2 nd year fellows conference march 22 25 2012 scottsdale
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2 nd Year Fellows Conference March 22 25, 2012 Scottsdale, AZ - PDF document

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2 nd 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

  1. Academic Clinician Timeline Considerations to Assistant • Excellence in Clinical Practice–Master Clinician • How long is the course to Assistant Professor? – Emphasis on quality and quantity of care • What is the role of 4 th yr fellowship or instructor position? – Innovation in delivery of care • What are the implications of appointment? – Quality improvement – Clock is started – Regional reputation or recognition – Salary may improve • Excellence in Teaching – Master Teacher – Benefits may change (improve) – Didactic, bedside – Research package may be available – Curriculum development, innovative teaching materials and methods – Responsibilities may dramatically increase – Mentoring Timeline and Evaluations GI Modern Family - Many Valuable Roles 18 16 13-14 14-15 15-16 16-17 17-18 18-19 19-20 20-21 21-22 22-23 23-24 14 0 1 2 3 4 5 6 7 8 9 10 12 10 8 Instructor 1 yr review 3 yr review 6 yr review Renew! Professor 6 On to Associate Assistant Nomination 4 Professor Assistant Professor Promotion 2 0 Non-Faculty Review Associate Professor 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 !!!

  2. A Little About Me • Clinician-Investigator • 60% Translational Research A Career in Research – Inherited cholestatic diseases, esp. Alagille syndrome • 30% Clinical Binita M. Kamath MBBChir MRCP MTR – Hepatology (outpatient) and Liver Transplant March 2012 (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? What are you letting yourself in for? • Flexibility – The work is never finished PASSION for the question/area you are • Salary not tied to patient #s studying – Dependent on grants DESIRE to touch the lives of people you will • Rejection never meet • Travel • Public speaking

  3. How to start a research career How to start a research career #1 • Desire and passion 1. Passion and an Inquiring mind • Inquiring mind 2. Pertinent question 3. Time • 90% perspiration, 10% inspiration 4. Money • Gladwell (“Outliers”): 10,000 hour rule 5. Research team Obremsky et al, J Orthop Trauma 2011;25:S124-127 How to start a research career #2 How to start a research career #3-5 • Pertinent question • Time (dedicated, not protected) – who cares? • Money • Testable • Research team – research assistants, – feasible and ethical students, statistician • Find your niche – path to independence • Negotiation The Right Institution How to start a research career • Mentor • Find a mentor and project – First Year! • Division Chief • Find your NICHE • Clinical colleagues • Strongly consider a Masters or PhD (if you • Researchers in the Division – track record don’t already have one) • University

  4. Currency for a Research Career Establishing your Research Career • Define your expertise/skill set • Abstracts • Network • Publications (1 st author) • Collaborations • Chapters, reviews – THEMATIC • Extend beyond your institution • Funding – institutional, foundation, NIH • Consortia Time Management Maintaining your Research Career • Sketch out your career path regularly • Learn to say “No” – Research, clinical, administrative, education • Learn when to say “Yes” – Advisory committee • Thematic • Be a good team player in your Division – Your CV must tell a story – White Board Define Goals Strategies and attributes of highly productive scholars • 3- 5 years……….10 years • Academic promotion • 94 highly productive scholars • Make an impact • Short-answer survey: 5 questions re: strategies in research writing • Division Chief, Section Chief, Research • 56% response rate Director • Nobel prize Journal of School Psychology 49 (2011) 691-720

  5. Recommendations of highly Recommendations of highly productive scholars productive scholars 4. Have protected time to write 1. Follow your bliss, be persistent and work 5. Pursue a systematic line of research that really hard cultivates your expertise 2. Collaborate 6. Stay current in the literature and become a 3. Manage your schedule wisely and prioritize reviewer Journal of School Psychology 49 (2011) 691-720 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

  6. I CAN DECIDE WHAT I WANT TO DO Why do I Like Private  SCHEDULE Practice?  PATIENT MIX  OFFICE LOGISTICS  STAFF JANET HARNSBERGER, M.D.  INCOME SALT LAKE CITY I CAN DECIDE WHERE I WANT TO MY PRACTICE IS PRIMARILY LIVE CLINICAL ON PURPOSE  WHERE MY SPOUSE LIVES  I CAN FOCUS ON PROVIDING MY FAVORITE  WHERE MY CHILDRENS’ EDUCATION IS KIND OF PATIENT CARE WITHOUT WORRY THAT I AM NOT MEETING EXPECTATIONS GOOD FOR RESEARCH AND PUBLISHING  WHERE I CAN ENJOY MY COLLEAGUES, FAMILY, AND SOCIAL LIFE  WHERE I CAN AFFORD A NICE HOME  I CAN DEVELOP MEDICAL ALLIANCES IN THE COMMUNITY TO ENHANCE PATIENT CARE I HAVE CONTROL OVER COSTS What’s it Like? AND INCOME It is like another family  I CAN CHOOSE THE SIZE AND RENTAL Needs nurtured COSTS OF MY OFFICE Nurtures me  I CAN WORK AS MANY HOURS AS I LIKE  I CAN HIRE THE STAFF I NEED It is mostly sane and pretty quiet  I CAN WORK WITH HEALTHCARE I can educate patients and staff TRANSFORMATION SYSTEMS TO FIGURE OUT HOW TO FIX THE OVERWHELMING FINANCIAL MESS OF MEDICINE

  7. Here is My Weekday Life Is Private Practice Right for You?  5:45 : wake up, get ready, have breakfast  Depends on your expectations and what you with Ric, read the paper value  7- 8:30: endoscopy  It is BIG for me to take good care of patients  9- 10 : telephone hour for patients  I find lots of ways to be a good citizen in my  10-2 : see patients in the office professional and my regular life  2- 3 : dictate letters, manage the office,  The relationships you build in your communities will determine your long-term satisfaction couple phone calls  3- 5 : hospital rounds, extra procedures  7pm : exercise with hubby, kids, friends What to Look for in a Will you Find What Your Private Practice Want?  If you are joining an established practice, I  Probably! would think you would want to be sure the  As a group, physicians want the best for aura of the practice is right for you those they watch over. This includes 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?

  8.  NIH  Roche/Genentech  BMS  Novartis  Vertex Kathleen B. Schwarz, M.D. President Ross Conference 2012  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  ,

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

  10.  Information for kids and parents  Image ge of the Mont nth  Digestive topics A – Z  Edit itoria rials ls  Find a pediatric gastroenterologist  Guid ideli line nes  Featured resources – eg dangers of popular  Origina inal article icles magnets! ◦ gastro tro, hepato tology gy, nutriti rition  Comic strip on how to prepare for a  Case report rts/Sho hort rt communica unicatio ions ns colonoscopy – Bowel Prep NO Sweat!  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

  12. Hepatology Clinically • First Faculty Position • Clinical interests drew w patients • Developed further expertise: ERCP, viral  Colorado A Journey to the Liver hepatitis  Given the opportunity i.e. Asked to participate in liver clinic • Took as mu  Welcomed to the clinic by the whole team much transplant call as I could possibly Bile and Beyond  Research at the bench: do do • Hepatic metabolism: partnered with local experts: Neonatology Michael Narkewicz MD  Clinical Research: Mentored by Ron Sokol • Opportunity: I wo would like you to be the director • Philosophy: we all participated: how else will you learn! Professor of Pediatrics of the liver center • Transplant: Hewit-Andrews Chair in Pediatric Liver Disease • Opportunity: Endowe wed chair • TAKE HOME University of Colorado SOM  Confession: I never saw a transplant until I was an attending! ME ME MESSAGE  I learned by apprenticeship: a great way to learn MENTOR KEY • If you put the patient first, good things alwa ways Children’s Hospital Colorado follow: w: for the patient and for you 3 5 A path to a career in hepatology Hepatology Research What advice do I have? • Me • Progression: Medical Student • Keep your interest and skills in general GI  4 th Year Rotation with Bill Balistreri  Found a niche or two  Passion for knowledge and clarity  Viral hepatitis: started with local experience: • Find the person wh • Residency who does liver and follow w them m leveraged adult expertise in HBV and HCV with early around like a puppy dog  Arnold Silverman and Ronald Sokol local treatment attempts that led to publications  Love and passion for GI and Liver and Patient Care  This led to participation in PEDS C and an • Fellows • Look at every liver biopsy at your place by wship introduction to NIH staff yourself  Pediatric Scientist Development Program NIH Funded  SPLIT: PI for PTLD studies  Two years of bench research in Meudon France  PALF • Find a niche expertise for yourself in liver  Centre de Recherches sur la Nutrition  BARC  Developmental regulation of hepatic glucokinase in newborn liver  Finally I had to do my own work: Cystic Fibrosis • Go to The Liver Me Meeting and to the AASLD • Foundation for hepatic metabolism interest single topic conferences 2 4 6

  13. What about that fellowship • Certificate of Added Qualifications in Pediatric Transplant Hepatology • You wi will ma make a lot of PVUs (Patient Value Units Ped ediat atric c Tran anspl splan ant Hep epat atology ology  Began from a move in Internal Medicine to recognize the or Personal Value Units) expertise needed in transplant hepatology  Pediatrics participated in parallel (ABP) • Third Take Home me Me Message ≠ • Current requireme ments • Do Wh What Ma Makes You Happy and Challenges You  Boarded in Pediatric GI and participating in MOC and You Wi Will Have a Great Career!  1 year (12 months) of training in a program accredited for Pediatric Hepatology Ped training in transplant hepatology in US or Canada 7 9 11 Criteria for a Training Program What I do know • Accredited by US or Canadian oversight • CAQ not required by UNOS to care for • UNOS transplant patients UNOS-approved center (for US trainees) • 500 pediatric transplants per year • Pediatric LT specialist and surgeon • MA • At least 6 mo MANY MA MANY MA MANY mo more patients wi with liver months on the IP liver service, we weekly disease wh who do not need transplants continuity clinic for 12 mo months • If you wa want to do hepatology: • Other mo months: hepatology or transplant-related experience, including transplant research  It is great • direct involveme ment in pre-, , peri-, and  It is rewarding postoperative care of at least 10 pediatric LT  It requires you to be interested and to be part of the community patients  It has great research opportunities • direct involvement in OP management of ≥ 20  It has great clinical opportunities  You will not make a lot of RVUs (Relative Value Units) from pediatric LT recipients hepatology procedures 8 10

  14. Why does it matter to me? Motility: Why you will want to be a neurogastroenterologist! Carlo Di Lorenzo, M.D. Jay Pasricha, Gastroenterology, 2011, 140:1126-8 Reasons people dislike motility Why you should give motility and FGID some love… • It is not about pus and blood ( is it • The most important job of the gut is to the testing or the disease?) “move” its contents from mouth to anus • Too invasive • Looks are not everything • “These squiggles do not mean • Motility problems are common anything” (no controls, not predictive, • Lots of “new gadgets” too many artifacts…) • CPT codes have been established • Not trained • Your market value increases (11/13 of last job advertisements mentioned “motility”) • Booooooooring! • Aren’t we all little squiggles on the face of the earth? New gadgets Gastrointest Endosc 2011;73:949-54

  15. “Motility disorders” are not just about Motility disorder demonstrated in: disordered motility Psychosocial • Gastroesophageal reflux factors • Achalasia • Toddler’s diarrhea • Functional abdominal pain Brain – Gut Interactions • Functional dyspepsia • Functional constipation Altered motility / Gut – immune Visceral secretion interactions hypersensitivity • Intestinal pseudo-obstruction • Hirschsprung’s disease • Other g.i. neuromuscular disorders Dogma: Motility disorders rarely have pain as the predominant symptom Test! 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 Emesis Interrupts the ENS Postprandial Program and Initiates Power-Propulsion Program The Migrating Motor Complex (MMC) MMC phase-III activity front Manometric recording 0 5 10 15 20 25 Time ports on catheter (min) Courtesy of Hans Jurgen Ehrlein, DVM B12 B13

  16. 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? P14 Great Role Models! You will be never out of a job! Michael Camilleri Douglas Drossman Michael Gershon Prevalence of Functional Abdominal Pain in Children Prevalence Sweden  IBS, constipation, diarrhea, dyspepsia, 13% Norway 6% and GERS: Finland Holland 8% 3%  All are common United  62% report symptoms Germany Kingdom 2.5% 12% USA  If you are symptom-free, you are in the 13% Italy 10% minority! Thompson WG et al. Dig Dis Sci 2002; 47:225 Chitkara DK et al. Am J Gastroenterol 2005; 100:1868

  17. Prevalence of Pediatric Constipation Functional disorders have an image problem Canada Finland 5-10% <5% UK 5-10% Greece 10-15% Turkey Japan Italy USA 10-15% 10-20% 15-20% 5-10% Saudi Arabia 5-10% Hong Kong >20% Australia Brazil 15-20% 10-20% van den Berg MM et al. Am J Gastroenterol 2006; 101:2401 Physician and patient perceptions: Training! organic vs functional  Train in a program that has a % responding “a great deal” or “very” “Motility Center” Physician response (%) Patient response (%)  Do research in motility Survey question Organic Functional Organic Functional  ANMS training program Problem was serious 35 3 * 60 78 *=p<0.05 Patient was disabled 36 6 * 45 69 *  Extra year of training in motility Request was reasonable 67 25 * 95 100 Doctor was helpful 58 41 91 85 (much like in transplant) Satisfied with 74 67 88 81 recommendation Liked doctor/patient 61 33 * 94 94 Dalton CB, et al. Clin Gastroenterol Hepatol 2004;2:121-6. Participating programs: Training in pediatric vs adults • Cedars-Sinai Medical Center, Los Angeles, CA • Medical College of Wisconsin (Adult ) and Children's Hospital of Wisconsin (Pediatrics),  Better training in adults for anorectal Milwaukee, WI manometry and biofeedback, HRM, • Nationwide Children’s Hospital, Columbus, OH (Pediatric) SmartPill • Penn State Milton S. Hershey Medical Center, Hershey, PA  Better training in pediatrics for • Temple University, Philadelphia, PA • Texas Tech University Health Sciences colonic manometry, impedance, Center, El Paso, TX antroduodenal manometry • University of Iowa, Iowa City, IA • University of Michigan, Ann Arbor, MI  Many psychosocial differences • University of North Carolina at Chapel Hill, NC between children and adults (role of • Wake Forest University School of Medicine, family) Salem, NC http://www.motilitysociety.org/pdf/ANMS_CTP_ Brochure_9.23.10.pdf

