Building Bridges, InstigatingInterfaces or Settling for Silos:

Interdisciplinary CareerDevelopment and Mentoring

Harold Alan Pincus, MDProfessor and Vice Chair, Department of Psychiatry

Director, Irving Institute for Clinical and Translation ResearchColumbia University

Director of Quality and Outcomes ResearchNew York-Presbyterian Hospital

Senior ScientistRAND Corporation

2

Environmental Context• Tremendous clinical needs

• Enormous scientific opportunities

• Clinical margins dropping (costs up/revenue down)

• Geriatrics not a profit center

• Increased scrutiny- IRB/COI/Data Security

• Increased accountability - reporting/P4P

• NIH “hard landing”

• Preparing for recovery – the long game

• Roadmap/CTSA’s

3

Biomedical Science Policy 101Biomedical Science Policy 101•• Who: clinical/translational/interdisciplinaryWho: clinical/translational/interdisciplinary•• What: possibilities for the futureWhat: possibilities for the future•• Where: institutions and centersWhere: institutions and centers•• From Where: From Where: ““anatomyanatomy”” of funding of funding•• How: processes and ethicsHow: processes and ethics•• How Much: research fundingHow Much: research funding•• Why: improving patient careWhy: improving patient care

4

Who?“Black Box” of Research Training/Career Development

Nursing

Specialties

Other Fields(e.g. economics, mathematics, etc.

• Recruitment•Training

• Early Career Development• Retention

• Mentorship•Funding

•Environment/Reward System

M.D./Ph.D.

Researcher

M.D.

Other Health Professions

Social Work

5

What Is Interdisciplinary Research?A discipline is … “the training of scholars and

subordinates to proper conduct and action byinstructing and exercising them in the same; mentaland moral training.” --Shorter Oxford EnglishDictionary

(i.e., keeping on the “straight and narrow”)

Interdisciplinarity …merging common aspects of twoor more disciplines, e.g. biochemistry,neurosciences.

Multidisciplinarity …emphasizes interaction acrossdisciplines to address a common problem, whileallowing researchers to maintain their disciplinaryidentities.

6

What Is InterdisciplinaryGeriatric Research?

Rather than being centered in one academic department ordisciplinary unit, interdisciplinary geriatric research….• Reflects true collaboration across two or more relevant

disciplines within or across institutions− Core geriatric disciplines: medicine, nursing, social

work− Related disciplines: e.g. pharmacy, psychology,

rehabilitation, nutrition, sociology, etc.• Builds new partnerships that expand geriatric research

foci and methods beyond traditional boundaries

7

An Example from Geriatric Health Care

• Multiple Targets (e.g., comorbidity, ADL domains, patient and familypreferences)

• Multiple Interventions (e.g., polypharmacy, nursing care, prevention,psychosocial interventions, systems change)

• Multiple Systems (health care, social services, mental health,rehabilitation, housing, etc.)

RequiresMultiple, simultaneous approaches for generating new knowledgefor solutions.

82-year-old woman with arthritis, depression and diabetes in an assistedliving facility…

8

What Are the Barriers?

Many disincentives; few incentives

Conceptual barriers−Difficulty agreeing on what to study:

problems and interventions−No common understanding across

disciplines—”translation” problem−Studying complex issues in multiple

simultaneous ways is inherentlycomplicated

9

What Are the Barriers?

Career development issues− Duration of training, debt, job opportunities− Getting ahead (often tied to individual department’s

measure of success)− Scarcity of interdisciplinary role models/ mentors

Psychological impediments− Turf and competition− Interdisciplinary research is “not pure,” seen as less

challenging or higher risk

Structural and Financial barriers− Extramural funding and review structures− Difficulties sharing indirect costs− No infrastructure support

10

Barriers to Translational Research

11

Where?

Where is the natural “home”?

13

14

15

16

17

18

Interdisciplinary Communication Is ParticularlyChallenging

“When people with completely differentscientific backgrounds get together to solvea common problem, they have to learn adifferent way of speaking, a differentlanguage.”

Dr. Alan MacDiarmid

University of Pennsylvania

2000 Nobel Prize Winner in Chemistry

(with a physicist and a material scientist)

19

20

You are the mammals!

21

22

Development of the RAND/Hartford Initiative Convened conference calls with foundation staff and

other leaders in geriatrics Developed a key informant interview protocol with

specific questions related to the overall design andevaluation of the initiative

Systematically surveyed leaders in the field (viaphone or mail) using the protocol

Formed National Advisory Board Funded 2 rounds of centers

23

How Can Interdisciplinary ResearchBe Facilitated?

