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September 22, 2017
R&R REDEFINED?
Training Retreat Offers Model for Teaching Research Skills

NCBI’s Dr. Laks Iyer (l) helps a woman use the telescope he brought to view the eclipse.
At CC Grand Rounds, longtime NIH grantee Dr. Keith Sullivan makes the case for a retreatstyle training module.

Usually when someone mentions getting a little “R&R,” thoughts of vacation come to mind. Now, though, rest and relaxation have a good reason to make room for “retreat and research.” That’s because a novel model for training early-career scientists has gained international attention—and applause—both from newbies as well as veterans in the research community.

At a recent Clinical Center Grand Rounds, Duke University’s Dr. Keith Sullivan presented “Academic Research Skills for the Physician-Scientist: From the Outer Banks to the Singapore Straits.”

The James B. Wyngaarden professor of medicine in the division of cellular therapy at Duke University Medical Center, Sullivan, who is also an NIH grantee supported by NCI, NHLBI and NIAID for more than 40 years, described a different kind of educational venue he and colleagues developed almost two decades ago to address gaps in traditional instruction.

“It’s not part of the repertoire of research institutions,” he explained, “to train individuals in those skill sets—writing, grants and protocol development—but more importantly, is this what you want to do in life? Is this what your family wants to do in life? And how can you be successful in that endeavor?”

Curriculum essentials—clinical trial design, bioethics, biostatistical analysis, grant writing, manuscript preparation—are well-established subjects for those headed into academic medicine and science, said Dr. Robert Lembo, deputy director of the Office of Clinical Research Training and Medical Education, who introduced the lecture.

“While there’s general agreement among educators on content,” he said, “there is no consensus on a standardized pedagogical approach to the development of research skills within the postgraduate medical education community.”

Beyond Basic Training

In 2001, Sullivan and several Duke collaborators designed a multi-dimensional model—the Southeastern Fellows Research Skills Retreat and Training Workshop—to teach not only the prerequisites, but also the intangibles of pursuing the ideal life of say, an M.D./Ph.D.

Over 2½ days, faculty gathers with fellows and their families to discuss many concepts and concerns not covered in most postgraduate educational settings.

Dr. Robert Lembo introduces Sullivan.
Dr. Robert Lembo introduces Sullivan.

“What are the components and challenges of a successful career in academic research?” asked Sullivan. It’s what most fellows want to know and what most veterans in the field want to share. “What are the skills [needed] to help that career along and how can these skills be applied by you to your current trainees?”

In developing the model, Sullivan said retreat designers considered several key factors about medical research:

First, its undeniable practical value to society. Sullivan showed slides on the decline of heart disease-related deaths over the last half century as well as evidence that progress against cancer is also growing—“ Proof,” he said, “that basic science and discovery have direct application for the health of the nation.”

Next, he showed a bell curve charting the age distribution of great innovation, which seems to peak around the late 30s to early 40s.

“This is something [young trainees] consider quickly because the clock is ticking,” Sullivan said.

New researchers also may look at grant funding, its “continued stringency” over the past 20 years and potential scarcity in future years. In addition, he said, the average trainee is about $200,000-$300,000 in debt after completing M.D. or Ph.D. programs.

Finally, the seasoned academic thought leaders factored in the value of family and community connections and what had been worthwhile in their own scientific careers and personal lives.

“This is the reason we decided to launch an antidote, inviting the family, inviting the children to a high-end resort where we can sequester the fellows in a lovely place—on a ribbon of sand between the Atlantic Ocean and Currituck Sound in the upper Outer Banks of North Carolina,” Sullivan said.

Concept Catches On

The annual retreat started small— choosing a location, the Sanderling Inn in Duck, N.C., within a few hours driving distance—with just the 15 or so fellows in Duke’s hematology/oncology program. Then, the module expanded to the University of North Carolina and Wake Forest and moved into cardiology and other subspecialties and surgery.

By 2009, a dozen institutions within driving radius, including NIH, had signed onto the approach. In recent years, the retreat has reached the inn’s maximum capacity, 140—up to 50 fellows and their families plus 20 faculty members. Since the beginning, just under 600 individuals have come through the retreat.

“There have been several instances where future collaborations, friendships formed [during a retreat]—understanding other people’s research—have had downstream benefits,” Sullivan reported.

The intensive training—non-retreat calls, texts and emails are strongly discouraged— begins with a focus on writing for scientists.

“This is one thing that really isn’t taught at institutions,” Sullivan pointed out, “and yet you and I as reviewers of manuscripts go crazy when we can’t figure out what the author is trying to tell us.”

Voices of Experience Speak

Other frequently unaddressed concerns that the retreat tackles include: How do I manage my time and work-family balance? How do I transition successfully from fellow to faculty?

NCI’s Dr. Steven Pavletic (l, middle row) took part in the retreat in 2016.
NCI’s Dr. Steven Pavletic (l, middle row) took part in the retreat in 2016.

LECTURE PHOTOS: ANDREW PROPP

In a unique twist, trainers conduct “concurrent sessions with spouses to explain what life is like for the academic career family,” explained Sullivan.

In addition, fellows engage in small group grant/protocol study sections—“This is the first time that almost all of the fellows have ever looked behind the curtain to see how an NIH scoring session works; they get to ask, ‘How can I be competitive against all those other applications?’” Sullivan noted—and open mic sessions for real-life storytelling across the career spectrum, from freshmen to senior researchers.