  18. Develop special expertise! Take home messages  Upper vs lower  Epidemiology/QOL • Become exposed to motility during  Manometry vs transit your training (give it a chance!) • Find a good mentor  Pathophysiology • Stick with it if you like it  New diagnostic techniques • If you like it, it will pay off  Traditional vs complementary (marketability, fame, “interesting” medicine patients, love from colleagues)  PRO, outcome studies

  19. Pediatric GI and Nutrition hierarchy • Training – General pediatrics • Pediatric GI and Nutrition – IBD Kevin Sztam, MD, MPH – Hepatology – Dysmotility Children’s – Transplant Hospital Boston Nutrition – Allergic disease – Short bowel – Malabsorption syndromes Nutritional Care Why people don’t like it • Everyone eats – who cares • Often secondary consideration • Uncommon cause of medical emergency • Few admissions for purely nutritional • Wide range of normal physiology diagnoses accommodating varied ranges of intake • GI disease often drives nutritional status • Measuring nutrient status can be challenging • Another team can manage it (dietitians, • We know everything already – just give nutritionists, ICU) enough • Other teams do manage it Why people like it Why people like it • Even if intake is adequate, may require optimization • Everyone eats – wide applicability of results • Opportunity to utilize knowledge of basic • Critical to many fields: GI, metabolism, nutrient metabolism surgery, endocrinology, infectious disease, • We really don’t know everything public health, international health, general pediatrics, adolescent medicine, cardiology, • Comfortable with wide ranges of normal psychiatry, neurology, molecular biology, ICU physiology

  20. Training varies in Pediatric GI, So much more Nutrition and Hepatology • Learning related to primary diagnosis • Few subspecialists are exposed to this • Presence of trained dietitians (ie, nutritionists) knowledge base – Variety nutritional deficiencies and excess • Goal in fellowship – Primary and secondary nutritional diagnoses – Understand and treat most common nutritional – Treatment approaches problems • This basic training can lead you to leadership – Know when to refer roles in different disciplines • Wide range of capability among providers Roles for Pediatric GI trained Roles for Pediatric GI trained physicians - Clinical physicians - Clinical • Depends on size and location of clinical program • Parenteral nutrition service • Role is usually team leader – Outpatient (Home parenteral nutrition service) • Coordination • FTT • Outpatient clinic – nutrition specific – Outpatient FTT clinic (multidisciplinary) – Inpatient service – large center – Co-morbid conditions requiring long term enteral – Integrated intestinal failure and rehabilitation nutrition • Congenital cardiac disease programs • Neurologic disease • Metabolic disease • Cystic fibrosis Roles for Pediatric GI trained Roles for Pediatric GI trained physicians - Clinical physicians - Metabolism • Children with non-GI primary diagnoses with • Nutritional assessment major nutritional effects – Indirect calorimetry – Congenital heart disease, spastic – Body composition testing (dexa scans, bioelectric quadriplegia, metabolic disease, impedance analysis, air displacement cystic fibrosis plethysmography) • Metabolic disease • Individual/small GI practice with nutrition niche – Standard of care, alternative therapy, differences in approach

  21. Roles for Pediatric GI trained Roles for Pediatric GI trained physicians - Obesity physicians - Public health • Increasingly important public health issue • Education – Departments of public health, • Pediatric origins of adult disease school-based nutrition programs • National – national societies, nutrition • Prevention guidelines, U.S. DHHS, NIH • Management • Global health – malnutrition and chronic – Behavioral diseases “of excess” – Therapeutic – Bariatric • Nutritional issues aside from hyperlipidemia Roles for Pediatric GI trained Roles for Pediatric GI trained physicians - Industry related physicians - Government • Formula companies • Food and Drug Administration • Food industry – Interacts with industry and investigators – Evaluate research, protocols, devices • Supplement industry • NIH • Part time – consultancy International program development in Roles for Pediatric GI trained developing settings physicians - Research • Assisting development of systems for • Any and all disciplines nutritional care • Usually requires cross-discipline collaboration • Developing local industry/products to support – patients usually followed by service where nutritional care primary diagnosis is categorized • Increasing demand for experts trained in • Nutrition education research and quality improvement – Increase capacity to provide services – Share knowledge of systems

  22. Roles in Nutrition for the Pediatric Gastroenterologist and Nutritionist • Not for everyone • You could find yourself anywhere

  23. ENDOSCOPY IS… • Cool…! • Fun, active • Attractive part of the “job doc” of a pediatric gastroenterologist • Good for people who are “Good with their hands” ENDOSCOPY AS A CAREER • Also, for those who enjoy the [ fill in the blank ] of doing procedures High tech • Jenifer R. Lightdale, MD, MPH New toys • • Satisfying way to help patients • Basically safe ENDOSCOPY IS ALSO… NEED FOR EVIDENCE BASIS • Intrinsically risky • My personal primary motivation for pursuing endoscopy as a career Takes practice Bonus for me: all the other factors still apply • • Constantly evolving as a technology Lots of room for research • • • Different in kids from adults • Lines up well with clinical research/education • Practiced often in the absence of evidence… • 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 THE BASICS * • Not just to be good at doing something… • Upon completion of fellowship, all trainees should be prepared to: • But to be known for advancing knowledge… • Appropriately recommend endoscopic procedures as indicated • So that everyone else can become better • 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.

  24. ROLE OF YOUR TRAINING DIRECTOR: THE TRAINING PROCESS • An expert endoscopist and teacher who should monitor • There is a natural progression as trainees accrue more technical expertise and on a regular basis confidence. • Acquisition of skills • Observation • Success in defined objective performance standards • Practicing the basics • “Must be appropriately trained in the SKILLS OF PATIENCE, TACTILE (!) and • Recognizing normal AND abnormal endoscopic findings VERBAL INSTRUCTION that characterize effective teachers of endoscopy..”* Learning manuevers /”tricks” • Ideally be actively involved in research in the field of endoscopy • Rate of skill acquisition known to vary • Enhances the quality of the trainees • • Consistently – takes 100-150 procedures to be safe overall learning involvement…”* vs. competent • Many more (i.e. >400 colonoscopies)* to be good *Spier B, GIE, 2010. GAGES – COLONOSCOPY SCORESHEET G LOBAL A SSESSMENT OF G ASTROINTESTINAL E NDOSCOPY S KILLS SCORE  HOW DO YOU KNOW WHEN YOU’RE COMPETENT SCOPE NAVIGATION Reflects navigation of the GI tract using tip deflection, advancement/withdrawal and torque 5 Expertly able to manipulate the scope in the GI tract autonomously 4 3 Requires verbal guidance to completely navigate the lower GI tract 2 1 Not able to achieve goals despite detailed verbal guidance requiring takeover • Still a matter of HUGE controversy SCORE  Recent development of valid measures • USE OF STRATEGIES Examines use of patient positions, abdominal pressure, insufflation, suction and loop reduction to comfortably complete the procedure 5 Expert use of appropriate strategies for advancement of the scope while optimizing patient comfort 4 GAGES* • 3 Use of some strategies appropriately, but requires moderate verbal guidance 2 1 Unable to utilize appropriate strategies for scope advancement despite verbal assistance • CAT (Pediatric Specific) SCORE  ABILITY TO KEEP A CLEAR ENDOSCOPIC FIELD Utilization of insufflation, suction and/or irrigation to maximize mucosal evaluation 5 Used insufflation, suction, and irrigation optimally to maintain clear view of endoscopic field 4 3 Requires moderate prompting to maintain a clear view 2 1 Inability to maintain view despite extensive verbal cues SCORE  INSTRUMENTATION (if applicable; leave blank if not applicable) Targeted instrumentation: evaluation is based on ability to direct the instrument to the target 5 Expertly directs instrument to desired target 4 3 Requires some guidance and/or multiple attempts to direct instrument to target 2 1 Unable to direct instrument to target despite coaching SCORE  QUALITY OF EXAMINATION Reflects attention to patient comfort, efficiency, and completeness of mucosal evaluation 5 Expertly completes the exam efficiently and comfortably 4 3 Requires moderate assistance to accomplish a complete and comfortable exam 2 1 Could not perform a satisfactory exam despite verbal and manual assistance requiring takeover of the procedure * Vassilou, Am J Surg, 2011 WHAT ABOUT ADVANCED PROCEDURES? WHAT ABOUT ADVANCED PROCEDURES? • ERCP More complex and technically demanding • More complex and technically demanding EUS • Generally carry higher risk of complications • Generally carry higher risk of complications ACHALASIA Treatment • Required less frequently than standard procedures • Required less frequently than standard procedures Advanced hemostasis Manometry catheter placement • Number of individuals trained to do them can be smaller • Number of individuals trained to do them can be smaller Stricturoplasty • Same rules about “numbers needed to be good” still apply • Same rules about “numbers needed to be good” still apply Stent placement Endoscopic mucosal resection (EMR) • By the guidelines*, training in advanced procedures • By the guidelines*, training in advanced procedures Endoscopic submucosal dissection (ESD) • Founded on a thorough mastery of standard procedures • Founded on a thorough mastery of standard procedures Enteroscopy (single vs. double balloon) • Requires year(s) of extra training beyond 3-year fellowship • Requires year(s) of extra training beyond 3-year fellowship Endoscopic fundoplication POEM • Requires adequate patient volume AND faculty expertise • Requires adequate patient volume AND faculty expertise *Principles of Training in Gastrointestinal Endoscopy, GIE, 1999. *Principles of Training in Gastrointestinal Endoscopy, GIE, 1999.

  25. OPTIONS FOR ADVANCED TRAINING OPTIONS FOR ADVANCED TRAINING • Advanced/Therapeutic Fellowships • Alliance with local adult colleagues • i.e. MGH/BWH, Columbia, HUP, Mayo, Cleveland Clinic, etc. • Arrange for dedicated time to train • Generally aimed at adult fellows • Coordinate with adult fellows • Some precedence for training pediatric fellows • May require malpractice insurance adjustments • Offers high volume, structured training May also include training in statistics, epidemiology, study design Alliance with local pediatric expert • • Goal is to develop “academic” physicians Ad hoc fellow vs. junior faculty position • • • Through a MATCH process as of this June 2012* • Requires adequate patient volume to allow trainee and trainor to practice skills *http://www.asge.org/apps/aef/aef_main.aspx *http://www.asge.org/apps/aef/aef_main.aspx OTHER OPPORTUNTIES FOR LEARNING ULTIMATELY • “Hands - on” Pediatric Endoscopy Courses • Important to understand what skills you are going to need • NASPGHAN Align your expectations with those of the group you are joining • • NASPGHAN/ASGE at the IT&T Center Firm commitment from your Division Chief (or whoever is hiring you) • • ASGE • Resources you will need • CME • Adequate “protection and support” • International opportunities • Understand procedural environment • Simulation • Establish backup call options • Nice to learn a technique BEFORE a patient needs you to know it • If joining a large group, need commitment for you to have the time • Computer-based • Do procedures • Porcine • Learn new skills • I ntense training for a few hours cannot substitute for repeated and persistent exposure… PEARLS NO MATTER WHAT YOU DO THANKS AND GOOD LUCK! • 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 •

  26. Objectives • Understand current options for academic promotion as a clinician-educator Being a Clinician-Educator: • Evaluate scholarship in education using No Longer by Default recognized criteria • Access resources for obtaining training Alan Leichtner, MD • Be prepared for the future innovations in Abbott Conference medical education How to be Promoted: The Dilemma of the Let’s Start with a Survey Clinician-Educator circa 1990: • Clinical work • Research • Medical education New HMS criteria for promotion History of Promotion at HMS Researcher Researcher Teacher/Clinician Researcher Clinician Educator

  27. BUSM’s Faculty Site Promotion Criteria at BUSM “Extraordinary educators, clinicians and researchers” What Activities Support Promotion as Tracks at BUSM 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 Numbers of mentees; Publications with trainees; Feedback from Mentorship mentees; Accomplishments of mentees Clinical Teaching and Level of teaching activities; Evaluations from mentees; Mentorship Leadership roles in education in professional societies; Direction of successful courses; Innovative teaching methods Administrative Teaching Success of programs led (popularity, evaluations, emulation) Leadership Roles 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 Boyer’s Model of Scholarship 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

  28. List of Criteria for Evaluating Buzz Group or “Think, Pair, Share” Educational Scholarship HOW DO YOU ASSESS SCHOLARSHIP IN MEDICAL EDUCATION? 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 Standards for Assessing Scholarship Standards for Assessing Scholarship Glassick Glassick Criteria Clarifying Questions Criteria Clarifying Questions 4. Significant Does the scholar achieve the goals? Does the scholar’s work add 1. Clear Goals Does the scholar state the basic purpose of his or her work clearly? Results consequentially to the field? Does the scholar’s work open Does the scholar define objectives that are realistic and achievable? additional areas for further exploration? Does the scholar identify important questions in the field? 5. Effective Does the scholar use a suitable style and effective organization to 2. Adequate Does the scholar show an understanding of existing scholarship in Presentation present his or her work? Does the scholar use appropriate forums Preparation the field? Does the scholar bring the necessary skills to his or her for communicating the work to its intended audiences? Does the work? Does the scholar bring together the resources necessary to scholar present his or her message with clarity and integrity? move the project forward? 6. Reflective Does the scholar critically evaluate his or her own work? Does the 3. Appropriate Does the scholar use methods appropriate to the goals? Does the Critique scholar bring an appropriate breadth of evidence to his or her Methods scholar apply effectively the methods selected? Does the Scholar critique? Does the scholar use evaluation to improve the quality of modify procedure in response to changing circumstances? future work? The Audience Keep a Portfolio • Lectures, clinical precepting, other educational sessions, courses – Audience, Evaluations, Impact – Participation, Direction Inter- Patient and UME GME UME professional Family • Innovative tools for teaching and/or evaluation • Mentoring • Leadership roles – Rotation Director, Program Director, Course Director • Scholarship – Not just Research