• Reorganize the way research is conducted and funded• Create a reward system that acknowledges the

necessary increments of time, effort, and stability• Provide incentives for collaboration• Enhance the ability of individuals and teams to anticipate

and meet a variety of challenges, both organizationallyand personally– Interdisciplinary workshops– Interdisciplinary mentoring– Building working relationships across and among

senior and junior investigators

24

Overarching Program GoalCreate incentives for leaders to “work around” barriers andbuild interdisciplinary research centers that:• Focus on the development of innovative clinical and

health services interventions for older adults• Provide interdisciplinary education and training

opportunities for junior investigators• Attract subsequent extramural peer-reviewed funding for

the design and study of highly innovative clinical andhealth services interventions (Pilots)

• Will serve as models to better understand how to expandinterdisciplinary geriatric health care research

25

Round 1 of the InitiativeFunded 5 institutions• Boston University• Duke University• University of California, Los Angeles• University of Pennsylvania• Yale University

Center Results (1/1/2003-6/30/2005)• 104 new grants awarded for a total of nearly $53 million• 365 manuscript acceptances• 162 conference presentations

Includes those products that came from a member of the core center team (orin close collaboration with them) and that directly related to the center’seducational or research agenda. Nonetheless, not possible to definitivelyattribute all of the products directly to the centers

26

Round 2 Funded Institutions

• Cornell University

• New York University

• University of California, San Francisco

• University of Massachusetts

• University of Missouri, Columbia

• University of North Carolina

• University of Washington

27

“Some people skate to the puck. I skate towhere the puck is going to be.”

-Wayne Gretsky

28

NIH CTSA Awards:NIH CTSA Awards:A Home for Clinical and Translational ScienceA Home for Clinical and Translational Science

Trial DesignTrial Design

AdvancedAdvanced Degree-Granting Degree-Granting

ProgramsPrograms

ParticipantParticipant& Community& CommunityInvolvementInvolvement

RegulatoryRegulatorySupportSupport

Biostatistics

ClinicalResources

BiomedicalInformatics

ClinicalClinicalResearchResearch

EthicsEthics

CTSACTSAHOMEHOME

IndustryIndustry

OtherOther

Institutions

29

What about YOU?

30

SURGEON GENERAL’S WARNING:Much of this presentation is

NOT evidence-based

• There is very little high quality data on processand outcomes of research training and careerdevelopment in aging/geriatrics (or medicine,generally)

31

Role / Tasks of theRole / Tasks of theID Clinical ResearcherID Clinical Researcher

•• Core professional functions: clinical care of patientsCore professional functions: clinical care of patients•• Intellectual orientation: creative and disciplinedIntellectual orientation: creative and disciplined

thinkingthinking•• Technical skill: systematic, objective investigationsTechnical skill: systematic, objective investigations•• Management skills: organization and maintenance ofManagement skills: organization and maintenance of

research effortsresearch efforts•• Values and motives: scholarly advances for improvedValues and motives: scholarly advances for improved

patient carepatient care•• Understanding of interdisciplinary perspectives:Understanding of interdisciplinary perspectives:

collaboration and integrationcollaboration and integrationBurke, Pincus and Burke, Pincus and PardesPardes: The: TheClinical Researcher inClinical Researcher inPsychiatry, Am J Psych 1986Psychiatry, Am J Psych 1986

32

What We Know About DevelopingWhat We Know About DevelopingClinical InvestigatorsClinical Investigators

•• Early research experience is predictive ofEarly research experience is predictive ofresearch successresearch success

•• Research fellowship (2-3 years) and protectedResearch fellowship (2-3 years) and protectedfaculty time are predictive of research successfaculty time are predictive of research success

•• Training in research intensive department isTraining in research intensive department ispredictive of research successpredictive of research success

•• Mentoring is criticalMentoring is critical•• NIH Roadmap is expanding opportunities forNIH Roadmap is expanding opportunities for

interdisciplinary traininginterdisciplinary training

33

Training Strategies• Values

• Mentors

• Mentors

• Mentors

• Colleagues / Peers

• Research Opportunities / Collaborations

• Formal/informal curriculum

• Infrastructure

• Flexibility

34

A Word AboutMentoring and Menteeing

35

Mentor

• Trusted old friend of Odysseus to whomhe entrusted his son, Telemachus, forprotection and preparation for leadership

• Athena often assumes Mentor’s shape

– Patron of wisdom (esp. strategizingintelligence), defense and guardianshipof city-state, and useful crafts

36

Mentoring Continuum

SupervisionInformal/Natural

Mentoring

EnhancedInformal

Mentoring

FormalMentoring

ProfessionalProfessionalCoachingCoaching

RoleModeling

37

38

Mentor Roles• Role model

• Facilitator of professional socialization – networking

• Advisor on goals / career paths – specificity

• Promoter of scholarly values and scientific integrity

• Nurturer – e.g., facing disappointment

• Teacher – rules / skills

• Advocate – e.g., saying no

• Pastiche of mentors and role models

39

Functions of the Mentor

• S/he may act as a teacher . . . sponsor . . . host and guide .. . exemplar . . . [and] may provide counsel and moralsupport

