12 • To give useful information and advice to young faculty embarking on an academic radiology career. Navigating through the research process can be difficult and it is very important to start on the right footing. • To provide anecdotal practical tips that cover academic faculty roles, getting started in research, grant writing, the mentoring process, and the necessary elements required to ensure continued research and career success. One of the first questions a trainee radiologist has to ask is, “Should I enter academics or private practice?” Historically, approximately 75% of radiologists in the United States enter private practice and about 25% choose academics.1 However, recent changes in the economy, including health care reforms that specifically affect radiologists, have resulted in a higher percentage of trainees entering academically oriented groups. The decision to enter a certain type of practice is not a straightforward one and will be impacted by various factors including family, spouse, financial status upon completion of residency, geographic choices, and drivers of success.2 Most physicians consider medicine a “career” rather than a “job.” Concerning radiology, results from a survey conducted more than two decades ago in British Columbia, Canada, among graduate residents and staff radiologists with and without a university affiliation, pointed out the fact that most academic radiologists make a decision on academic radiology because of the teaching, research, and publication experience.3 Most respondents had decided on an academic career path during their second half of residency of radiology or later. The influences most often cited as leading toward an academic career were a desire to teach, the inspiration of a role model, and an interest in research. Therefore, when all is “said and done,” one would like to look back on one’s professional accomplishments and feel that he/she has been successful. Success means different things to different people and to the same person at different stages of his/her life or career. Success can be associated with a sense of achieving personal growth, having favorable relationships with others, maintaining a work/life balance, or attaining eminence or status.4 Some say “success” is similar to “happiness” in that “happiness is between the ears”—meaning that one is inherently happy or not and that no degree of material goods will affects one’s true happiness. However, for many individuals, success in their career will involve one doing meaningful daily work, being recognized nationally and internationally as a leader in their field, completing a body of work or research that directly or indirectly improves other peoples’ lives, being a role model for people entering the field, and being appropriately financially remunerated. Nevertheless, tips for professional success include obtaining early accomplishments, having highly successful mentors, and choosing coauthors who will actively contribute to the conduct of some-one’s projects. Prior studies have shown that one of the biggest barriers preventing recent graduates from entering academic radiology is the perceived pressure to write successful grant applications in order to be promoted.5,6,7 This may have been the case a generation ago, but is not the case in our current environment. There is much more to academic radiology than writing grants. Studies have shown that among the reasons to pursue an academic career are the research opportunities available and the presence of positive role models.8 There are now four broad components of being a modern-day academic radiologist, which include (1) being an excellent specialized or subspecialized clinical radiologist, (2) teaching and scholarship, (3) research, and (4) administration/committee service.9 These four “legs” of the academic mission provide tremendous career latitude and expose those interested in pursuing an academic career to opportunities that were not previously available. In addition, the boundaries between so-called “academic” and “nonacademic” practices are now less distinct with many opportunities to excel available in larger “semi-academic, semiprivate” practices. The majority of radiology residents will complete a subspecialty fellowship. Academic medical centers (AMC) are often tertiary or quaternary referral centers and require physicians who are subspecialized in their respective specialties. We tend to forget that the 99.9% of people in the world who are not physicians expect to get the best care if they choose to be cared for in an AMC. Therefore, it is essential that AMCs recruit and retain experts in their respective fields to meet their clinical mission. Thus, anyone who has completed a radiology fellowship meets the basic requirements to work in an AMC. By definition, the majority of AMCs are affiliated with medical students, residents, and fellows who must be trained and educated. The majority of clinical training is performed by clinical faculty in largely an apprenticeship model.10 The primary mission of a medical school is education. One of the most substantial changes that have occurred over the past 20 years is the recognition that teaching is an essential role of a medical school, therefore it is imperative that medical schools reward faculty who are excellent clinician-educators through the promotion process. Historically, promotion was based on the “publish or perish” principle. However, the majority of AMCs now understand that there is nothing wrong with being an excellent clinician-educator and have created promotion tracks that allow faculty promotion based on excelling in these two important missions. The surest way to a speedy promotion is through obtaining independent National Institutes of Health (NIH) or Canadian Institutes of Health Research (CIHR) or equivalent government-sponsored funding, particularly for faculty on the tenure or research track. This principle has not changed over the past 50 years. However, it must be emphasized that the majority of academic radiologists have never submitted a grant or been the recipient of an NIH R01 or equivalent research grant.11 There are many components to “research” that include writing case reports or series, performing prospective trials, writing book chapters, participating in educational or scientific exhibits, and performing retrospective case series, prospective studies, and clinical trials. The majority of academic radiologists participate in these clinically oriented studies as opposed to basic science, and this type of clinically oriented scholarly activity has been the basis for the majority of faculty promotions in academic radiology. Increasingly, there are opportunities to pursue research in other areas including evidence-based medicine, society