  29. Where to Publish Training as an Educator • Mentors • Medical education journals • Academies or Medical Educator Communities • Medical journals • University Resources • On-line sites • Courses, e.g. Harvard Macy Institute – MedEd Portal • Fellowships – ACGME Site • Advanced Degree Programs – Traditional – MEd, MMEd, MHPEd – On-line or Hybrid Trends in Medical Education • Simulation: Cognitive skills, procedures, team training, systems design EXAMPLES OF NEW TECHNOLOGY • Endoscopic procedures: Simulators, live courses, IN MEDICAL EDUCATION hands-on courses • Project-based Learning • Team training – Crisis Management, Patient Safety and Quality • Inter-Professional Education • On-Line Resources Is the Lecture Dead or moving on-line? The Digital Revolution Khan Academy Link to Khan Academy Digital Native Digital Immigrant • • Born before 1980 Born after 1980 (Mostly Millenials) • Can speak digital, but have • Native speakers of computers, an accent, e.g. print out videogames, digital music, emails, call someone to see video cams, cell phones if they received email, bring • Prefer to receive information people into office to see a quickly, from multiple sources screen • Prefer to interact with content • Don’t understand skills of • Constantly multitasking digital native Digital Native and Immigrant coined by Marc Prensky Slide Modified from Curtis Whitehair

  30. Not Just Wikipedia: The Wiki in Medical Blogs: Ask the Mediatrician Medicine - GanFyd Link to Ganfyd Link to Mediatrician Beyond Simulation: Virtual Virtual Conference Room Environments Second Life Link to Second Life 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

  31. 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

  32. Why you should listen to this talk How to give a great talk • Listening is hard work! Carlo Di Lorenzo, M.D. • 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 Cardinal rules • Communicate your ideas and evidence • Tell them what you are going to tell them • Persuade your audience that they are true • Tell them • Be interesting and entertaining • Tell them what you told them • In summary, tell a story and make it a good one, build an arc • And do not worry: people do not learn from talks! Do not apologize Show enthusiasm • “I did not have time to prepare this • Have a good attitude and smile talk properly” • Your audience is more likely to • “My computer broke down so I will remember your personal style than your present only half of the data” content • “I do not have time to tell you about • An enthusiastic speaker can make an this” average talk good, and a good talk great • Ok to be anxious (adrenaline is a great • “I do not feel qualified to address drug!) this audience”

  33. The beginning The invitation You have two minutes to engage • What is the purpose of the meeting your audience: • Who is the anticipated audience • Why should I tune into this talk (most important!) • What is the problem? • Respect your audience • Why is it an interesting problem for • Format and time allowed me? • Other presentations at the meeting What to put in Preparation 1) What you believe is important • Teach them something they do not know 2) What the audience will find interesting • Very last minute information 3) There is no number 3 • Be enthusiastic but balanced! 4) You do not have to tell them • Not everybody loves urea cycle everything you know (even defects (or motility disorders) though it is sooooo important)! Preparation Being seen, being heard • Have something to say • Speak to someone at the back of • Use slides to illustrate your points, do not decide what to say based on your the room, even if you have a slides microphone on • The problem of hand-outs (including this • Make eye contact; identify a one) nodder, and speak to him or her • KISS: Keep It Short and Sweet (better still, more than one) • Audience reads 3 times faster than you • Move! can speak • Watch audience for signs of fatigue • Slides are not a teleprompter

  34. If you are beginning to lose the audience The jokes • “Wake-up slide” • Joke • Question • Interaction with the audience • Skip complicated slides (not ideal!) Visual jokes Some jokes require time OK in every country Dilbert does not work in Argentina The mystery of the “Sphinxter” “Do not tell bad, old or insensitive jokes; do not use jokes in front of small audiences” (Di Lorenzo, 2012 )

  35. Text • Spelling and grammar – Don’t rely on built-in fools tools How to make good slides – Get help • Print the slides • KILL (Keep it large and legible) • Rule of fives (sixes, sevens) – Five words per line – Five lines per slide Fonts - Bad Slide Structure – Good • If you use a small font, your audience won’t be able to read what you have • Use 1-2 slides per minute of your written presentation • CAPITALIZE ONLY WHEN • Write in point form, not complete NECESSARY. IT IS DIFFICULT TO sentences READ • Include 4-5 points per slide • Don’t use a complicated font • Avoid wordiness: use key words and phrases only • Be consistent • Names the axes of all graphs Slide Structure – Good Slide Structure – Good Show one point at a time: • Make sure the slides show what they are supposed to show (no “this slide – Will help audience concentrate on doesn’t really show it but…”) what you are saying – Will prevent audience from reading • And not more… ahead • Take time to explain – Will help you keep your presentation • Assume the audience is naive focused

  36. Slide Structure - Bad Distracting animations • Do not use distracting animation CAN ≠ SHOULD • Do not go overboard with the animation • Be consistent with the animation that you use • Make sure your animation works Color - Good Color - Bad  Using a font color that does not contrast with  Use a color of font that contrasts sharply with the background color is hard to read the background  Using color for decoration is distracting and – Ex: blue font on white background annoying.  Use color to reinforce the logic of your  Using a different colour for each point is structure unnecessary – Ex: light blue title and dark blue text – Using a different color for secondary points is also  Use color to emphasize a point unnecessary – But only use this occasionally  Trying to be creative can also be bad Background – Bad WATCH THE DAY TURN TO NIGHT AS THE SUN SETS ON  Avoid backgrounds that are distracting or THE TOP OF THIS ONE! difficult to read from  Always be consistent with the background that you use Are you reading my very important point or are you looking at that stupid animation?!?. 32

  37. Rehearse Travel • Check length, contents, flow • Bring back up • By yourself and in front of audience • E-mail it to yourself that can give honest and • Do not check it in (same for good constructive feedback clothes if the talk is same day or • Print the slides and read them early AM on day after) • Do not have to accept every • Laptop allows very last minute suggestion (you know the topic changes (experienced presenters) better than anybody else) Day of the presentation Presentation • Be rested • Do not read • Dress up comfortably • Translators (allow them time to catch up) • After you have given the presentation to • Timing of slide entrance (ok to keep a the organizers, review it one more time copy of your slides at the podium) • Check the room and the set-up • No fancy fade ins • Water • No really, don’t • Bathroom The end Mistakes to avoid • Closing slide • DO NOT read your slides • Closing comments (thank audience and • DO NOT stand behind the podium person for asking the question) • DO NOT dress casually • Questions: • DO NOT face the screen - When to repeat the question • DO NOT use too many acronyms - Uninterpretable (or stupid) • DO NOT shake the laser pointer (not a questions – escape routes lightsaber!) • DO NOT use casual language (thing, stuff, - When you do not know the answer just, cool, you guys…) • Disconnect your microphone!

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

  39. Non NIH Funding for the Junior Faculty CCHMC Sources of External Funding Member Fiscal Year 2011 State 1% Other Mitchell B. Cohen, MD 6% Federal Industry Professor and Vice Chair of Pediatrics 86% 7% Director, Gastroenterology, Hepatology and Nutrition Cincinnati Children’s Hospital Medical Center CCHMC Sources of Federal Funding CCHMC Sources of NIH Funding Fiscal Year 2011 Fiscal Year 2011 National Heart Lung & Blood Institute (NHLBI) 27,194,368 Nat’l Inst. of Allergy and Infectious Disease (NIAID) 15,597,771 National Institutes of Health (NIH) 110,775,374 Nat’l Inst. of Diabetes and Digestive & Kidney Disease (NIDDK) 15,359,053 Agency for Healthcare Research and Quality(AHRQ) 13,604,616 Nat’l Inst. of Child Health & Human Development (NICHD) 12,588,512 Nat’l Inst. of Neurological Diseases and Stroke (NINDS) 8,140,455 Health Resources & Services Administration(HRSA) 5,133,213 National Cancer Institute (NCI) 6,496,551 Centers for Disease Control (CDC) 3,458,165 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 Department of Defense Army (DOD) 2,286,752 National Institute of Mental Health (NIMH) 3,520,469 Substance Abuse & Mental Health Service Admin(SAMHSA) 686,229 Nat’l Inst. of General Medical Sciences (NIGMS) 2,723,720 National Center for Research Resources (NCRR) 2,621,625 Food & Drug Administration (FDA) 538,853 Nat’l Inst. on Deafness & Other Communication Disorders (NIDCD) 2,418,618 Administration on Developmental Disabilities(ADD) 502,327 National Eye Institute (NEI) 2,395,459 National Institute of Aging (NIA) 770,865 Department of Education(DOED) 189,241 National Institute of Dental Research (NIDR) 526,481 Department of Health and Human Services(DHHS) 157,626 National Library of Medicine (NLM) 268,600 National Institute of Nursing Research (NINR) 147,317 Department of Labor(DOL) 94,190 National Institute of Biomedical Imaging and Bioengineering (NIBIB) 96,534 National Science Foundation(NSF) 37,542 Total 110,775,374 Total 137,464,128 A personal funding journey: CCHMC Foundation and Other Agency Awards Fiscal Year 2011 NIH funding • Individual NRSA, NIDDK "E. coli heat-stable toxin: Cystic Fibrosis Foundation 744,660 Gastrointestinal receptor response." (DK 07790), July Charley’s Fund 664,148 1986- June 1988, $66,000 American Heart Association 546,500 Hamilton County Public Health 459,088 March of Dimes 402,954 • Clinical Investigator Award, NIDDK "Regulation of ST Crohn’s & Colitis Foundation of America 355,887 action: Human intestinal ST receptor." (DK 01908), July The Hospital for Sick Children 266,882 1989- June 1994, 75% effort, $374,600 Robert Wood Johnson Foundation 265,299 American Cancer Society 230,000 The American Bd. of Med. Spec. Research & Educ. Fdn. 219,654 • NIH: Expression and function of the guanylin ligand family. The Leukemia and Lymphoma Society 218,271 RO1 DK47318 1995-2011 Cancer Free Kids 215,000 Miscellaneous Other (88) – average ~60K/award 5,193,270 Total 9,781,613

  40. • T32 DK07727, Program Director: MB Cohen, Training Program in Pediatric • NIH: Test kit to quantify fat absorption in cystic fibrosis. (R42 DK 48537), (M. Gastroenterology and Nutrition: 5% effort; 07/01/05 - 06/30/15 $2,009,290 Janghorbani, PI), $388,817; Co-investigator, 15% effort, 11/01/96-10/30/98 (subcontract $120,503) • DK058701 Studies on intestine-enriched transcription factor, IKLF (20% effort) 09/01/2001 - 06/30/2006, MB Cohen, PI • NIH: Biomedical Research Support Grant (RR 05535) Enteroaggregative Escherichia coli heat stable toxin, May 1991 - March 1992, $11,000 • 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 • NIH: Biomedical Research Support Grant (RR 05535): Localization of guanylin and the E. $207,366 coli heat stable enterotoxin receptor by in situ hybridization, December 1992 - September 1993, $7,500. • R24 DK 064403, Cincinnati DDRDC: Center for Growth and Development (CGD), 04/01/03-03/31/08, MB Cohen, PI (15% effort) • 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: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 • NIH: Development of accurate test kits for malabsorption. (R43 DK 48190), (M. in Pediatric Digestive Disease Janghorbani, PI), 7% effort, $79,324, subcontract, 9/30/94-3/31/95, $10,000. Non-NIH funding B orderline pancreatic function in cystic fibrosis. (R43DK55924-01A1), (M. Janghorbani, PI), • American Gastroenterological Association • $91,415; Co-investigator, 5% effort, 06/01/00-05/31/01 (subcontract $30,000) – 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 • NIAID-DMID-94-29: N01-A145252: Evaluation of control measures against human – Research Preceptorship, Michelle R. Ritter, Summer Student, May 1989- August 1989, $1,500 infectious diseases other than AIDS. Co-investigator. (GM Schiff, PI.), MB Cohen – Mentor, AGA Senior Fellowship Research Award to Dr. Glen Lewis, July 1993-June 1994, $7,500. Coinvestigator: 25% effort, 1994-2002, $11,374,000 – AGA Summer Undergraduate Research Fellowship to Noeet Elitsur, ($4000), 2003 • DMID Protocol # 07-0052 A Randomized, Double-blind, Placebo-controlled Dose – Sponsor/Mentor: Praveen Goday 1999-2001 ($72,000) Escalation, Inpatient Phase I Study to Determine the Safety and Immunogenicity of a – Sponsor/Mentor: Jeffrey Rudolph, MD 2000-2002 ($72,000) 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 • ALF: – Mentor, American Liver Foundation Award to Dr. Jane Balint, July 1994-June 1995, $7,500. • 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 of Enteric Vaccine: 30% effort, 6/1/02-5/31/07; 10% effort 11/1/07-10/31/12. • AstraZeneca – Unrestricted Educational Grant 1999, $3,995 • 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 • Avant Immunotherapeutics (dmLT) from Enterotoxigenic Escherichia coli, 20% effort – Choleragard planning grant, MB Cohen PI $10,000 07/01/06-06/30/07 • Bristol-Myers • Mead Johnson Nutritional Group – "Intestinal receptor for E. coli heat-stable enterotoxin: Increased receptor density and potential role as a receptor for an intestinally – Development of accurate test kits for malabsorption. Project 8538. September 1994-September 1995. $24,000 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 • Miles Pharmaceutical Company: – Prospective, controlled double blind randomized comparison of ciprofloxacin vs trimethoprim/sulfamethoxazole vs • CCHMC 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 – Regulation of STa-induced intestinal secretion.“ Trustee Award, July 1988-June 1991, $92,000 – Prospective, double-blind, randomized comparison of Ciprofloxacin 500 mg daily for 3 days vs. trimethoprim- – Translational Research Initiative, $3,000 DDRC Retreat, 2002 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, • Cystic Fibrosis Foundation 5% effort, $26,259. – 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) • Procter and Gamble Company – Fellowship Sponsor (Stephen Guthery), (GUTHER99B0), 1999-01 ($76,000) – Escherichia coli pathogen assays. February 1993-February 1994. $80,000. – Fellowship Sponsor (Valerie McLin (MCLIN01B0) 2001-3 ($84,500) – Efficacy of bismuth subsalicylate in decreasing stool output in children with short bowel syndrome or intestinal – Clinical Fellowship to Nissa Erickson (ERICKS03B0)July 1, 2003-June 30, 2004 $42,000 aganglionosis. September 1994- September 1995, $25,000 – First Year Fellowship Award (Pasternak PASTER05B0) 7/1/05-6/30/06) 7/1/05-6/30/06 $42,000 – Fellowship Research and Education, 1997-1998, $5,000 – Unrestricted Educational Grant, 1998, $2,400 • Marion Merrell Dow Foundation – Bifido 624 in Prevention of Day Care Diarrhea, MB Cohen, PI 06/15/02-10/15/03 $367,000 – 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)

