Portal de Periódicos da CAPES

A Pediatric Department's Innovative Grant Writing Workshops

2018; Elsevier BV; Volume: 197; Linguagem: Inglês

10.1016/j.jpeds.2018.02.060

1097-6833

Lisa A. Joss‐Moore, Heather T. Keenan, James F. Bale, Jurrien Dean, Kurt H. Albertine,

Innovations in Medical Education

Sustaining the pipeline of engaged, productive physician-scientists in pediatric departments is crucial to the mission of academic pediatrics. Today, however, physicians are less likely to pursue biomedical research than ever before.1Garrison H.H. Deschamps A.M. NIH research funding and early career physician scientists: continuing challenges in the 21st century.FASEB J. 2014; 28: 1049-1058Crossref PubMed Scopus (110) Google Scholar, 2Milewicz D.M. Lorenz R.G. Dermody T.S. Brass L.F. National Association of MDPPEC. Rescuing the physician-scientist workforce: the time for action is now.J Clin Invest. 2015; 125: 3742-3747Crossref PubMed Scopus (132) Google Scholar, 3Reynolds H.Y. In choosing a research health career, mentoring is essential.Lung. 2008; 186: 1-6Crossref PubMed Scopus (39) Google Scholar, 4Rosenberg L. Physician-scientists-endangered and essential.Science. 1999; 283: 331-332Crossref PubMed Scopus (210) Google Scholar, 5Wyngaarden J.B. The clinical investigator as an endangered species.N Engl J Med. 1979; 301: 1254-1259Crossref PubMed Scopus (408) Google Scholar, 6Moody F.G. Clinical research in the era of cost containment.Am J Surg. 1987; 153: 337-340Abstract Full Text PDF PubMed Scopus (3) Google Scholar, 7Ferkol T. Zeitlin P. Abman S. Blaisdell C.J. O'Brodovich H. NHLBI training workshop report: the vanishing pediatric pulmonary investigator and recommendations for recovery.Pediatr Pulmonol. 2010; 45: 25-33Crossref PubMed Scopus (13) Google Scholar Although retention, promotion, and tenure guidelines are changing at academic institutions, obtaining extramural funding remains one of the most important measures of scholarship.1Garrison H.H. Deschamps A.M. NIH research funding and early career physician scientists: continuing challenges in the 21st century.FASEB J. 2014; 28: 1049-1058Crossref PubMed Scopus (110) Google Scholar Despite the academic importance of extramural funding, grant awards from the National Institutes of Health (NIH) and other funding agencies to physician-scientists are declining.8Alberts B. Kirschner M.W. Tilghman S. Varmus H. Opinion: addressing systemic problems in the biomedical research enterprise.Proc Natl Acad Sci USA. 2015; 112: 1912-1913Crossref PubMed Scopus (41) Google Scholar, 9Hobin J.A. Deschamps A.M. Bockman R. Cohen S. Dechow P. Eng C. et al.Engaging basic scientists in translational research: identifying opportunities, overcoming obstacles.J Transl Med. 2012; 10: 72Crossref PubMed Scopus (37) Google Scholar, 10Nathan D.G. Wilson J.D. Clinical research and the NIH—a report card.N Engl J Med. 2003; 349: 1860-1865Crossref PubMed Scopus (67) Google Scholar, 11Zemlo T.R. Garrison H.H. Partridge N.C. Ley T.J. The physician-scientist: career issues and challenges at the year 2000.FASEB J. 2000; 14: 221-230Crossref PubMed Scopus (188) Google Scholar, 12Health NIo Research portfolio online reporting tools.https://report.nih.gov/success_rates/Date: 2016Google Scholar Here we describe our innovative investments to prepare fellows and faculty ("participants") to write impactful grant applications that are competitive at the national level. The investments are made through the Department's Grant Writing Workshop, a 2.5-day immersive-writing program at which participants develop their grant applications. Participants applying for our intramural Primary Children's Hospital Foundation Career Development Award are required to attend the workshop prior to submission. Faculty who are transitioning from K to R awards also attend the workshop. The number of participants is generally capped at 10, the majority of whom are members of the Department of Pediatrics. Faculty-mentors are established investigators with a history of NIH funding as Principal Investigator. At least one-half of the faculty mentors are also members of NIH study sections. A biostatistician also attends the workshop. Women and under-represented minorities (URM) are included in the workshop at both the participant and faculty-mentor levels. Under-represented minority participants and faculty-mentors are recruited from within the Department of Pediatrics and from other departments at