Tuesday, June 30, 2015

Research and Career Development


By Christine Laronga, MD, FACS

As I reflect on my academic career spanning 15 years and 2 institutions, several items emerge as key steps in my journey from Assistant Professor to Professor. First is identifying that you wanted to make the trip in the first place and then setting a realistic goal for this accomplishment. For example, I envisioned 5 years would be needed to go from Assistant to Associate Professor and another 5 years to rise to Professor. Set your own pace though. Now that you have established your long term goals, you need to break it down into yearly achievable goals to keep you on track. To do this, you need to know early what the requirements are for promotion at your institution. The requirements may fall into categories, such as research, teaching, service and clinical leadership, but they all go hand in hand. Each component will help your research and career development.

Clinical leadership entails building a practice and being recognized by one’s peers as an expert in your field. Building a practice usually takes a year or two during which time you are busy introducing yourself to the other departments (referrals). Offer to teach a didactic lecture or give grand rounds. This fulfills requirements for teaching on your CV but also gets your name out there.  Make several generic talks –The Surgeons Role in Breast Cancer etc.  This way you can be ready on short notice to give the talk and you can update it as new information /technologies become available. I had 3 ready to go my first month in practice. Usually the first month or so is slower as you are awaiting insurance coverage to see patients; so take advantage of this time to do meet-and-greet sessions with the community doctors (again a great way to get referrals). Most institutions have someone that can arrange these contacts and even go with you. Some hospitals will also have a monthly conference / tumor board for their doctors and you can offer to give a talk (good thing you have 3 talks ready). These sessions would go on your CV under invited talks (teaching) but also can be applied to service (local / community). Speaking of community, one of your talks should be created for the public. Many churches, schools, hospitals,  or organizations host community events to raise awareness. Check out your local community newspaper to find some of these. Reach out and offer your services. This helps build your practice and gets you service credit. To complete your service requirement as an Assistant Professor, volunteer to be on a hospital committee that isn’t too time demanding, until you get settled. You want a continuous item such as cancer committee because the commitment should span years. Your goal as an Assistant professor is to establish yourself in the local/regional area as a clinical expert and educator. Your reach will extend nationally / internationally as you progress from Associate to Professor.

Research development requires awareness of your ultimate goals. If you want to be a basic science / translational researcher, as a surgeon you will need great collaboration with your basic colleagues. You will need start up funds and need to bang out preliminary results to apply for grant funding. Shoot for mentored research grants. A grant awardee needs to show expertise in the arena of their studies.  Your studies will take years to come to fruition. So you need to start off with review articles and retrospective chart reviews at your institution. Publish these results. Present these results regionally and nationally. Most institutions have a minimum number of publications required for promotion, of which a proportion are expected to be as first author. Review articles and retrospective chart reviews are perfect for you to be a first author and they hone your knowledge base about your future research endeavors. For example, if your institution wants 5 publications with 1 as first author, you may want to target 1 a year. Don’t cram in the last year. A key to my success was building databases the minute I arrived at my first job.  I created an IRB protocol encompassing an extensive amount of data from demographics, presentation, pathology, to surgery, adjuvant treatment, and complications about one disease entity such as ductal carcinoma in situ. (Yes by now you have figured out that I am a breast surgical oncologist).  Then you make datasheets that are easily filled out by circling items on a piece of paper or ipad, such as Race. You get the tumor registry data in this example and you do your chart review. The following year you add follow-up data and additional patients accrued in your first year of practice. Each year you create an abstract based off that database – what margin width is acceptable, does every lumpectomy patient need radiation or tamoxifen, predictors of upstaging to invasive cancer, the role of sentinel lymph node biopsy, etc. The list of possibilities is endless. Keep building on the database and eventually you will have long-term follow-up on a portion of the database.  Create abstracts for local, regional and then national meetings. Over time as you involve trainees to assist with the database, you transition to senior author and the abstracts move to national and international platforms. Try to convert every abstract presentation, regardless of oral or poster into a manuscript, even if you have to combine two smaller projects into one paper. Also initially you may need to target lower impact journals until your data matures or has large numbers. Just get published. Papers provide expertise and preliminary results that are used for grant applications and your CV for promotions. They are also great ways to collaborate and create networks for your future success.

So in summary, build a strong foundation early on in your job (canned talks, community awareness talks, meet-and-greets, didactic lectures for trainees and the community physicians, build databases and establish a research network for collaboration of projects – both within and external to your department, and engage in service activities at your hospital and in the community). Think local regional and then extend national as you transition from Assistant Professor to Associate Professor to Professor.   A Professor is expected to have a national reputation and be involved in leadership roles on a national level. They must show continued productivity with teaching and research. Their service is on a more national level. Set yearly short-term goals and expectations and monitor on your progress. Finally read “Navigating Your Surgical Career – An AWS Resource Guide to Success” recently published and available on our website or the Harvard bookstore.
  
All the best in your success.

Dr. Laronga is board-certified in general surgery. Her clinical and research interests are diseases of the breast from bench to bedside (genomics/proteomics, nipple sparing mastectomy, quality of life, and quality indicators). She recently served as treasurer of the Association of Women Surgeons 2012-2014. Currently she is the Florida representative (Board of Governors) for the American College of Surgeons, The Florida State Chair for the Commission on Cancer, and on the Florida Division Board of the American Cancer Society. She serves on several national societal committees, such as the Society of Surgical Oncology and the Society of University Surgeons.

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