  41. May need help to stand on your own • 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 of SYNSORB Pk in the Treatment of Uncomplicated VTEC Gastroenteritis in Children (PK001A), 08/12/99 - 08/11/00 $73,430 Why apply for non-NIH Funding? “Negatives” • Gets YOU on the playing field • Usually smaller grants – less ROI – Provides more targeted award – written for YOU • Usually less indirect costs • Career development – time limited opportunity • Sometimes cannot keep all or some of the award with • Focused area – more specific to your research – Designed to help you get NIH funding and/or leverage your NIH award NIH money (additional trainees, specific supplies, etc) • Not always easier to get than NIH award – Offers better pay line (not always) • Round peg – square hole (does a colleague agree it is – Bolsters institutional confidence (and yours) in the initial written for YOU) investment • If professional society – usually need to be a member. – Gets you known by those in the field – Gives practice at organizing (thoughts and administrative • Bottom line, be aware of limitations but NON-NIH details) for NIH grant funding SHOULD be part of your portfolio. – Not everyone plans (wants) to get an NIH grant Non-NIH Sources of Funding: • CDC-Centers for Disease Control and Prevention Federal – May have separate set asides, e.g, IBD • Office of Orphan Products Development – http://www.grants.gov/ – Clinical development of products for use in rare diseases or • AHRQ - Agency for Healthcare Research and Quality conditions. The products can be drugs, biologics, medical devices, or medical foods. – Comparative Effectiveness – http://www.fda.gov/ForIndustry/DevelopingProductsforRareDiseases – Prevention and Care Management Conditions/WhomtoContactaboutOrphanProductDevelopment/default .htm – Health Information Technology • DOD- Department of Defense – Patient Safety – Focus varies by congressional mandate (congressionally directed – Innovations/Emerging Issues medical research programs), e.g, genetics of food allergy – Can use local QI or national QI networks as springboard for – http://cdmrp.army.mil/funding/default.shtml grant applications – http://www.darpa.mil – http://www.ahrq.gov/fund/ragendix.htm

  42. Foundation • HRSA -Health Resources and Services • NASPGHAN Foundation Administration – http://www.naspghan.org/wmspage.cfm?parm1=664 – HRSA makes grants to organizations to improve and expand health care services for underserved people. • NASPGHAN Foundation in Office Member Grant for – http://www.hrsa.gov/grants/apply/index.html 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 • NASPGHAN Foundation/TAKEDA Pharmaceuticals Awards $75,000 per year for two years; 70% protected North America Research Innovation Award time to conduct the proposed work. Two-year grant for innovative, high-impact research 1. NASPGHAN Foundation/George Ferry YIA in pediatric gastroenterology, hepatology and nutrition. Applicants at any career level may apply. 2. NASPGHAN Foundation/Nestlé Nutrition YIA • NASPGHAN Foundation/ASTRAZENECA Research 3. NASPGHAN Foundation/Crohn’s and Colitis Foundation Award In Peptic Ulcer Diseases of America YIA (offered in even numbered years) • NASPGHAN Foundation Fellow to Faculty Transition Epidemiology, pathogenesis, natural history, Award in Inflammatory Bowel Disease genetics, diagnosis and management of peptic Senior pediatric gastroenterology fellows -additional diseases affecting children. clinical and research expertise in pediatric IBD. AGA/AGA Foundation/FDHN Research Scholar Awards http://www.gastro.org/aga-foundation/grants 2003 AGA Foundation Research Scholar Award Recipients AGA Foundation Research Scholar Award Recipients 1993 AGA Foundation Research Scholar Award Recipients 1984 – Present Paul Dawson, MD Srisaila Basavappa, PhD David Polk, MD Ezra Burstein, MD Lauren Gerson, MD 1984 AGA Foundation Research Scholar Award Recipients Menno Verhave, MD Holger Kulessa, PhD Nathan Bass, MD, PhD Eugene Chang, MD 1994 AGA Foundation Research Scholar Award Recipients Hiroshi Nakagawa, MD, PhD Robert Schwabe, MD Gordon Luk, MD Sheila Crowe, MD Gianrico Farraugia, MD 2012-13 AGA Research Foundation Awards - At a Glance James Madara, MD Laurence Miller, MD Herbert Gaisano, MD 2004 AGA Foundation Research Scholar Award Recipients Andrew Chan, MD Jean-Pierre Raufman, MD Joanna Groden, PhD Eligible Award Amount Term # of Application Start Steven Powell, MD Sushovan Guha, MD, PhD Joseph Sellin, MD Award Name Richard Weinberg, MD Chin Hur, MD Zhiping Li, MD Category Awards Deadline Date Michael Wolfe, MD 1995 AGA Foundation Research Scholar Award Recipients Yuriko Mori, MD, PhD Frank Anania, MD Mary Rinella, MD Bobby Cherayil, MD AGA-Takeda Research Scholar Award in Career Development $120,000 2 Extended to 1985 AGA Foundation Research Scholar Award Recipients Adnan Said, MD Nicholas Davidson, MD Thomas Judge, MD years 1 7/1 David Perlmutter, MD Nourredine Lomri 2005 AGA Foundation Research Scholar Award Recipients Gastroesophageal Reflux Disease 1/13/2012 Andrea Todisco, MD We are the 10%. James Reynolds, MD Michael Choi, MD Mitchell Schubert, MD Chris Yun, PhD Ariel Feldstein, MD George Wu, MD, PhD Sarah Glover, DO 2 1996 AGA Foundation Research Scholar Award Recipients Martha Harding, DVM, PhD Career Fred Askari, MD, PhD 1986 AGA Foundation Research Scholar Award Recipients Elyanne Ratcliffe, MD Research Scholar Award (RSA) Development $120,000 years TBD 9/7/2012 7/1 David Brenner, MD Martin Beinborn, MD Noah Shroyer, PhD Richard Benya, MD Andrew Leiter, MD, PhD * Daniel Kessler, PhD 2006 AGA Foundation Research Scholar Award Recipients Julian Walters, MD Robert Marks, MD Claudia Andl, PhD Walter Smalley, MD 1987 AGA Foundation Research Scholar Award Recipients Kenneth Hung, MD, PhD R. Robert and Sally Funderburg Research Established Investigators $100,000 2 Nancy Van Houten, PhD Serhan Karvar, MD Lee Kaplan, MD, PhD years 1 8/31/2012 1/1 David Wang Sarah Keates, PhD Darryl Daugherty, MD Award in Gastric Cancer Lyman Bilhartz, MD Eric Lemmer, MD, PhD 1997 AGA Foundation Research Scholar Award Recipients Akhil Maheshwari, MBBS, MD John Lake, MD Nadia Ameen, MBBS Shumei Song, MD, PhD Career Ginny Bumgardner, MD, PhD 1988 AGA Foundation Research Scholar Award Recipients Kenneth Yu MD AGA- Emmet B. Keeffe Award in Ian Crispe, MD John Barnard, MD Development $70,000 1 Karen Hall, MD, PhD 2007 AGA Foundation Research Scholar Award Recipients Mitchell Cohen, MD Klaus Kaestner, PhD Neena Abraham, MD Translational or Clinical Research in Liver year 1 2/3/2012 7/1 Bernard Davis, MD Hoda Malaty, MD, PhD Michael Beyak, BSc, MD Junior Samuel Klein, MD Joseph Pisegna, MD Sean Koppe, MD Disease Norman Sussman, MD Mark Worthington, MD Scott Magness, PhD Faculty John Wiley, MD Olga Mareninova, PhD 1998 AGA Foundation Research Scholar Award Recipients Geoffrey Nguyen, BA, MD 1989 AGA Foundation Research Scholar Award Recipients Kris Steinbrecher, PhD Career Victor Ankoma-Sey, MD Gregory Fitz, MD Michael Bates, MD, PhD Kevin Mullen, MD Seema Khurana, PhD 2008 AGA Foundation Research Scholar Award Recipients Development $25,000 1 John Samuelson, MD, PhD Yuko Akiyama, MD Rudra Rai, MD Elsevier Pilot Research Award year 1 1/13/2012 7/1 Carol Semrad, MD Branko Stefanovic, PhD Edda Fiebiger, PhD Established Steven Weinman, MD, PhD Shie-Pon Tzung, MD Lara Gawenis, PhD Vincent Yang, MD, PhD Pradipta Ghosh, MD Investigators 1999 AGA Foundation Research Scholar Award Recipients Richard Saad, MD Kirsten Sadler-Edepli, MMSc, PhD Patrick Abrahams, PhD 1990 AGA Foundation Research Scholar Award Recipients Michael Volk, MD, MSc Kevin Behrns, MD June & Donald O. Castell, MD Esophageal Career Development $25,000 1 James Goldenring, MD, PhD Jay Horton, MD 2009 AGA Foundation Research Scholar Award Recipients year 1 1/20/2012 7/1 Janet Larkin, MD Lewis Roberts, MD Steven Lidofsky, MD, PhD Gregory Austin, MD, MPH Clinical Research Award Horst Weber, MD Mark McNiven, PhD Michele Battle, PhD Rohit Loomba, MD, MHSc 2000 AGA Foundation Research Scholar Award Recipients AGA/AGA-Broad Foundation Student Student 1 10** Iryna Pinchuk, PhD 1991 AGA Foundation Research Scholar Award Recipients Andrew Feranchak, MD $2,500 24*** 3/23/2012 7/1 Dorsey Bass Hiromi Gunshin, PhD Andrew Tai, MD, PhD Research Fellowship Awards Award year James Corasanti, MD, PhD Nicola Jones, MD, PhD 2010 AGA Foundation Research Scholar Award Recipients Raymond Dubois, MD, MPH James Lillard, PhD Ian Corbin, PhD Steven Freedman, MD, PhD David Rudnick, MD Ype deJong, MD, PhD AGA - Horizon Pharma Fellow Abstract DDW Loyal Tillotson, MD, PhD Anne Wolf, MD Porfirio Nava-Dominguez, PhD Travel $1,000 Travel 3 3/09/2012 7/1 Kenneth Olive, PhD Prizes 2001 AGA Foundation Research Scholar Award Recipients 1992 AGA Foundation Research Scholar Award Recipients Andres Roig, MD Terrance Barrett, MD Shrikant Anant, PhD Catherine Rongey, MD, MSHS Charles Baum, MD Rebecca Chinery, PhD Anisa Shaker, MD Student $500 8 Alice Chow, MD Ngoc-Duyen Dang, MD AGA - Horizon Pharma Student Abstract DDW David Cistola, MD, PhD James Gorham, MD, PhD 2011 AGA Foundation Research Scholar Award Recipients Award 2/24/2012 7/1 Steven Cohn, MD, PhD Jan-Michael Klapproth, MD Ashwin Ananthakrishnan, MD, MPH Prizes $1,000 Travel 3 Richard Hodin, MD Michelle Southard-Smith, PhD Carla Coffin, MSc, MD Travel Award Karl Houglum, MD Karen Edelblum, PhD Ciaran Kelly, MD 2002 AGA Foundation Research Scholar Award Recipients Anne Henkel, MD Dominic Nompleggi, MD, PhD Willemijintje Hoogerwerf, MD Moti L. and Kamla Rustgi International DDW Sherry Huang, MD 2012 AGA Foundation Research Scholar Award Recipients Don Rockey, MD Travel Award $500 Travel 2 3/09/2012 7/1 Phillip Tarr, MD Braden Kuo, MD Kara Gross Margolis, MD Travel Awards Brent Upchurch, MD Konstantinos Lazaridis, MD Robert Schwartz, MD, PhD Charles Madden, PhD Shehzad Sheikh, MD, PhD Chinweike Ukomadu, MD, PhD

  43. • Gates Foundation • ACG Institute - http://gi.org/acg-institute/ http://www.gatesfoundation.org/grantseeker/Pages/d – Junior Faculty Development Grant $225,000 ($75,000 per year for each of three years) is to assist promising clinical efault.aspx researchers to develop research and careers that have a direct bearing on clinical gastrointestinal practice • Thrasher Foundation - pediatric medical research – Clinical Research Award – Al Thrasher Awards: 3yrs, up to $400,000. Median award is – Clinical Research Award Pilot Projects – Smaller Programs Clinical Research Award $230,000, with most between $150,000-$300,000. • CF Foundation- http://www.cff.org/ – Early Career Awards are limited to a maximum of $25,000 in direct costs, plus up to 7% indirect costs. 2 years. – Basic and clinical research grants, Fellowships – http://www.thrasherresearch.org/ • CCFA http://www.ccfa.org/ – Career Development Awards: • Burroughs Wellcome Career Award for Medical – Up to $90,000 per year, 1-3 years Scientists • Research Fellowship Awards • Scientific Conferences and Workshops – http://www.bwfund.org/pages/52/Grant-Programs/ • Senior Research Awards – Career Awards for Medical Scientists • Student Research Fellowship Awards • March of Dimes – – open to MDs and MD/PhDs. People should have 3-5 papers. Award is $700,000 over 5 years. http://www.marchofdimes.com/professionals/grants.html • Broad - http://broadmedical.org/ – Basil O'Connor • Junior faculty who do not yet have an R01. K08 is OK. Award is – Strong potential of clinical applicability for IBD in the $150,000 over 2 years ($75,000 annually). foreseeable future. Rolling deadline. – Prematurity Grant Program Think Local • Industry • Local – Investigator initiated – Your institution – Sponsor initiated • Trustee • Procter Scholar • Directly related to your area of focus (or emerging focus) • Budget adequate to cover your costs without risk • K12 • ?Profit to help pay for unfunded research • CTSA PF • Is it doable – can you enroll the patients? • Digestive Health Center PF • Will it compete with other demands for your time? • Other Center PF • Is it scientifically worthwhile? • Will it bring an opportunity to your patients/your center?

