugathasan, M.D. Professor in Pediatrics & Human Genetics Emory University School of Medicine Current Role and Responsibilities • Division of effort – 50% research – “40%” clinical (6 weeks of service, 3 ½ day clinics, ½ endoscopy) – 10% administration/program development % p g p • Research – Principle Investigator: Risk Stratification & Identification of Immuno-genetic and Microbial Markers of Complicated Disease Course in Pediatric Crohn’s Disease. • 5.4 million, 20 center, 4 year study – IBD genetics of African-Americans – Genomics (methylation) markers of IBD 1

Pathways are not always direct! • Medical school in Srilanka • Pediatric training in the UK for 4 years • Fellowship – Very first exposure to any research research • Mucosal immunology (Dr Fiocchi) • Stayed in the lab for additional one year (good investment yields dividends!) Pathways are not always direct! My circuitous pathway • First real job as an assistant professor (age-38 years) • K23 award (40 years) – Mucosal T-cells in early and late Crohn’s disease • Switched gears – mucosal immunology was not Switched gears mucosal immunology was not going anywhere!!. While side-project – population based IBD epidemiology brought fame. • Extended tentacles into genetics of the IBD. • 5 years later – gene discovery leading to Nature genetics publication. How to get a clinical research started ! Look for a research question ! that interest you There is no substitute for having a good question which is Answerable Important � START small, no project is small to start � Always have a ‘side-project’ � Collaborate � Create a formal plan for execution � Time � resources � Utilize available resources � Do not get turned off with negative feedback from divisional / department 2

How to get started ? Create a formal plan & Time management � Work on your projects for at least 15 minutes – EVERY DAY ! � Start your day with your research on your research days, half days ! � Emails, letters, dictations …… CAN WAIT ! IBD pathogenesis – how to invest, where to invest in 2010? Enteric flora Genetics of interest Immunology Level o Environment Infectious agents 1960 1970 1980 1990 2000 2010 …as time goes by… IBD Research From a Recent Fellow’s Perspective p Ying Lu, MD NASPGHAN 2009 3

Timeline for flu study IRB and Idea for Write IRB grant Start End Analyze Submit Manuscript research and grant approved recruitment recruitment data manuscript accepted Flu season Flu season April May/ Sept Oct Dec Spring June Aug June Second Third year year Timeline for HPV study Idea for Write IRB IRB Grant Start Still research and grant approved approved recruitment recruiting April May/ Sept July Aug Present June 2008 Second Third Graduation year year Research project • Feasible – Resources • money, assistant, statistician, GCRC, CRP – Time – Patients – Patients • Mentorship – Expert in field – Experience with research, grants, publications – Will not fight for authorship – Looks out for your interest, not their own – Approachable, available, willing to help 4

Ideal research project • You’re interested in topic (not just others) • Contribution to field • Niche • IRB approved funded and ready to go • IRB approved, funded, and ready to go • First author paper on original article by graduation • Disclaimer: Even the most simple study requires a lot of work! My personal track • Clinical versus basic science research • Clinical versus research track after fellowship • Future endeavors F t d IBD from the perspective of the “research friendly clinician” Athos Bousvaros MD MPH 5

My career pathway • Began fellowship in 1988, completed in 1991 • Three years in laboratory doing mucosal immunology – Mentor became disenchanted with science, quit during my first research year. – Preferred patient care • Returned to clinical medicine with strong interest in IBD, and desire to apply what I had learned in the laboratory to patients. • Spent the last 17 years doing just that. • Approximately 70% of my time is patient care, the rest being research How can a clinician do research? • Read the literature • Further study – Coursework, MPH • Identify collaborators – Epidemiologists – Epidemiologists – Clinical trials experts – Basic scientists – Statistician is essential • Form a “team” to study IBD • Participate in multicenter collaboratives – CCFA and others The “Wall” vs. the “Web” Microbiology Pharmacology Genetics Epidemiology Outcomes “The wall” – physical separation, profit based medicine, research funding, regulatory (FDA and IRB), personal issues ( ) GI allergy IBD Short Bowel Motility Hepatology 6

My research has reflected my collaborative teams • Angiogenesis – Judah Folkman – vascular biology lab • Tacrolimus in UC – Transplant group at Pittsburgh • Probiotic studies – Jon Vanderhoof and Rose Young – expertise in LGG Jon Vanderhoof and Rose Young expertise in LGG – Patricia Hibberd – clinical trials • Vaccine studies – Denise Jacobson • Microbiome in IBD – Broad Institute, Harvard, and MIT • All my colleagues, both locally and nationally that help. Advice • There is no one pathway to success. • All aspects of academic medicine are important. “Community of Excellence” – Patient care – Clinical research – Basic research Basic research – Teaching – locally, nationally – Preparation of educational materials – Community service – Advocacy • Go and seek out collaborators, and get them interested in IBD. • Become actively involved in NASPGHAN and CCFA • WRITE, WRITE, WRITE Epidemiology and outcomes research Michael Kappelman, MD, MPH Assistant Professor University of North Carolina at Chapel Hill U i it f N th C li t Ch l Hill 7

Current Role and Responsibilities • Division of effort – 75% research – 20% clinical – 5% teaching • Research – Health services research and clinical epidemiology related to IBD (Variation in care and outcomes, descriptive epidemiology, costs, pharmaco-epi ) – Initial funding via institutional K12 award – Currently in process of applying for individual career development awards (NASPGHAN, CCFA, NIDDK) Current Role and Responsibilities • Clinical work – 6 weeks a year “on service” – ½ day of clinic every other week – ½ day of endoscopy per month – Countless “add-on’s” as needed • Teaching – Small group preceptor—med school clinical epidemiology course – Teaching of residents and students rotating through inpatient and outpatient rotations My circuitous pathway • Psychology major as undergraduate • Research assistant for a study of erectile dysfunction • Entered medical school with an interest in psych • Favorite 1 st year course was molecular biology • Spent 1 st summer in basic science laboratory • Additional year of basic science research between med school and residency • Applied for and began fellowship, initial interest in IBD genetics 8

My circuitous pathway • An article in the New Yorker changed my career pathway “ The Bell Curve” by Atul Gawande • Epiphany: Why not apply the same principles used by CF for years to measure and improve used by CF for years to measure and improve IBD care and outcomes? • Switched gears again sometime in the middle of my 1 st year of fellowship • Good advice from Athos: – Go outside the field of pediatric GI and identify a mentor and academic plan to learn new skills and techniques which you will bring back to the specialty Fellowship Training • Primary mentor (methods): – Jonathan Finkelstein: general pediatrician with expertise in QI and health services research, mostly in asthma and abx overuse • Secondary mentors (content): y ( ) – Richard Grand and Athos Bousvaros • Formal training – MPH in clinical effectiveness • Research projects: – Epidemiological study design and analysis of large databases Job Search • Personal happiness matters most (family, friends, support, etc) • Mentor • Negotiations – Worked with division chief/department plan to Worked with division chief/department plan to determine a career pathway (mutually beneficial to me and the program) – Identified necessary resources (protected time, clinical and/or research supplies, equipment, access to patients, etc.) – Past and prior mentors very helpful 9