the School of Medicine. Innovations of the workshop are active writing, with immediate one-on-one feedback, and 3 days of off-site, uninterrupted writing time. The workshop is held in November and April at a local ski resort (~$15 000 total cost per workshop). The dates allow participants ample time to prepare their applications for our Primary Children's Hospital Foundation Career Development mechanism and NIH submission cycles. The structure of the workshop presupposes protected time for research and provides active writing immersion with faculty-mentor engagement (Appendix; available at www.jpeds.com). Didactic sessions are minimal and cover concepts of clear writing, the specific aims page, statements of significance, innovation, scientific premise, and project impact, as well as the approach section, including study design with supporting data, budget and justification, and assembling an application. Discussion of career development (K-series) awards takes place in separate break-out sessions. The didactic sessions provide participants with framework and examples to assess their proposals in the context of NIH applications and peer review. To facilitate active learning through one-on-one writing critique by faculty-mentors, with immediate rewriting by the participants, we maintain a participant:faculty-mentor ratio of 2:1 to ensure maximum time for one-on-one interactions. Participants interact with all faculty-mentors, including faculty-mentors whose expertise is outside the area of an application. Writing skills introduced in the didactic component are honed through the one-on-one discussions.13Wisdom J.P. Riley H. Myers N. Recommendations for writing successful grant proposals: an information synthesis.Acad Med. 2015; 90: 1720-1725Crossref PubMed Scopus (15) Google Scholar The discussions also expose weaknesses in feasibility and study design. Outcome is step-wise improvement in the clarity and focus of the sections of each grant application. The statistician provides one-on-one advice on study design and statistical assessments. Resource books complement effective writing skills.14Strunk W. White E.B. The elements of style.4th ed. Allyn & Bacon, Needham Heights1979Google Scholar, 15Zeiger M. Essentials of writing biomedical research papers. McGraw-Hill, New York2000Google Scholar Workshops also include 2 additional group activities to reinforce the importance of clear writing and the value of favorably engaging reviewers. The first is a mock study section of an NIH grant application, the purpose of which is to impress the participants on how quickly a grant application is reviewed. A deidentified NIH grant application is critiqued by primary, secondary, and tertiary reviewers selected from the faculty mentors. The application receives harsh reviews and is scored poorly, intentionally. The participants then prepare for a repeated mock study section of the same proposal, at which they will be the reviewers. Three participants are randomly selected as reviewers. After review from the participants, one of the faculty mentors adds overwhelmingly positive comments in the discussion phase of review. The champion's perspective demonstrates the effect of having a reviewer argue persuasively that an application will be impactful. The other activity involves participants orally presenting the specific aims page of a fellow-participant on the workshop's final day. Immediately before the presentations, the specific aims pages are collected and redistributed randomly to the participants, who are given 10 minutes to read and consider the project before giving a 3-minute presentation to "sell" the project, outlining the topic, hypothesis, and specific aims, significance, innovation, scientific premise, primary piece of supporting evidence, and project impact. Through both activities, participants begin to appreciate the concept of reader interpretation to reinforce the importance of writing with clarity for easy understanding by reviewers. From 2007 through 2015, the period for which we have complete data, 125 participants attended a workshop; 89 were fellows or faculty in the Department of Pediatrics or a Pediatric Clinical and Translational Scholar.16Byington C.L. Keenan H. Phillips J.D. Childs R. Wachs E. Berzins M.A. et al.A matrix mentoring model that effectively supports clinical and translational scientists and increases inclusion in biomedical research: lessons from the University