  45. Predoc Fellowships Graduate Medical * Loan Repayment School School NIH Early Career Funding Independent Residency Postdoc Specialty Jr. Faculty Investigator Judith Podskalny, Ph.D. Fellowships Division of Digestive Diseases and Career Awards R-series Nutrition, NIDDK NIH 2nd Yr Pediatric GI Fellows , 2012 Mentored Career Development BEFORE submitting a K-application: Awards (Ks)  K01 – Mentored Research Scientist  Have a position at an institution that allows Development Award (NIDDK uses for PhDs) you to apply  K08 – Mentored Clinical Scientist Development  Pick appropriate mentors Award  Publish at least 1-2 papers  K23 – Mentored Patient-oriented Research Funding Career Development Award  Generate your own preliminary data Opportunity Announcement  K25 – Mentored Quantitative Research Career  Identify the correct FOA Development Award  Be a U.S. citizen, permanent resident, OR  K99/R00 – Pathway to Independence Award have applied for permanent residency 2nd Yr Pediatric GI Fellows , 2012 2nd Yr Pediatric GI Fellows , 2012 ‘Pathway to Independence Award’ : for all mentored Ks: K99/R00 is exception:  Does not require citizenship/perm. res.  U.S. institutions only  Cannot have a faculty appointment and must have no more than 5 yrs research experience  3 – 5 yrs, not renewable  To move to R00 phase, must have a  Minimum 9 calendar months (75% effort) ‘tenured’ faculty position (R00 is not required guaranteed)  K99 = 1 – 2 years  R00 = 2 – 3 years 2nd Yr Pediatric GI Fellows , 2012 2nd Yr Pediatric GI Fellows , 2012

  46. K award includes: …refer to the ‘parent announcement’ website  Salary, with additional fringe benefits for current FOAs for all Ks: (NIDDK = $90,000 plus fringe at institution’s rate) http://grants.nih.gov/grants/guide/parent_announcements.htm  Research support for tech support, supplies, travel, courses, animals, patient costs, etc. …refer to the NIH K awards table for salary (NIDDK = $25,000 for K01, K08; $50,000 for information: K23 if justified) http://grants.nih.gov/training/careerdevelopmentawards.htm  average 5 yr award, at $150,000/yr = $750,000 2nd Yr Pediatric GI Fellows , 2012 Elements evaluated in a K application: Elements evaluated in a K application:  Candidate = Principal Investigator  Candidate  Career Development Plan/Career Goals &  Career Development Plan/Career Goals & Using letters of recommendation, Biosketch, candidate’s statement, reviewers evaluate Objectives Objectives potential to become independent investigator  Research Plan  Research Plan and leader in proposed area of research  Mentor(s), Co-mentor(s), Consultant(s),  Mentor(s), Co-mentor(s), Consultant(s), Collaborator(s) Collaborator(s)  Environment & Institutional Commitment to  Environment & Institutional Commitment to the candidate the candidate 2nd Yr Pediatric GI Fellows , 2012 2nd Yr Pediatric GI Fellows , 2012 Elements evaluated in a K application: Elements evaluated in a K application:  Candidate  Candidate  Career Development Plan/Career Goals &  Career Development Plan/Career Goals & • Significance Objectives Objectives • Innovation Reviewers look at plans to evaluate progress  Research Plan  Research Strategy • Approach towards independence, additional specialized ..appropriate to applicant’s background and training, faculty development, grant writing  Mentor(s), Co-mentor(s), Consultant(s),  Mentor(s), Co-mentor(s), Consultant(s), workshops, etc. level of expertise; hypothesis driven with Collaborator(s) Collaborator(s) preliminary data; merit of research question; design and methodology  Environment & Institutional Commitment to  Environment & Institutional Commitment to the candidate the candidate 2nd Yr Pediatric GI Fellows , 2012 2nd Yr Pediatric GI Fellows , 2012

  47. Elements evaluated in a K application: Elements evaluated in a K application:  Candidate  Candidate  Career Development Plan/Career Goals &  Career Development Plan/Career Goals & previous mentoring experience, expertise in protected time, space, opportunities for Objectives area of research, productivity, relevance of Objectives collaboration, intention to integrate candidate mentor’s statement/plan to candidate’s into research program, position NOT  Research Plan strengths and areas to develop  Research Plan contingent on getting K-award  Mentor(s), Co-mentor(s), Consultant(s),  Mentor(s), Co-mentor(s), Consultant(s), Collaborator(s) Collaborator(s)  Environment & Institutional Commitment to  Environment & Institutional Commitment to the candidate the candidate 2nd Yr Pediatric GI Fellows , 2012 2nd Yr Pediatric GI Fellows , 2012 Common problems with K- 2011 NIH K Awards* : applications: New Awards  Unclear or missing hypothesis Applications (Success Rate) Total Awards  Overly ambitious  Unclear future plans (i.e. where will the research lead) K08  Inadequate career development plan 489 143 (29%) 929  Poorly written  Inadequate grasp of the literature K23 648 174 (27%) 967  Technical issues (incorrect model/cell line, not using best methods, “technique in search of a project”, etc.)  No power analysis for sample size K99 878 151 (17%) 305  Mentors lack correct expertise  “Pedestrian” * approx., not finalized for FY11 2nd Yr Pediatric GI Fellows , 2012 2nd Yr Pediatric GI Fellows , 2012 Loan Repayment Programs • Five different LRPs – must pick ONE  Clinical Research LRP  Clinical Research LRP  Clinical Research LRP for Individuals from Loan repayment programs.. disadvantaged backgrounds  Pediatric Research LRP  Pediatric Research LRP  Health Disparities Research LRP  Contraception and Infertility Research LRP 2nd Yr Pediatric GI Fellows , 2012

  48. NIH Loan Repayment Allocations FY 2010 LRP ‘features’: [TOTAL = $75.5 million] $80 Clinical/Disadvantaged  Provides up to $35,000 per year for 2 years $70 Bkgd. towards repayment of educational loans Contraception/Infertility Dollars (in millions) $60 $16  NIH pays the taxes on this amount directly to Health Disparities $50 the IRS Pediatric $40  May re-compete (i.e., get 4 or even 6 years) Clinical $30 $45 $20 $10 $- 2nd Yr Pediatric GI Fellows , 2012 2nd Yr Pediatric GI Fellows , 2012 LRP – Time-line for 2013 cycle Eligibility:  US citizen or permanent resident  Sept. 1 – November 15, 2012 – applications accepted  Owe more than 20% of yearly salary  Feb - April, 2013 – applications reviewed by ICs  as bona-fide educational debt and funding plan prepared  Perform 2 years of research --  May – July, 2013 – LRP office verifies financial  concurrent with loan repayment period 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 2nd Yr Pediatric GI Fellows , 2012 National Institutes of Health (’11) Finally… the NIH budget is BIG…. >$30,000,000,000 2nd Yr Pediatric GI Fellows , 2012 2nd Yr Pediatric GI Fellows , 2012

  49. Also REMEMBER -- Training contacts:  NIH staff want to help you succeed – contact  NCI: Dr. Ming Lei us with your questions leim@mail.nih.gov  Unless you apply , you’ll never know if you  NIAID: Dr. Katrin Eichelberg will be funded keichelberg@mail.nih.gov  NICHD: Dr. Dennis Twombly dtwombly@mail.nih.gov Judith Podskalny, Ph.D. 301 594-8876 jp53s@nih.gov 2nd Yr Pediatric GI Fellows , 2012 2nd Yr Pediatric GI Fellows , 2012

  50. How to write a research paper • Real success in academic medicine requires a mentor, an important project, perseverance, and patience. Fame does not come overnight. All Mitchell B. Cohen, MD things cometh to him/her who waiteth, if he/she Professor and Vice Chair of Pediatrics works like hell while he/she waiteth. Director, Gastroenterology, Hepatology and Nutrition – Delbert A Fisher, MD Cincinnati Children’s Hospital Medical Center Harbor-UCLA Medical Center, Torrance CA Who dunnit? Why publish: • Original peer reviewed manuscript published? • Publications expose data to critical review and benefit society/medicine/children by your work product. • Original peer reviewed manuscript submitted? • If project was worth an abstract, probably worth writing • Original peer reviewed manuscript “in preparation”? 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 Why publish this paper? What is unique? • 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.

  51. Focus • Write the first draft in a limited number of sittings. • Make a list of your major hypotheses • Drips and drabs are an inefficient way to write and you • Create a path or story. Have a conversation with the can lose your focus reader. The reader wants to know what you set out to discover (hypothesis), how it was done (method) • Make your thoughts concrete, worry about polishing later what was found (results) and how you came to your • “Just get it down on paper, and then we’ll see what to do conclusions/what are the limitations of your study with it.” (discussion). – Maxwell Perkins, editor for Ernest Hemingway, F. Scott Fitzgerald and Thomas Wolfe, advice to Marcia Davenport (1927) • Don’t meander. “I didn't have time to write a short letter, so I wrote a long one instead.” Blaise Pascal Organize Write • Collect references. READ them. • You need not begin writing with the introduction. • Decide which references relate to each hypothesis. • Put your data together and then write your results. Put them in folders (paper or electronic). – Generally say it once, e.g., graph, OR table, OR text • Summarize all the points relating to hypothesis 1 on • This section is the easiest and the core of the paper. one folder, hypothesis 2 in a second folder…. • 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: Time line: How much time does this take? • Don’t let the manuscript age on your desk/computer. It is not a fine wine. Academics does not reward hibernation. Write manuscript; Perform submit for research, publication Plan report experiments, abstract IRB, IAUCUC approvals

  52. 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 Introduction • A "preview" of what's to come. Often structured. May be the • What questions did you ask in your experiments? only thing that is read! Why is it interesting? What is already known - the • If not structured, summarizes the purpose, methods, results introduction summarizes the relevant literature so and conclusions of the paper. that the reader will understand why you were • It is not easy to include all this information in just a few interested in the question you asked. words. Start by writing a summary that includes whatever • One to four paragraphs (1 page or so) should be you think is important, and then gradually prune it down to enough. size by removing unnecessary words, while still retaining the necessary concepts. • End with a sentence explaining the specific • Don't use abbreviations or citations in the abstract. It should question you asked in this experiment. be able to stand alone without any footnotes. MATERIALS AND METHODS • How did you answer this question? There should be • Do not put results in this section. You may, enough information here to allow another scientist however, include preliminary results that were used to repeat your experiment. Look at other papers to design the main experiment. "In a preliminary that have been published in your field to get some study, we observed a circadian rhythm of guanylin idea of what is included in this section. levels so we performed all of our experiments • If you had a complicated protocol, it may helpful to between 9-11am.” include a diagram, table or flowchart to explain the • Mention relevant ethical considerations. If you used methods you used. human subjects, did they consent to participate. If • Explain the power calculation. you used animals, what measures did you take to minimize pain? IRB and IACUC approval.

  53. Results Don’t fight with the editor • 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. DISCUSSION Authorship • Highlight the most significant results, but don't just repeat • Authorship credit should be based on what you've written in the Results section. How do these – 1) substantial contributions to conception and results relate to the original question? Do the data support design, acquisition of data, or analysis and your hypothesis? Are your results consistent with what other investigators have reported? If your results were interpretation of data; unexpected, try to explain why. Is there another way to – 2) drafting the article or revising it critically for interpret your results? What further research would be important intellectual content; and necessary to answer the questions raised by your results? – 3) final approval of the version to be published. How do your results fit into the big picture? Authors should meet conditions 1, 2, and 3. • End with a one-sentence summary of your conclusion, emphasizing why it is relevant. Authorship Old CW – First (or last) is best • Author, First • Acquisition of funding, collection of data, or general supervision of the research group alone does not constitute • Author, Middle authorship. • Author, Last • 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 • New CW to take public responsibility for appropriate portions of the • It takes a village. content.