• The mentor has another function, and this isdevelopmentally the most crucial one:- To support and facilitate the realization of the Dream

Levinson DJ, et al: The Seasons of a Manʼs Life. New York, Alfred A. Knopf, 1978

40

Mentoring Themes• Creating “The Dream”

• Time management

– Cross-sectional

– Longitudinal

• Prioritization

• Goal setting – getting concrete

• Relationship management

• “Eyes on the Prize” / Finding and maintaining the“Passion”

41

Mentoring Foci• Overall career development

• Academic promotion strategies

• Grant development

• Paper development

• CV maintenance

• Training plan

• Network development

• Career plan oversight– Long– Medium– Short

42

43

The Direction-Self-Direction Scale

Guided independence and scientific creativity

Micromanagement Sink or swim1 2 3 4 5 6 7 8 9 10

44

Mentee StrategiesMentee Strategies

•• Identify what Identify what –– then whom then whom –– you need you need•• Develop vision / goals / objectivesDevelop vision / goals / objectives•• Be specificBe specific•• Be persistentBe persistent•• Be reliableBe reliable•• Think broadly Think broadly –– e.g., pastiche, e.g., pastiche,

telephonetelephone

45

Mentoring Skills ModelMentoring Skills Model

MENTEEMENTEESPECIFIC SPECIFIC SKILLSSKILLS

MENTORMENTORSPECIFIC SPECIFIC SKILLSSKILLSAcquiring Acquiring

MentorsMentors

LearningLearningQuicklyQuickly

Showing Showing InitiativeInitiative

Following Following ThroughThrough

ManagingManagingthe the RelationshipRelationship

InspiringInspiringProviding Providing Corrective Corrective FeedbackFeedback

ManagingManagingRisksRisks

Opening Opening DoorsDoors

Instructing/Instructing/DevelopingDevelopingCapabilitiesCapabilities

Listening Listening ActivelyActively

Identifying GoalsIdentifying Goals& Current Reality& Current Reality

Building TrustBuilding Trust

EncouragingEncouraging

SHARED CORE SKILLSSHARED CORE SKILLS

Sense of HumorSense of Humor

46

Periodic Evaluation• Process

– Clear objectives

– Regular purposeful meetings

• Communication

– Feedback

– Mentees able to challenge

• Outcomes

– Sense of progress/development

– Improved networks

47

Mentoring Tools

• Individual

• Institutional

48

Nature’s Guide for Mentors• A mentor for life

• Personal characteristics

• Sensitivity

• Appreciating individualdifferences

• Respect

• Unselfishness

• Being widely read andwidely receptive

• Networking

• Support for other thanone’s own

• Availability: the open door

• Inspiration, optimism

• Balancing direction andself-direction

• The art of questioning andlistening

• Life after science

• Celebration

49

50

Attitudes• Running a marathon• No real shortcuts• Building a pyramid• You will not be the only person

in your area• Do not get discouraged• Persistence pays off• In basketball a .650 field goal

percentage is a great season (.300 in baseball)

51

52

There Is No Substitute for a Good Idea

53

Develop a Career Strategic Plan• Long term

- “The Dream”• Intermediate term

- “Blocks in the pyramid” - develop thesis• Short term

- skill building/training• Ultra short term - getting things done• Establish an affiliation/identity/niche

54

What’s on YOUR T-shirt?

55

Establish and Sustain Your Priorities• Understand promotion/tenure criteria• Avoid seduction of review papers,

chapters, book reviews (unless “twofer”/”threefer”)• Concentrate on most important things

– Original-data papers– Meeting presentations– Grant applications– Study sections

• Postpone substantial administrativeroles until established academically

• Continue clinical roles?

56

Develop a Grant “Strategic Plan”

• If You Do Not Apply, You Do Not Get Funded

• Make your career strategic plan concrete

• Get help

– Mentors

– Colleagues (home/away)

– Program officers

• Understand reviewer perspectives

• Diversify portfolio- Federal/Foundations/etc.

• Plan ahead

57

Publications

58

Be Your Own Worst Critic and Seek Out Constructive

Criticism Early in the Process of Every Project

59

Networking• Get to know colleagues• Share, discuss, invite participation• Be a regular at 2-3 selected professional

societies• Exchange ideas through e-mail, phone

calls, letters, meetings, and publications• Avoid “wars”: you are all involved in the

search for knowledge• Establish “thematic” sub networks across disciplines

60

• Do what you love; the data, findings, publications, fame, fortune, and tenure will follow!

• But be patient

In Summary...

61

And Celebrate...

• Your successes

• Your publications

• Your grants

• Your contributions to the field and to patients and their families

• Accomplishments of your students and colleagues

• Your family and friends

62

Have Fun!Have Fun!