Other components discuss trial design and statistics, joining/starting a lab and negotiation and managing conflict.

“Universities are great at doing this—ethical principles, trial basics and regulatory realities,” Sullivan admitted, “but it’s the downstream stuff that really is important—how to analyze the data and put the paper together—that are not always well taught.”

There’s even a 3-hour “course assimilation” period, held picnic-style at the shoreline amid sand and surf with fellows and their families. At first it was simply labeled “beach time,” but one financial sponsor balked at what was perceived to be a “frivolous thing” on the agenda. Planners, however, doubled down, stressing the importance of building and maintaining strong interpersonal relationships for healthy and productive physician-scientists. Organizers fought for the built-in social/recreational module, eventually renaming it.

“It’s not frivolous,” Sullivan argued, “because this is the time in a beautiful setting with your family that you have emotion and that binds and bonds into long-term memory what you’ve learned in the course.”

Elements of Success

In 2016, Sullivan and company were asked to bring their retreat model overseas, to the National University of Singapore. The program there, now past its second season, involves not only clinician-scientists in the fellow stage, but also several at the associate and assistant professor levels. The Singapore group reported more successful [RO1-equivalent] grant applications than ever.

“Success in an academic research career is rewarding but challenging,” concluded Sullivan. “Career development skills are often neglected in institution training programs…Whether in the Far East or Southeast, problems are similar for trainees and junior faculty. Faculty participation in focused guidance programs and mentorship remains key to career success for our physician-scientists.

“Success isn’t just what you accomplish in your life,” he ended, emphasizing a sentiment shared by the Singapore coordinator to sum up the retreat experience, “it’s about what you inspire others to do.”

‘TEACHERS ARE STUDENTS…STUDENTS ARE TEACHERS’
Past Attendees Laud Retreat Experience

NCI’s Dr. Steven Pavletic has first-hand experience with the Southeastern Fellows Research Skills and Training Workshop. Senior clinician and head of the graft-versus-host and autoimmunity section in the Experimental Transplantation and Immunology Branch, he attended as faculty in 2016.

“My assigned roles were to lead two small working groups in sessions on clinical protocols and grant writing,” he said. “In addition, I was asked to give a short TED-like talk on leadership in the session on academic career development. This latter was particularly enjoyable since it forced me to succinctly reflect on what I currently do, how I got here and what I could teach the next generation of physicians on academic life. I also taught them about unique opportunities in the NIH intramural program for those pursuing research careers, since it is not so widely known.

“The main impression I took from this course is the reinforcement in the conviction about the old saying that ‘Teachers are students and students are teachers.’ The main differences between me and my students are only time and experience. Teaching and learning are truly two-way roads. Trying to convey a little piece of what we have learned to help navigate better through the increasing challenges of the academic clinical research is what this course is all about. The summary impressions of this outstanding and unique course are simple: I wish that somebody had delivered something like this to me when I was at that stage and I am immensely grateful for this opportunity to have attended...Dr. Keith Sullivan and Duke University should be commended for launching this course 17 years ago.”

Earlier this year, Sullivan (r) as well as NCI’s Dr. Hoyoung Maeng and Dr. Kathryn Lurain gather with other retreat participants for the group shot.
Earlier this year, Sullivan (r) as well as NCI’s Dr. Hoyoung Maeng and Dr. Kathryn Lurain gather with other retreat participants for the group shot.

NCI’s Dr. Hoyoung Maeng and Dr. Kathryn Lurain were trainees together at the retreat earlier this year.

“It is a valuable experience that the fellows get connected with other institution fellows—juniors and seniors—and have the chance to ask about the things that we did not have opportunities to ask with daily busy training,” recalled Maeng, staff clinician in the Vaccine Branch of the Center for Cancer Research. “It was protected learning time also with some relaxed time to enjoy the family on the beach.”

In relation to her NCI fellowship, she also mentioned mutual benefits gained by trainees and faculty. “I felt very proud that we were more experienced than anyone over there—including some faculty—in terms of clinical protocols, since we see solely clinical trial patients,” Maeng said. “There are pros and cons for seeing the trial patients, but for me it served the purpose of coming here and it was great to share my experience at the fellows level with other trainees from other institutions. I am very grateful for the opportunity…and hope it continues.”

Chief fellow in the combined NCI/NHLBI Hematology/Oncology Fellowship, Lurain agreed, “I would echo Hoyoung’s sentiments. I found being able to spend time in a dedicated setting with successful faculty, young and old, to be incredibly helpful and inspiring to my own career. The grantwriting workshop was also especially helpful as this is not something we get a tremendous amount of practice with at the NIH, but is fundamental to a successful academic career outside the intramural program. And it wasn’t half bad getting to hang out with my family and Hoyoung in a beautiful setting.”

Finally, Pavletic also had a message “for the future organizers of this and similar courses. This course teaches the new researchers also about resilience and tenacity, which are indispensable character ingredients in these days of greatest need for a larger clinical researcher work force. Such courses and the medical schools must adjust their curricula to build new leaders [that] the future of medicine needs. Besides the indispensable outstanding training in medical care, they need also to acquire skills and awareness on how to manage and lead large teams and complexes in academia, industry, government, health care and finance.

“Doctors are, by definition, very busy but we need to find ways to reclaim our profession and develop the new generation of clinicians-scientists who will be able to exert their roles as the leaders of the future. Such courses as this at Duke provide an indispensable and empowering tool.”

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