  55. Abbott Nutrition Health Institute is a global organization devoted to: What is the Abbott Nutrition Health Institute ? • Educating health care professionals throughout the world on the importance of nutrition as therapy to improve patient care and outcomes • 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: Visit the Learning Center for Continuing Education. • Gain access to knowledge and information concerning nutritional solutions that improve patient outcomes • Online Independent Study • Learn how science-based nutrition as therapy can improve patient care and overall health • Clinical Courses in the areas of Pediatric and Adult Therapeutic Nutrition • Become part of a community dedicated to advancing care and bettering lives through science-based nutritional solutions • Accredited CE courses for Nurses and Dietitians • Stay informed about international conferences, where researchers • Professional Development and health care professionals exchange valuable ideas • Clinical Information in the Resource Library ANHI Web-Site Learning Center Self-Study CE and CME Links 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

  56. How in the world did I end up here? International Research as a Pediatric Gastroenterologist and Nutritionist • University – molecular immunology lab • Industry – molecular biology (Merck, Wyeth) • Human rights monitoring project in a refugee resettlement in Guatemala Kevin Sztam, MD, MPH Children’s Hospital Boston • NJMS 1997: goal to work in international health Harvard Medical School • HIV and HCV prevention in injection drug users in Newark, NJ Affiliated with Columbia University • Led medical delegations – Guatemala, Cuba ICAP - International Center for • Master’s in Public Health – International Health AIDS Care and Treatment Programs and exposed to Peds GI and Nutrition • Residency, Fellowship at Columbia Fellowship Kevin’s Dream Team • Pediatric GI and Nutrition mentor (Dr. Richard Deckelbaum) • Receive good general GI training • Pediatrician with HIV and nutrition • Complete a research project research experience – Pursue a smaller project • Director for 14-country international – Pursue a dream project • Super interesting HIV care and treatment program • Something to build a career on • Kenyan PhD nutritionist at Columbia Earth Institute (development organization) • Kenya HIV program directors Nutritional status with Study antiretroviral therapy (ART) • A Macronutrient Supplementation Program • Even with ART poor nutritional status is for Patients Initiating Antiretroviral Therapy predictive of mortality in Central Kenya • ART itself is a nutritional therapy • Identified grant opportunity (2 nd yr fellow) • ART increases BMI 5–20% up to 6 months – Doris Duke Operations Research for AIDS • Supplementing with macronutrients did not Care and Treatment in Africa necessarily lead to weight or improve mortality • Award in 2006 • Rationale for supplementation, but effectiveness • 2 nd yr fellow not proven • Few data on locally-available supplements Swaminathan 2010; Ahoua 2011; USAID 2009; Schwenk 1999

  57. 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 Intervention • Feasibility – operational and safety • Experimental intervention • Cost • Anthropometrics – Macronutrient supplementation for 24 wks • BMI at 24 weeks*, and 48 weeks with 50% of energy requirement for family of 5 • MUAC and TSF at 0, 24, 48 weeks – Monthly: Maize (30 kg), beans (15 kg), • Questionnaires vegetable oil (2.25 Kg), porridge mix (8.25 kg) • Dietary Intake at 0, 24, 48 weeks • Food Security at 0, 24, 48 weeks – Nutrition counseling (both sites) • Quality of Life at 0, 24, 48 weeks – Multiple micronutrient supplement • Clinical Status at 0, 24, 48 weeks (Multivitamins) • Household food inventory at 12, 36 weeks – Aflatoxin surveillance (Maize, porridge, • Laboratory • CD4 Count at 0, 24, 48 weeks peanuts) • Complete Blood Count at 0, 24, 48 weeks Pilot Study Design Anthropometrics Comparison Site Intervention Site n=100 n=100 Ambulatory, starting ART Ambulatory, starting ART Site A Site B p BMI <20 BMI <20 n=100 n=100 Anthropometrics Body Mass Index, Kg/m 2 , median 17.96 17.39 0.04 Treat with ART and MMS Weight, Kg, median 47.85 46.65 0.29 Nutrition Counseling Treat with ART and MMS Height, cm, median 162.65 164.0 0.86 Nutrition Counseling PLUS BMI over 18.5 36 28 0.23 Treat with 24 wks Macronutrient Supplement Mid-upper arm circumference, cm 22.0 21.35 0.007 (Maize, beans, oil, porridge) Triceps skinfold thickness, mm 10 9 0.003 24 and 48 wk Follow Up 24 and 48 wk Follow Up Home Visit at 12, 36 wks Home Visit at 12, 36 wks

  58. Clinical and Immunologic Status Time to the first severe adverse event 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 Log rank p = 0.39 No statistical difference in time to 1st SAE Things I’ve learned Our team • Muhsin Sheriff (ICAP), Mark Hawken (ICAP), Juma Rashid (KEMRI) • Study from start to finish • Murugi Ndirangu (GSU), Stephen Arpadi (CU), Richard Deckelbaum (CU) – Conceptualization, building team, grant, hiring • Geoffrey Nyamongo, Stanley Njuguna, Albino Luciano • Gideon Chulele, John Kennedy Muthiru staff, training, selecting sites, lab set up, • Mathew Kimani (Kenya), Ashley Bogosian (NYC) budgeting, QA, database construction, multi- • Study staff: Martin Kumbe, George Mutembei, Isaac Wachira, Rosemary country and multi-institution collaboration, Nyowera, Kezia Wanjiru, Rosemary Chedeye, Alex Wacharia lead a diverse team across time zones • KEMRI National Reference Laboratory • Wafaa El-Sadr (PI, CU) – Food growing and grain processing, political • Hongyu Jiang (Children’s Hospital Boston) interactions, facility renovation • Christopher Duggan (Children’s Hospital Boston) • District and Hospital Directors, lab and pharmacy staff • Our participants in Central Province, Kenya New studies in Tanzania Why you might like or dislike this type of work • Tanzania with Harvard HIV group • Work on a major global epidemic disease • Trial of novel energy dense macronutrient • Interface with HIV programs, NGOs, govts supplement for adults • Attempt to perform research in challenging • Observational study of Plumpy’Nut environments (Nutriset, France) in HIV-infected children • High mortality • Programmatic studies of nutritional care • Integrate knowledge of nutrition to improve for HIV-infected adults nutritional care for HIV-infected people • Balance clinical duties and family with research demands

  59. Major international public health Follow your dream issues for Peds GI & Nutrition • Challenging but possible • Chronic disease – Right mentor, some funding – obesity, hypertension, hypercholesterolemia • Spend time to create your opportunities • HCV • Malnutrition • Diarrheal disease and mucosal immunology

  60. Objectives • Appreciate the characteristics of good mentors Moving from Mentee to Mentor • Understand the actions mentors perform • Apply tips for being a good mentor • Create a developmental network for Alan Leichtner, MD mentoring Abbott Conference • Understand identify barriers for mentoring and seek strategies to overcome them Why Mentoring Goes Wrong Bad Mentors • No Mentoring • The Users – use the mentee’s work solely for their own development – Constant need to reinvent the wheel – No efficiency gained from collaboration • The Avoiders – never have enough time to – Slower progress on projects devote to their mentee – Slower career development • The Criticizers – believe mentoring is a license • Bad Mentoring for criticizing Modified from Ed Benz Who says there is no science behind Buzz Group or “Think, Pair, Share” mentoring? WHAT ARE THE DESIRED Sambunjak D, Straus SE, Marusic A. CHARACTERISTICS OF A MENTOR? A systematic review of qualitative research on the meaning and characteristics of mentoring in Assignment : academic medicine. Think about your experiences being mentored and providing mentorship JGIM 2009; Take one minute and come up with 3 of the most Qualitative meta-analysis important characteristics for a mentor 8,487 citations from bibliographic search 9 articles met inclusion criteria

  61. List of Most Important Characteristics Desired Characteristics of Mentors of a Mentor • Personal – Altruistic – Understanding – Patient – Honest – Responsive – Trustworthy – Nonjudgmental – Reliable – Active Listener – Motivator Sambunjak, et al Desired Characteristics of Mentors What Trainees/Junior Faculty Want • Career counseling, including help with CV • Relational – Accessible preparation – Dedicated to developing relationship with mentee – Want to offer help in mentee’s best interest • Project oversight – Able to identify mentee’s strengths • Scholarship help – Able to help define and reach goals – High standards for achievements • Time-management and work/life balance – Compatible practice style, vision, personality • Professional • Teaching skills, curriculum development, – Senior and well-respected in the field teaching portfolios – Knowledgeable and experienced [More junior mentors who are well-connected may be as effective] Sambunjak, et al Modified from Community of Mentors OFD Children’s Hospital Boston What Trainees/Junior Faculty Want Multiple Types of Mentoring • Clinical practice strategies, quality • Dyadic mentoring improvement methodologies • Team mentoring, e.g. SOCs • Advocacy • Collaborative peer mentoring • Enhancing professional visibility, locally and • Project-based mentoring nationally • E-mentoring • Joining professional societies • Understanding the organizational culture Modified from Community of Mentors OFD Children’s Hospital Boston

  62. Actions of a Good Mentor: 20 Tips Actions of a Good Mentor: 20 Tips 1. Set expectations early and adjust as necessary 7. Follow-through on specific commitments you over time make to your mentee(s) 2. Be explicit about credit 8. Monitor progress 3. Plan for a long-term relationship 9. Respect individuality and show appreciation for mentee’s abilities 4. Help your mentee determine what he/she really wants to do, but challenge them to expand goals 10.Give feedback, foster self-reflection and and seek new opportunities and be flexible performance improvement 5. Help match ideas and resources 11.Provide moral support to cope with stresses and build motivation 6. Help mentee establish connections with collaborators and network 12.Help mentee with project/career/life balance Modified from Klibanski Modified from Klibanski Actions of a Good Mentor: 20 Tips Actions of a Good Mentor: 20 Tips 13.Role model good mentorship 18. Teach the “rules of the game” and how to navigate political situations 14.Understand co-dependence issues 19.Build independence 15.Keep appropriate distance 20.Plan early for separations 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 Modified from Klibanski Age of Mentors: Benefits of Being a Mentor Old vs. Young • Advantages • Advantages • Help in achieving academic goals, e.g. – Seniority, authority, clout – Fewer commitments progress in a research area – More extensive network – More understanding of – Perspective – “seen it • Credit towards academic promotion – part of current generational issues all” – Enthusiastic, bold educational portfolio – expected in senior – Experienced as mentor • Disadvantages • Disadvantages level professors – Less seniority, authority, clout – Less time • Developmental of a legacy in a field – Less secure – Less understanding of – Less developed network current generational issues – Less experienced as a mentor – Fatigue Modified from Start early in your career ! Ed Benz

  63. MENTOR 1500 Pediatric Gastroenterologists in Society 500 Vote in Election 145 PGPAC Members (100 fellows and 45 faculty) GENERATIONS OF MENTEES The Developmental Network • Unusual to find one mentor who can provide everything a mentee needs Getting Career • A better solution is to devise a network to Job Done meet all mentee needs – like a cabinet • Model developed by Kathy Dram, Monica Personal Higgins, and David Thomas and modified for use by Jean Emans Support • 3 roles required of network Barriers to Effective Mentoring Barriers to Effective Mentoring • Mentee • Mentor – Unable to make effective changes – Lack of time – Misreading of events – Insufficient mentoring skills – Inability to develop network because of scant resources – Lack of flexibility • Relationship – Lack of specific knowledge – Lack of fit – racial, ethnic, gender, or of mentee’s career generational issues – No benefits for mentoring – Lack of continuity – Competition between mentor and mentee, or abuse of mentee

  64. Strategies to Improve Mentoring Strategies to Improve Mentoring • Personal • Institutional – Improve mentoring skills – Faculty development – workshops, coaching program – Make sure you understand generational issues – Programs for mentees on mentorship – Make regular meetings/contacts – Give incentives to mentors – Partnership agreement/contract may be advisable – Foster concept of networks of mentors, each – Progress reports and set deadlines fulfilling a different role – Assist in creation of a developmental network – 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 “ When you see a turtle on the more developmental networks are taking their top of a fence post, remember place • Mentoring has its benefits, but is still that he didn’t get there by underappreciated himself .” • Start early (you have probably done this already) Alex Haley Checklist for Mentors Checklist for Mentors Preparation Additional topics for discussion at first or early meetings • Introduce yourself by phone, brief letter, or email • • Give mentee ample opportunity to propose agenda for first meeting Research: Details of intended project, ownership, available resources, skill • Ask for updated CV/resume development, grant opportunities, timeline • Ask mentee to think about short- and long-term goals • Promotion: Elements, timeline • Balance: Family, day care, pace, negotiations with First Meeting chief/supervisor • Express interest in mentee’s career Follow-up Meetings • Ask open-ended questions; be an active listener and help mentee reflect on plans • Review the mentee’s CV/resume with him or her • Meet according to agreed upon plan • • Review the most recent career conference the mentee has had with his/her chief Track progress carefully • Help formulate short- and long-term goals • Give honest feedback about accomplishments • Ask about the Development Network • Continue to suggest additional resources • Set up mutual expectations and responsibilities • Continue relationship for a minimum of one year • Decide on frequency of meetings

  65. References References 1. Balmer D, D'Alessandro D, Risko W, Gusic ME. How mentoring relationships 7. Johnson MO, Subak LL, Brown JS, Lee KA, Feldman MD. An innovative evolve: a longitudinal study of academic pediatricians in a physician educator program to train health sciences researchers to be effective clinical and faculty development program. J Contin Educ Health Prof 2011;31:81-6. translational research mentors. Acad Med 2010;85:484-9. 2. Carey EC, Weissman DE. Understanding and finding mentorship: a review for 8. Kiefer JC. Tips for success: fostering a good mentoring relationship. Dev junior faculty. J Palliat Med 2010;13:1373-9. Dyn 2010;239:2136-9. 3. Detsky AS, Baerlocher MO. Academic mentoring--how to give it and how to get 9. Ogunyemi D, Solnik MJ, Alexander C, Fong A, Azziz R. Promoting residents' it. Jama 2007;297:2134-6. professional development and academic productivity using a structured 4. Feldman MD, Huang L, Guglielmo BJ, et al. Training the next generation of faculty mentoring program. Teach Learn Med 2010;22:93-6. research mentors: the University of California, San Francisco, Clinical & 10. Sambunjak D, Straus SE, Marusic A. A systematic review of qualitative Translational Science Institute Mentor Development Program. Clin Transl Sci research on the meaning and characteristics of mentoring in academic 2009;2:216-21. medicine. J Gen Intern Med 2010;25:72-8. 5. Geraci SA, Kovach RA, Babbott SF, et al. AAIM Report on Master Teachers and 11. Santoro N, McGinn AP, Cohen HW, et al. In it for the long-term: defining Clinician Educators Part 2: faculty development and training. Am J Med the mentor-protege relationship in a clinical research training program. Acad 2010;123:869-72 e6. Med 2010;85:1067-72. 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.