of Utah.Acad Med. 2016; 91: 497-502Crossref PubMed Scopus (34) Google Scholar The remaining 36 participants were from other departments. Of all participants, 52% were female, 74% were physician-scientists (MD, DO, MD-PhD), 26% were basic scientists (PhD), and 5% were URM. Notably, 40% of participants received federal funding within 24 months of attending a workshop. Breakdown of the number and direct costs of funded and unfunded applications by application type and sex for participants from the Department of Pediatrics is shown in the Table. Application types submitted to federal agencies include career development awards (K-series), investigator-initiated (R-series), as well as programmatic grants (U-series). Among these application types, success rates were highest for K-series grants and lowest for R-series (Table). Encouraging outcomes were similar success rates for male and female participants for K-series grants (60% for male and 62% for female), non-R01 R-series grants (31% for male and 33% for female), and nonfederal agencies (38%-100% for male and 33%-100% for female). Also encouraging, budget award amounts were higher for female participants for about one-half of the awarding agencies and award types. However, female participants applied for fewer R01 and equivalent grants, with none of their applications being awarded. Both outcomes are recognized nationally as contributors to lower NIH R01 success rates for women.17Ginther D.K. Kahn S. Schaffer W.T. Gender, race/ethnicity, and National Institutes of Health R01 research awards: is there evidence of a double bind for women of color?.Acad Med. 2016; 91: 1098-1107Crossref PubMed Scopus (107) Google Scholar, 18Ley T.J. Hamilton B.H. Sociology. The gender gap in NIH grant applications.Science. 2008; 322: 1472-1474Crossref PubMed Scopus (149) Google Scholar, 19Pohlhaus J.R. Jiang H. Wagner R.M. Schaffer W.T. Pinn V.W. Sex differences in application, success, and funding rates for NIH extramural programs.Acad Med. 2011; 86: 759-767Crossref PubMed Scopus (157) Google Scholar We do not know why female participants submitted fewer applications than male participants. Upon follow-up, we learned that more female participants did not resubmit an application following an unsuccessful submission compared with male participants. Our current efforts are to discover reasons for these disparities.TableProposals submitted (funded and unfunded) by Department of Pediatrics Workshop Participants (2007-2015)AgenciesAward typeMale participantsFemale participantsFunded number of awards (total costs)Unfunded number of awards (total costs)Success rateFunded number of Awards (total costs)Unfunded number of awards (total costs)Success rateFederalR01/DP23 ($5 617 204)8 ($19 908 410)27%0 ($0)6 ($12 367 453)0%R03/R21/R18*Higher rates of funding for male, compared with female, participants reflect awards with greater budget allocations.5 ($3 001 488)11 ($4 354 250)31%6 ($1 413 077)12 ($3 577 623)33%K01//K08/K23/K246 ($4 313 129)4 ($2 915 779)60%10 ($5 357 058)6 ($3 864 486)63%U01/U18/P30/P54*Higher rates of funding for male, compared with female, participants reflect awards with greater budget allocations.1 ($1 309 003)2 ($5 000 000)33%4 ($2 797 691)3 ($8 480 757)57%Other*Higher rates of funding for male, compared with female, participants reflect awards with greater budget allocations.5 ($2 116 437)8 ($5 575 305)38%6 ($425 977)4 ($13 373 439)60%Association or foundationPCHF20 ($566 883)4 ($100 000)83%25 ($666 434)5 ($125 000)83%Other*Higher rates of funding for male, compared with female, participants reflect awards with greater budget allocations.†Includes Doris Duke, Robert Wood Johnson, Thrasher, March of Dimes, American Heart Association.33 ($6 367 121)55 ($14 238 409)38%17 ($1 560 139)25 ($7 433 645)40%University‡Includes University Center for Clinical and Translational Science and non-University of Utah university funding.Total8 ($413 606)12 ($800 007)40%14 ($1 074 977)7 ($607 990)67%Industry§Includes Pfizer and Nestle.Total4 ($194 416)3 ($502 384)57%5 ($47 500)10 ($1 130 817)33%State of Utah¶Includes Utah Center for Birth Defects and Birth Defect Network, Salt Lake Valley Health Department.Total2 ($71 727)0 ($0)100%9 ($2 485 937)0 ($0)100%Clinical TrialTotal8 ($1 041 343)0 ($0)100%17 ($2 048 630)2 ($280 035)89%PCHF, Primary Children's Hospital Foundation.* Higher rates of funding for male, compared with female, participants reflect awards with greater budget allocations.