standards, or clinical guideline development. We formerly heard about the “tripartite” mission of academic medicine that refers to clinical work, teaching, and research. However, the unceasing regulatory scrutiny that has defined the last 15 years has changed our three-legged “stool” into a four-legged “table” with the fourth leg representing administration and committee work.9 There is a unique skill set associated with being a very good administrator that involves an aptitude to tackle never ending regulatory hurdles and to manage people. There is a science to administration and management, and these skills are part of standard business school curricula. However, these essential people management skills are not taught in medical school, and many physicians chose to study these in formal postgraduate education or have acquired them over time. Undoubtedly, the administrative aspects of health care are one of the largest growth opportunities in academic medicine. The scope of academic radiology continues to expand and provides a broad range of professional opportunities. Common questions that young faculty often ask include: “Where should I start?” “What should I get involved with?” and “Should I get involved in projects that I need to do or that I want to do?” There are no correct answers to these questions, but there are some general guidelines that may be useful. Unless you are absolutely certain about the specific area of academic radiology you wish to pursue, it is beneficial to get wide exposure to the field. Most academic radiologists will already have subspecialty training, so the clinical aspect of the position is fairly straightforward. However, it is very important that you establish yourself as a good clinician as this will help with future multidisciplinary collaborations. Dedicating oneself to the clinical work when on service is important too, since being a good clinician will increase your reputation among clinical colleagues. In addition, the clinical work and patients encountered often generate the ideas for valid research questions or meaningful projects. You will also be interpreting studies with trainees that include medical students, radiology (and clinical) residents, and fellows. As a teacher and consultant, you are acting as a role model to young trainees and imparting the basic and essential knowledge regarding how to be a clinical radiologist. You may also be their first image or “the face” of your specialty. Thus, you should try and establish a good rapport with these individuals and try and allocate at least 30 minutes each day for dedicated teaching when you are on the clinical service. An alternative if one is busy is to think aloud, or to impart at least one “teaching point” on each case that you interpret. An important lesson learned over time is that your ultimate reputation will be determined by those with whom you have interacted (your colleagues and your supervisors) and the individuals you train. We live in a very “small world” and both good and bad news travel fast. The medical field is even smaller and so your reputation will spread wide and far. Thus, it is important to foster good relationships with your trainees, allied medical colleagues, and administrative personnel. In addition, given the increased popularity of 360-degree physician performance assessments when it comes to retention, promotion, and tenure of faculty, this makes more than good common sense.12 New faculty come to AMCs with varying experiences with research. Most AMCs require some scholarly production for promotion. However, this requirement varies widely with the institution and the promotion track. Radiologists with little exposure to research should begin to work on small projects such as case reports, case series of unusual disease entities, or unique findings and educational exhibits. It is important to get engaged in research activities early as the first 5 years of activities have an influence on the research career trajectory later on and are a predictor of future research productivity. It can be very intimidating to get started on that first paper, and we highly recommended that one finds a mid-career or senior colleague who can mentor one through the process from start (idea generation or research question) to finish (manuscript drafting and publication). Young radiologists should try and identify colleagues in their own or other departments (e.g., clinical) with similar interests to work on collaborative projects and share responsibilities as this will dramatically increase scholarly productivity over time. Collaborating with clinical specialists will also increase one’s visibility among clinical colleagues, and when it comes to publishing, it opens up avenues for publication in high-impact mainstream journals. Junior radiologists may also wish to begin to review for journals. Many radiology journals are looking for reviewers and will assign manuscripts based on the complexity of the manuscript and experience of the reviewers. It is important not to review for too many since one can easily get overwhelmed. We began reviewing straightforward papers like case reports in our fellowship and junior faculty years and found that critiquing the writing of others greatly improved our scientific writing. For the initial journal reviews, it is a good idea to consult a senior colleague, who can read over the review and approve or edit it as appropriate and give general advice before submitting the review. The discussions that ensue will guide the young radiologist and build his/her reviewing skills as well as provide a networking opportunity with the senior colleague. From the academic institution’s perspective, if the junior radiologist receives some protected time for academic activities (20%, for example), he/she will be expected to produce scientifically as a priori determined by his/her department (e.g., to publish a minimum of one paper per year, to present papers and posters in scientific meetings, to participate in educational activities, etc.). Some faculty will have prior research experience upon entering their first academic position and may wish to pursue extramural funding. As mentioned above, the surest guarantee for academic promotion is obtaining an NIH R01 or equivalent research grant. However, R01s are difficult to obtain, especially for junior faculty and subspecialists such as radiologists. An important consideration for these young investigators is when to apply for extramural funding. There have been numerous promising young radiologists whose first academic pursuit was to apply for an NIH/CIHR grant. This may not be the best strategy since the funding rate in 2012 was 18% and the average age at which a principal investigator receives his/her first R01 (NIH) is 42 years old (PhD applicants) and is even older for MD and MD-PhD applicants.13 Writing a grant is similar to writing a business plan for a venture capital firm. The funding agency wants to make sure they will receive a benefit for their investment. In the business world, this means a monetary return on investment. In the scientific world, the NIH/CIHR wants to make sure the proposal they fund is scientifically rigorous, the proposed project will be completed on time, and the results will be published in the peer-reviewed literature. The best predictor of future success is past performance and the NIH/CIHR is more likely to fund an investigator with a prior history of funding and relevant scientific publications as opposed to someone whose first grant submission is an NIH R01/CIHR Operating Grant application. There have been numerous investigators who spent the first few years of their academic career solely working on an R01/Operating Grant that was not funded. Consequently, these young investigators became discouraged and left academics because they only focused on their R01 applications and had no other scholarly achievements during this time period. A better strategy for young faculty is to begin to write abstracts and small papers on a subject of interest. The next step is to apply for a small career development award that provides funding to acquire preliminary data. Tips on strategies to succeed as a young investigator can be obtained at specific forums or scientific meetings (Table 12.1). Getting started on that first grant proposal can be daunting and so there are many short courses on grant writing available, many of which will include the practice of writing an actual NIH/CIHR type grant proposal and receiving critique from colleagues and experts in the field. Asking someone to review your grant application ahead of time is key (ideally, two experts in the field and one person outside the field). We should keep in mind that some grant reviewers are not experts in the grant proposal field. Examples of grant writing courses and workshops on research proposal development specific to radiology are provided in Table 12.2. Career development awards are generally awarded to faculty within 5 years of completion of their (residency or fellowship) training and funds can be awarded toward supplies, equipment, or scanner time or toward salary support of research assistants or the faculty. Providing salary support frees up time for the young investigator to acquire data and develop the project. It is also a good idea to start networking at this stage, regarding new and downstream follow-on research ideas. Seed grants and career development awards are offered by numerous radiology societies and federal organizations (Table 12.3). For instance, the RSNA Research & Education Fund will fund projects totaling $2.9 million in 2012.14 The application is not as competitive as an NIH/CIHR grant and the intent of these grants is to assist young investigators who wish to obtain preliminary data for future NIH grant submissions. For these career development awards, one needs to form a team of mentors and collaborators who will ensure the successful completion of the project. At a similar level are the NIH K series/CIHR Young Investigator awards, which are similar to the radiology society awards in that they support early career development15 (Table 12.3). Some junior radiologists without prior formal education in research may use part of this “given” time for research through salary awards to pursue a graduate degree, which should equip them with the methodologic tools required to succeed in future grant competitions and in a long-term academic career through the “research track.” Table 12.1 Workshops on career development for young investigators
Steps for Using Research as a Success Tool in Academia
Learning Objectives
Introduction
The First Five Years
Name | Details | Link |
ARRS Clinician Educator Development Program | Nominees are selected and receive a grant to attend a 2-day workshop for junior faculty physicians to gain proficiency in teaching skills and designing educational activities. Interactive workshops are presented by leading educators and cover such topics as: adult learning theory and practice; developing curriculum; interactive techniques and exercises; case-based learning; designing a teaching-learning website; developing a teaching portfolio and writing self-assessment modules. | |
AUR Academic Faculty Development Program | Candidates are nominated by the department chair of each participating university. This is a 1-day program, held during the AUR annual meeting, for junior radiology physician faculty members. The program is comprised of several presentations addressing such topics as: informatics in imaging; opportunities in education; how a chair can help your career; update of ABR, maintenance of certification; ethical issues and advice for publishing and peer review; funding opportunities through the RSNA; opportunities in research; and how to attain and maintain academic productivity. | https://www.aur.org/AnnualMeeting/Faculty_Development_Program/ |
CIHR Young Investigators Forum | This forum is not focused on radiology, but aims to bring young investigators from different areas together to interact with one another, and attend workshops important for career development and related skills: Grant writing, time management, research team, translational research, etc. |
Abbreviations: ARRS, American Roentgen Ray Society; AUR, Association of University Radiologists; CIHR, Canadian Institutes of Health Research; RSNA, Radiological Society of North America.
Given the health system reforms that are upon us, grant funding may in fact become more difficult, but on the other hand, there will be a greater emphasis on sponsoring projects that are patient centered or that look at health services aspects such as comparative effectiveness of imaging modalities.16,17 These areas offer exciting new avenues for focus of future research efforts. In addition, librarians, division directors, department directors, and mentors can help young academics identify funding opportunities and direct them to relevant organizations and funding sources.18
Table 12.2 Radiology grant writing courses and workshops on research proposal development
Name | Details | Link |
RSNA Writing a Competitive Grant Proposal | A 1.5-day grant writing program for researchers in radiology, radiation oncology, nuclear medicine, and related sciences, interested in actively pursuing federal funding. This program focuses on developing strong specific aims and tools for getting started on the grant process. Participants are typically academic radiologists. | https://www.rsna.org/Writing_A_Competitive_Grant_Proposal.aspx |