  66. Disclosures Curriculum Vitae • Latin: course of (one's) life • No Funding Conflict Creating your CV and • First Known wn Use: 1902 • Some me slides borrowe wed from m Mi Miriam m Vos • Webster: “a short account of one's career and • Other data borrowe Academic Portfolio wed from m the University of qualifications prepared typically by an applicant Colorado SOM M we website for a position” Michael Narkewicz MD • Overview w of your professional • http://www Professor of Pediatrics www.ucdenver.edu/academics/colleges/m accomp mplishme ments. In the US, used almo most edicalschool/facultyAffairs/Appointme mentsPromo mot Hewit-Andrews Chair in Pediatric Liver Disease exclusively by those pursuing an academi mic or ions/Pages/Promo motionsTenure.aspx me medical career. Associate Dean for Clinical Affairs • • Typically a "living docume ment" wh which wi will reflect University of Colorado SOM, Children’s Hospital the developme ments in a professional's career, Colorado and thus should be updated frequently. 2 3 CV and Promotion • CV • The CV is a key comp CV - longer, mo more detailed synopsis of your mponent of the promo motion education, background, teaching and research process experience, publications, presentations,  Know what is expected at your institution! awa wards, honors, affiliations, etc • Use the promo motions and CV guidelines at your • “ A forma institution mal record of your progress up the academic ladder.” (K. Barrett, JPGN 2002)  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 4 5 6

  67. Key Components - 1 Don’t Include all education! Key Components - 2 • Personal history or biographical sketch • Academi mic appointme ments  Begin with “Current Position” --- include title(s) and  List these chronologically (including dates) professional address (with email and FAX)  Include full-time and adjunct faculty positions  Do NOT include birth date or Social Security Number • Ex: Associate Professor 2001-2007 • Education • Hospital, governme ment or other professional positions  In chronologic order, list institutions attended dates and degrees (Begin with college or university)  List positions chronologically  Include internship, residency, fellowships, post-doctoral  May divide into sections (hospital, government, etc.): training • I do University, Hospital, National • Ex: University of Colorado SOM Denver, CO: Fellowship, Pediatric • Ex: Medical Director Liver Transplantation 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 8 9 Key Components - 3 Key Components - 4 Key Components - 5 • Honors, special recognitions and awa • Ma • Inventions, intellectual property and patents held wards Major Commi mmittee and Service Responsibilities or pending  Graduate school honors and distinctions  Group (as appropriate) under headings: Departmental, SOM, university and hospital  Clinical, teaching, research or service awards  Include state and national committees, tasks forces, boards • Review  Elected and honorary society memberships w and referee wo work and commissions  Honorary fellowships  Service on editorial board (Include dates)  List important community service or public health activities • Ex: Resident Teaching Award  Grant review committees and study sections  Note leadership positions, key responsibilities • Society for Pediatric Research (have to be nominated and elected)  Service as ad hoc reviewer for journals professional societies or • Ex: Medical Board 1997-2009 (President 2006-2008) scientific meetings (State dates, journals, meetings) • Me Memb mbership in professional organizations • Licensure and board certification  List organizations (and dates) • Invited extramu mural lectures, presentations and  Include offices held and other leadership positions  Include dates of state certification, board certification and visiting professorships (numb mber: eases counting) recertification (participation in MOC) • Ex: Member Research Committee NASPGHAN 1997-2000  As list lengthens, may divide into headings: Local, regional,  Do NOT list medical license numbers national, international 10 11 12

  68. Key Components - 6 Key Components - 7 Key Components - 8 • Teaching record • Grant support • Bibliography  In separate sections, list major presentations to medical (or  Can introduce research focus:  Check all bibliographic citations for accuracy other undergraduate) students, graduate students, house • Primary research foci: Developmental Amino Acid Metabolism,  Number all publications (beginning with the earliest) and list in officers Biomarkers in CF liver disease and ALF, Clinical trials in viral order of publication hepatitis  List course numbers and dates  Underline your name as it appears in author list  List all grants awarded; list active grants first  State ward/clinic attending duties (e.g., “2000-03: Supervision  Include, in separate sections , the following items:  Include your role (e.g., principal investigator, co-investigator), and bedside teaching of residents, high-risk hypertension  Papers published in peer-reviewed journals (may include in- funding source (and grant number), dates, percent effort, and clinic - 6 hours/week” ) press and accepted articles) total direct costs  Key administrative positions (course or training program  Books and monographs  Divide into headings as appropriate (current and prior funding, director) and dates  Book chapters, invited articles & reviews in non peer-reviewed whether competitive, by type of funding agency, etc)  List specific accomplishments (course development, journals innovative syllabus, etc)  Other publications, non-published documents, reports, • Supporting details should be provided in research or policy papers, lay press articles (must be complete separate teacher’s portfolio and available for review) 13 14 15 Key Components - 9 What to do Teaching Portfolio • Bibliography – 2 • Start it when you get back (if you haven’t already done this  Other “products of scholarship” (software, CD’s, case • Back up simulations, videos, etc.)  Letters to the Editor  Scientific abstracts published or presented at scientific • Systema matically update: meetings • List meeting, journal reference and type of abstract (plenary, oral  Every paper accepted or poster)  Every abstract • Divide into headings (Competitive, non-competitive)  Each time you lecture  Do not list manuscripts that have been submitted or that are “in • Review preparation” Debatable, helpful to keep track w Mo Monthly:  Update committees etc (end dates)  Teaching 16 17 18

  69. Documentation of Teaching Teaching Portfolio: Beyond CV Descriptions of Teaching Activity Effectiveness • Teacher’s Statement • Teaching is increasingly recognized as key in • Cl Classroom m instructional activities (courses, lectures) • Evaluations of Didactic Teaching Activities the academi mic environme ment • Cl Clinical instructional activities (bedside rounds, ad • Docume mentation is key to successful recognition  Ask if there will be an evaluation and will you get some form of hoc talks) feedback. • Other didactic activities (invited lectures, CF CF team m  If not: Have a form and distribute and collect talk) • Evaluations of Clinical Teaching Activities • Te Teaching leadership and admi ministration (course  Almost all rotations ask residents/students for evaluations director)  Ask for summaries after time on service • Cu Curriculum m Innovation and Sc Scholarship (developed  Solicit feedback simu mulation) • Me Mentorship • Mentorship (whom m have you me mentored)  Letters of Support • Outside educational efforts (eleme mentary school talk) • Se Self St Study and Imp mproveme ment (workshops attended) • Te Teaching Awa Awards 19 20 21 Let’s Get It Started 22

  70. WHAT IS OUT THERE • Job announcement letters sent to Department INTERVIEWING AND NEGOTIATING • Announcements in scientific journals FOR A FACULTY JOB • Websites of academic institutions • Mail list servers Binita M. Kamath, MBBChir MRCP MTR • Informal sources PREPARATION PREPARATION • Do you need to be working at a top-rated institution, • Know your needs or would a less-intense atmosphere be preferable? • Know your strengths • What is your ideal combination of research, teaching • Most candidates underestimate themselves and clinical practice? • Know your weaknesses • Do you want/need to be in a particular area of the • Ask your mentor country? • Negotiate appropriately • Will your partner’s professional needs set limits on your search? INITIAL CONTACT GOALS OF THE INTERVIEW • CV + cover letter • Convince the department that your work is exciting and that you will be a leader in your field • Telephone call • Informal meeting e.g. NASPGHAN annual meeting • Convince each member of the department that you • Set up the 1 st interview will be a good colleague • Clarify reimbursement • Find out if the institution and the department are right • Get schedule ahead of time for you

  71. THE INTERVIEW THE INTERVIEW • Demanding and exhausting experience • Dress code • You are on display at ALL stages of the visit (even before you arrive!) • Job talk • Be nice to admin staff • Focus on your work • Find out about the academic interests of the people • Make the future directions clear you are likely to meet • Be dynamic • Be ready to ask them about their work/interests • Learn about the institution and the surrounding area AFTER THE FIRST VISIT SALARY/COMPENSATION • Financial analysis of compensation data (2007) • If not interested, promptly call the Chief • Compared returns to General Pediatrics • If interested – call/email those you met with • Pursuing fellowship in GI is a negative financial decision • 2 nd visit (take partner) • Request particular people to meet with • NASPGHAN Workforce Salary Survey (2003-4) • Salary and start-up negotiation • Assistant Professor $139K (135) • Housing • Private Practice $226 (207) • Schools • 0-5 Years from Fellowship $155 (138) Rochlin and Simon, Pediatrics 2011 NEGOTIATION - SALARY NEGOTIATION – START-UP • How much and for how long? • Try to talk to a friendly insider • Usually 3 years guaranteed • You can (almost) never negotiate up from the start • Source • Space • Understand the incentive process completely • Equipment • Consider the whole package • Animals • Research technician or assistant

  72. NEGOTIATION – OTHER BENEFITS AFTER THE SECOND VISIT • Health insurance • Wait for the verbal job offer • Life and disability insurance • Can also occur after the 1 st visit • Retirement benefit • Faculty tuition benefit • Timeline is idiosyncratic • Housing benefit / mortgage assistance • Professional liability insurance • Unlike fellowship, residency • Vacation • Relocation expenses THE JOB OFFER LETTER THE JOB OFFER LETTER ▪ Start date ▪ Administrative support ▪ Faculty title and track ▪ Academic $ support (travel, subscriptions, membership fees) ▪ Salary and benefits, including incentive compensation ▪ Specific items of research support - equipment, ▪ Effort distribution (% time for research, clinical and supplies, personnel teaching) for at least the first 3 years ▪ Other special considerations that were verbally ▪ Office and research space agreed upon ▪ Basic office supplies (including computer) • Lawyer? SUMMARY STAYING AT THE SAME INSTITUTION • Do your homework • Sometimes explicit and clear • Be dynamic • More often, awkward • Aim to be in a position to weigh up more than 1 offer • Mentor vs. Division Chief • Negotiate appropriately, but don’t underestimate yourself • Can be difficult to negotiate • You must like your future colleagues • Must still interview elsewhere • Your partner must be happy • It does not have to be forever

  74. What Was I Thinking? RUNNING A PRACTICE “I ain’t gonna work on Maggie’s farm no more” Bob Dylan Janet Harnsberger MD Salt Lake City I Was Threatened The Vision  You will lose your skills  A Private Practice with  Your fund of knowledge will be antiquated  Personalized care for children  On time service  You will not have any referrals  Wonderful esprit de corps  You can’t use the endoscopy suite  Versatile working hours  You are GENERALLY A BAD PERSON  Strong community camaraderie Starting a Private Practice Starting a Private Practice  The bank will loan you the money you need  It is really easy for equipping an office, malpractice  It takes a maximum of two week’s work insurance, and a few month’s of salaries  Almost every community needs you  Choose an office preferably in a building or  You can figure it out so that you are not on neighborhood with lots of Pediatricians and call all the time Family Practitioners  It is incredibly fulfilling and rewarding  Hire your office manager  Es agradable a hablar Espanol !

  75. Starting…. Starting….  Bond with the office manager by deciding  Be maximally available to the medical together on office décor, stationery, chart- community (at first) keeping plans, ancillary staff  Set up lunches with potential referring groups- make use of your pharmaceutical reps!  Meet with the Hospital Administrators  Be on the wards and in the physician lounge in  The administrators will buy the endoscopy the mornings, noon, and at afternoon rounds equipment you need and set up Grand Rounds  Drop a pile of your cards in all the ERs and other introductions  Communicate  The administrators will send out notice of your practice to the newspaper and the hospital staff  Join community clubs My Logistics Credentialing  Joe and Bill offered me space in their office  Plan on a minimum of 2 months for this to be accomplished once you have provided  The bank loaned me $25,000 the required information  Chris and Dick’s built short exam tables  I hired my whole staff (one person) from  Write “pending” on license and malpractice medical records coverage so as not to delay the  I gave conferences everywhere credentialing process  Julia designed my award-winning stationary Credentialing Malpractice  Start compiling lists now for applications  You will need to submit the same information to obtain malpractice coverage as you sent for  Have you met training criteria for the procedures credentialing and “level of care” credentials that you are  For the first three years, your costs are on a requesting? sliding scale (up)  Continuing medical education  The expense is not bad as you start  Malpractice history  Give the process 2 months, apply with multiple  Criminal investigations (be forthcoming..) companies (the rates change ephemerally)

  76. Now the Practice is Up and Is Private Practice a “Dead End?” Running!  You need to keep track of things  Get QuickBooks – its an easy way to pay your  Of course not bills and track your expenses over the years  Get Paychex – they will do your payroll and ALL of 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 Maintaining Your Office Staff and Your Expenses Reputation  Rent, utilities, telephones and cleaning  BE SUPPORTIVE to the opinions of your referring physicians  Malpractice  BE SUPPORTIVE to your office staff  Hospital and NASPGHAN Dues  Ask them what is not going well  Salaries  BE SUPPORTIVE to your patients and their  Office supplies parents I wrote 14 checks in January 2009 – you just  TRY NEVER TO WASTE ANYONE’S TIME do not need a business manager for this Maintaining Your Office Staff and How Did it Work Out for Me? Reputation  Be honest and straightforward  Utah Woman of the Year in 2000  Educate and learn from your office staff  I received the only national Best Practices  Psychiatrize with the staff Award for a private medical practice  Be predictable  Teacher of the Year awards from the  You will be offered opportunities to engage Department of Pediatrics – four times in alternative ventures. This generally does  Horizonte Community Service Award not come out well.