† Includes Doris Duke, Robert Wood Johnson, Thrasher, March of Dimes, American Heart Association.‡ Includes University Center for Clinical and Translational Science and non-University of Utah university funding.§ Includes Pfizer and Nestle.¶ Includes Utah Center for Birth Defects and Birth Defect Network, Salt Lake Valley Health Department. Open table in a new tab PCHF, Primary Children's Hospital Foundation. Participant evaluations completed at the conclusion of each workshop are overwhelmingly favorable. Participants repeatedly identified "protected time to write, with immediate feedback from the faculty-mentors" and "uninterrupted time to focus on their proposal" as the most valuable aspects. Measures introduced by the Department of Pediatrics Research Enterprise prospectively encourage persistence and support by facilitating mentoring from within, and outside, the Department, providing a forum for junior faculty to discuss their application and resubmission plan with senior faculty via a "chalk-talk," and encouraging junior faculty to use the University of Utah's CCTS grant review opportunity. A limitation of assessment of the workshop's effect on success rates is lack of a comparison group in our department that did not attend the workshop over the same period. We did not make this comparison because the latter group is dominated by more senior, successful faculty. We also did not compare against historical success rate within our department because the grant-funding environment and overall success rates at the NIH have changed over the years. For these reasons, comparison is limited to similarities to overall 2016 NIH success rates of ~40% for K-series awards and 18% for R-series awards,12Health NIo Research portfolio online reporting tools.https://report.nih.gov/success_rates/Date: 2016Google Scholar showing that the workshop participants have similar success rates. Fostering the research grant award success of pediatrician-scientists requires institutional initiatives and investment.2Milewicz D.M. Lorenz R.G. Dermody T.S. Brass L.F. National Association of MDPPEC. Rescuing the physician-scientist workforce: the time for action is now.J Clin Invest. 2015; 125: 3742-3747Crossref PubMed Scopus (132) Google Scholar, 20Cornfield D.N. Lane R. Rosenblum N.D. Hostetter M. Jobe A. Albertine K. et al.Patching the pipeline: creation and retention of the next generation of physician-scientists for child health research.J Pediatr. 2014; 165 (e1): 882-884Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar, 21Feldman A.M. The National Institutes of Health Physician-Scientist Workforce Working Group report: a roadmap for preserving the physician-scientist.Clin Transl Sci. 2014; 7: 289-290Crossref PubMed Scopus (23) Google Scholar, 22Christou H. Dizon M.L. Farrow K.N. Jadcherla S.R. Leeman K.T. Maheshwari A. et al.Sustaining careers of physician-scientists in neonatology and pediatric critical care medicine: formulating supportive departmental policies.Pediatr Res. 2016; 80: 635-640Crossref PubMed Scopus (7) Google Scholar The purpose of our department's innovative faculty development workshop is to provide protected, focused, active-learning in the art of clear writing and its application to grantsmanship. Our strategy is to facilitate award of extramural funding and to shorten the time to independent (R-series) funding, particularly for female faculty, to support the departmental goal to facilitate preclinical and clinical research and develop our pipeline of physician-scientists in pediatrics. Our approach is multifaceted and includes provision of foundation funds, protected time, research and career mentoring, and grant writing training and support.20Cornfield D.N. Lane R. Rosenblum N.D. Hostetter M. Jobe A. Albertine K. et al.Patching the pipeline: creation and retention of the next generation of physician-scientists for child health research.J Pediatr. 2014; 165 (e1): 882-884Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar, 23Brown A.M. Morrow J.D. Limbird L.E. Byrne D.W. Gabbe S.G. 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There is no "I" in Team: new challenges for career development in the era of team science.J Pediatr. 2016; 177: 4-5Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar The success of our approach requires buy-in of departmental leaders and senior faculty, and is an example of "departmental mentoring" in action.