  77. 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

  78. Kathleen B. Schwarz, M.D. President, NASPGHAN 2 nd year fellows Ross Conference 2012 Outline What you can do for them  What you can do for them  Clinical Service – how much, how long is the day?  Clinics – near and far – how many patients?  When they can do for you  Procedures – how many? What kind?  Body language and other tips  Weekend call – how many? (with or without a fellow?)  Sensitive issues  Teach – what level? how much?  The bigger picture for your family  Hospital committees – how many? What happens if you  The bigger picture for you say no? What are the employer’s expectations? RVU’s for Selected Services 2008  How many RVU’s are you expected to contribute?  Service (HCPCScode) Total MD P M  Medicare uses a physician fee schedule to determine  Intermdiate Office Visit (99214) 2.53 1.42 1.06 0.05 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  Diagnostic Colonoscopy (45378) 5.64 3.69 1.65 0.30 service. These resources include the physician’s work, the expenses of the physician’s practice, and professional liability insurance.  Total Hip Replacement (27130) 37.66 21.61 12.54 3.51  Physician work RVUs account for the time, technical skill  www.nhpf.org T H E B A S I C S Relative Value Units (RVUs ) and effort, mental effort and judgment, and stress to provide a service.

  79. What they can do for you Pay you  Provide nursing and nutritionist assistance Basic salary  Provide up to date endoscopy equirment Incentives  Provide research assistance – lab, technician, biomedical CME statistics and the protected time to do it Malpractice/medical licenses  Provide secretarial assistance Opportunities for advancement  Provide an office References  Provide benefits – especially health insurance AAP salary scale per region and rank  Provide a grievance structure NASPGHAN Practitioner’s Database  Provide an efficient billing service Body language and other tips Sensitive issues  Pregnancy  Let the interviewer talk first  Malpractice suit against you  They will ask you questions about your background  Mental health issues  They will try to figure out who you are  Drug or alcohol dependence  Try to figure out what they want  Gay/lesbian/biseual  Tailor your response about yourself to fit what they  HIV want but don’t fabricate a story  Prison history  Get the employer hooked on you!  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

  80. 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!!!

  81. Timeline and Evaluations AP 102 13-14 14-15 15-16 16-17 17-18 18-19 19-20 20-21 21-22 22-23 23-24 Academic Promotions 0 1 2 3 4 5 6 7 8 9 10 Instructor 6 yr review Renew! 1 yr review 3 yr review On to Assistant Nomination Professor Professor Promotion David A. Piccoli, MD Biesecker Professor of Pediatrics at The Children’s Hospital of Philadelphia Review Raymond and Ruth Perelman School of Medicine Associate at the University of Pennsylvania Professor On Track – For Promotion Timeline Considerations of an Assistant • Understand the process • How long is the course to Associate Professor? • What is required in my track? • Obtain, maintain the documentation • What resources are available at this stage? – Start up package • Ongoing mentoring – Salary support – Research environment • Ongoing feedback – Clinical mentor – Research mentor • COAP guidance and feedback Timeline and Evaluations – Research 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 13-14 14-15 15-16 16-17 17-18 18-19 19-20 20-21 21-22 22-23 23-24 0 1 2 3 4 5 6 7 8 9 10 0 1 2 3 4 5 6 7 8 9 10 Instructor 1 yr review 3 yr review 6 yr review Renew! Instructor 1 yr review 3 yr review 6 yr review Renew! On to On to Assistant Nomination Assistant Nomination Professor Professor Professor Promotion Professor Promotion Research Startup Funds Paper Paper Paper K grant – mentored scientist award Review Paper Paper Paper Paper Review Independent Laboratory space Paper Paper Paper Paper Associate Associate Professor Professor Paper Paper Paper Paper Supplemental grants R01 award – sustained funding, and more Paper Paper Paper Paper Paper, ………. Mentor for MDs, PhDs, students

  82. Timeline and Evaluations CE Track – Papers & Chapters 13-14 14-15 15-16 16-17 17-18 18-19 19-20 20-21 21-22 22-23 23-24 0 1 2 3 4 5 6 7 8 9 10 Instructor 6 yr review Renew! 1 yr review 3 yr review On to Assistant Nomination Professor Professor Promotion Establish Clinical Expertise in focused area Clinical or translational research Review Regional and national reputation Associate Professor Leadership – New programs or initiatives Funding, Development, advocacy Papers, chapters and reviews, ………. 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 Reappointment Process • Formal dossier prepared at years 1, 3, 6 Provost / Dean Promotion Committee • Evaluate rate of progress and productivity – Scholarship (CV) Medical School Committee – Clinical productivity and excellence – Teaching quality and quantity (EDB) Departmental Committee – Roles and responsibilities (Academic plan) Division Chief • Identify strengths and address deficiencies

  83. Documentation - Reappointment Academic Plan ACADEMIC PLAN FOR ______________________, Degree ____ • Division chief letter of recommendation • Department Education Officer letter Proposed Start Date: ______________________ Mentor: _______________________ • Academic plan Breakdown of duties: % Research % Clinical Service % Teaching % Administration • Candidate CV 100% Research: • Candidate Educational Database Clinical Services: Teaching: • Clinical roles and productivity Administration: Approved: Candidate ____________________________________ (date)___ Chief ________________ Division of ______________ (date) ___ Chair________________ Department of ____________(date)___ Educational Database Evaluations • CV • Thou shalt give, and thou shalt receive • Personal statement • Maintain these in an ongoing fashion • Teaching activities • Learn from them, learn to give them • Administrative teaching • HAMSTER – (house officer and medical student evaluation record) • Teaching evaluations • Oasis • Departmental teaching review • Individual letters • Other letters • Course reviews • Educational officer letter (Departmental letter) Promotion Process HAMSTER Evaluations • Same as for reappointment Non-Clinical Lectures Labs • Same documentation requirements < 3.5 Does not meet expectations Does not meet expectations ≥ 3.5 - ≤ 4.2 Meets expectations Meets expectations • Review and support by internal consultants ≥ 4.2 Exceeds expectations Exceeds expectations • Review and support by external consultants Clinical GME UME • Review by each level of Promotions Committees < 3.9 Does not meet expectations Does not meet expectations ≥ 3.9 - ≤ 4.8 Meets expectations Meets expectations • Review and evaluation of candidate by the Dean ≥ 4.8 Exceeds expectations Exceeds expectations and/or Provost

  84. Academic Clinician Specific Criteria Letters of Support • Extramural consultants • Medical knowledge, clinical judgment, clinical skills, technical skills – List supplied by chair, candidate or both • Communication with other health professionals – Solicitation comes from committee • Compassion and respect for and communication – Full package is sent to consultants with patients • Intramural consultants • Dedication and enthusiasm for patient care • Other recommendation letters • Professionalism and respect for colleagues, • Teaching letters trainees, and allied health professionals • Overall performance Academic Clinician Documentation Institutional Goals • Letters from colleagues and referring physicians • Recruitment • Evaluations / letters from former trainees and • Promotion house staff • Retention • Evaluations / letters from allied health • Faculty success professionals • Faculty happiness • Faculty!! • It is in the institution’s best interest to make this straightforward, and successful. Special Situations and Policies With thanks, and encouragement ! • 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 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 • Moving to another track achieving their goals.

  85. Introduction And Disclaimer How to Tell the NIH You are Pregnant…  Initiate discussion @ initial years of academic medical careers  Challenges  Realities And other lessons (to date) on  Strategies growing your career and family.  Individual and unique experience  Collective wisdom  No hard and fast rules Jenifer R. Lightdale, MD, MPH Children’s Hospital Boston Background Background JL’s original 5 - year plan…  Jenifer R. Lightdale, MD, MPH Marriage Start MPH End MPH Baby Publish, publish, publish  Residency UCSF  Fellowship Boston  On staff in Boston since 2001 -2 Fellowship Apply for K Work on K Promotion  HSR Research Fellowship 2001  KO8 AHRQ “Pediatric Sedation and Patient JL’s reality check… Safety” (exp 2007)  Wear several “hats” at CHB and HMS Start MPH Baby # 2  GI – Director of Quality and Patient Safety Baby # 1 End MPH Publish, publish, publish Marriage  CRC - Director of Clinical Research Education Promotion  Hospital – Executive Sedation Committee, BEST Fellowship Apply for K K gets funded Work on K Promotion Labs, PRUDENT Project, COC Buy a house Background JL’s Anagram… B  Work-life balance balanc nce A  An issue for all physicians  Unique and particular challenges L  Young academic physicians A  Modern era of medicine N  JL’s Anagram C  Strategies E

  86. JL’s Anagram… MD Career Satisfaction B  1973 – 86% of 2700 MDs: “no doubt at all” about career choice 1 A  1990 – only 60% reported: L “would enter medical school again” 2 A  2000 – more than 37% surveyed: “less satisfied than 5 years prior” 3 N  2009 – U. Chicago (NORC) MDs with less C job satisfaction than clergy and physician assistants 4 1. Hadley, Acad Med, 1992. ENJOY OY 2. Harvey, AMA, 1990. 3. Chan, Radiology, 1995. 4. NORC, 2009. MN , KG and rest of faculty!! Physician Attitudes JL as “Living Proof”  Affected by more than just long work  New dx: “New age guilt” hours 1  “It’s okay to love work!”  Antidote – “I love going home.”  Collegial environment 3  Perceived stress 2  Enjoy it all  Frequent, small pleasures 3  As much of the time as possible.  Laughter, humor, lighthearted interactions 4 1. McCranie, Behav Med, 1988. 2. Ramirez, Lancet, 1996. 3. Larsen, JPSP , 2002. 4.Sotile, 2002. JL’s Anagram… Choices in early career/family B  Work  Academic vs.Private Practice A  Primary care vs. Fellowship  Research vs. Clinical L  Part time vs. Full time  Take on administrative function  Stay or Move A  Home N  Move or Stay  Rent vs. Buy ChoiCE iCE  ARM vs. Fixed rate mortgage  Children E  Public vs. Private school

  87. Making good choices JL’s Anagram… B  Recognize that choice is stressful 1 A  Maintain sense of control L  Value self-protective choices A  Take a mid-term view  Embrace “cognitive - dissonance” 2 NICH CHE  Recognize when you’ve made the C wrong choice E 1. Sotile, 2002. 2. Roese, 2005 Developing a niche Important to find your niche:  Extremely important to success  Develop a subject (research) area:  Emphasize strengths  Concept that many fail to master  Feel challenged  Passion for topic  Early years of career (residency through early faculty)  STAY FOCUSED!  Smorgasbord approach 1  Take ownership  Talk it up  Variety of projects  Publish your data  Based primarily on availability 1. Stead et al, Acad Emerg Med, 2005 Niche JL’s Anagram… B  National recognition A  Invited reviews L  Chapters in reference texts  Moderate sessions ALLOC LOCATE E TIM IME  Invited faculty N  Promotion C E

  88. Major obstacles to Principals of time management `managing time well:  Schedule “appointments” to get tasks  Procrastination done 1  Day, week, month  Interruptions  Plan in advance  Establish priorities  Email 1  Emphasize flexibility  “Do it”  “Delegate it”  Take “time out”  “Defer it”  Increase efficiency  “Delete it” 1. Brunicardi and Hobson, 1996. 1. Allen, “Getting Things Done” 2001. Allocate time at work: Allocate work vs. home time… Work Home • Try to alternate spheres… emphasizing flexibility as priorities change. 1. AAAS Survey, Science, 2001. Allocate work vs. home time… Allocate work vs. home time… Work Work Home Home • Try to alternate spheres… emphasizing • Try to alternate spheres… emphasizing flexibility as priorities change. flexibility as priorities change.

  89. JL’s Anagram… Limit setting B  Limit call-time, and afterhours work 1 A  Set reasonable limits on your availability to patients/ colleagues LEARN RN to SAY NO  Use your gut to determine if you are A overwhelmed  “Template” responses to say “no” to N both colleagues and patients and learn to use them… C E 1. Sotile, 2002. To your colleagues: To your patients:  “I am so sorry that you’re having  “I would love to, but my plate is full.” difficulty. I’m not available, but  “That sounds great, but I’m someone I know and trust is. Please swamped.” let me refer you.”  “I’m honored, but I’m now focusing  “I’m really concerned about you. I’m on other areas.” sorry that I don’t have more time  “I’m sorry, but that’s out of the today to discuss this. Can we schedule a follow-up appointment for question. I’ve just been out of the us to sit down and explore this office and I’m trying to dig out here.” further?” 1. Babitsky and Mangraviti, 1998. 1. Babitsky and Mangraviti, 1998. JL’s Anagram… Adjust constantly B  Moment-to-moment balancing act 1 ADJUS JUST  Day to day L  Year to year A  Accept change in plans come with the territory N  Be confident that you will maintain C priorities E 1. Allen, “Getting Things Done” 2001.

  90. Background JL’s Anagram… BUY HELP LP JL’s original 5 - year plan… A Marriage Start MPH End MPH Baby Publish, publish, publish L fellowship Apply for K Work on K Promotion A JL’s reality check… N Baby # 2 Marriage Baby # 1 Start MPH End MPH Publish, publish, publish C Promotion fellowship Apply for K K gets funded Work on K E Buy a house Advantages of Growing UP At work: 1  Identify your resources  Clinical job  NPs/ RNs  Administrative Assistance  Fellows  Nursing assistance  AAs  Techs/ RAs  Grants  Students  Salary support  Delegate wisely  Research Assistance/ Technical  Think upstream as well as support down…  Handoff (e.g. Email)  Home  Follow-up  Help with maintenance  Avoid micromanaging  Childcare 1. Allen, “Getting Things Done” 2001. At home: Conclusion Question:  Identify your resources  Housecleaning  Home/ yard work How do you tell the NI H  Cooking you are pregnant?  Childcare providers  Family Answer:  Delegate wisely  Follow-up You don’t necessarily need to…  Avoid micromanaging

  91. Conclusion: Thank you for your attention! BUY HELP LP ADJUS JUST LEARN RN to SAY NO ALLOCA LOCATE E TIM IME Best of Luck!! NICH CHE CHOICE ICES ENJOY OY

  92. 2012 2 nd 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 _________________________________________

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