Forum for Clinical Mentored K Awardees

December 1-2, 2016

Co-Chairs
Stephen I. Katz, M.D., Ph.D.
Susana Serrate-Sztein, M.D.
Joan McGowan, Ph.D.
Amanda Boyce, Ph.D.
Kristy Nicks, Ph.D.
Marie Mancini, Ph.D.

Introduction

The NIH K08 and K23 Career Development Awards provide support for a sustained period of "protected time" (3-5 years) for intensive research career development under the guidance of an experienced mentor, or sponsor, in the biomedical, behavioral or clinical sciences leading to research independence. Previous discussions have identified the K-to-R01 transition as a critical point in the development of clinician-scientists’ independent research careers.

Purpose

This forum was first held in 2012. Based on the positive feedback received from participants, NIAMS also held the meeting in 2013, 2014, and 2015. The purpose of the meeting was to bring together physician-scientists who are currently in the third year of their NIAMS K08 or K23 award, as well as physician-scientists who have recently received R01 (or equivalent independent research) awards, established clinician-researchers, early-stage physician-scientists in the NIAMS intramural research program, and representatives of professional and voluntary organizations for a shared, open discourse on the challenges junior investigators face in pursuing research independence. The forum also provided an opportunity for the K awardees to network with one another, as well as to interact with NIAMS leadership and extramural staff. The long-term goal of this forum is to enhance the Institute’s support of early-stage physician-scientists by encouraging and enabling K08 and K23 awardees to continue performing basic, translational, and/or patient-oriented research in their chosen fields.

Research Presentations

The forum started in the afternoon of December 1, with an overview of the research being conducted by the investigators who currently hold K awards. Awardees briefly outlined their research projects and progress. Each presentation was followed by a short question and answer period. This session provided attendees with the opportunity to hear about each other’s research projects and to provide feedback and suggestions for advancing the research.

Concurrent Sessions

On December 2, scientists with K awards participated in a morning “Round Robin” session with NIAMS program, grants management, and review staff, as well as with NIAMS staff who coordinate clinical research. At the beginning of the session, Dr. Amanda Boyce provided a brief overview of the structure of the NIH and the NIAMS, as well as information about the various functions of the NIAMS extramural program. The K researchers then met in small groups with NIAMS staff to ask questions and learn about the Institute’s policies, procedures, and programs. While the investigators with K awards spoke with extramural staff, the other participants met with the NIAMS Director, Dr. Stephen Katz, and Deputy Director, Dr. Robert Carter, to discuss topics such as recent efforts to enhance support for K08 and K23 researchers, research training, NIH support for basic research External Web Site Policy, NIH support for investigator-initiated versus Institute-initiated research, a new NIAMS initiative to foster highly innovative research, and potential ways to connect research in NIAMS mission areas with the NIH precision medicine initiative.

Setting the Stage

After the morning sessions, the two groups of participants came together for a series of talks that set the stage for the afternoon discussion. Dr. Katz began the session with brief remarks. He thanked the patient and voluntary organizations that, through sponsorship of various funding programs and other resources, are partners with the NIH in supporting early-stage investigators. Dr. Katz also noted that, because of the NIAMS commitment to developing clinician scientists, in 2016 the NIAMS increased its investments in the K08 and K23 investigators, as well as in training, and in research innovation. Regardless of future budget outcomes, the NIAMS is committed to supporting outstanding science and fostering future generations of scientists.

K Award Outcomes and Funding Opportunities

Dr. Amanda Boyce presented some historical outcomes data on the NIH/NIAMS K08 and K23 awards. She noted that the NIH and NIAMS have performed various analyses of the career development awards programs. Some key findings were that K awardees are more likely than comparable researchers without a K award to publish, apply for subsequent NIH awards, be awarded an R01, and apply for and receive at least one competitive renewal of an R01 grant. Among K awardees, individuals who received both an NIH K award and foundation support were more likely to apply for and receive R01 funding than those who did not. Dr. Boyce also discussed some of the challenges facing K08 and K23 awardees, such as salary coverage, student loan debt, transition to research independence, mentoring support, and protected time for research. She then highlighted several ways in which the NIH is attempting to help K08 and K23 researchers overcome these challenges, including:

  • a recent NIH salary and research cost increase for K08 and K23 awards,
  • the NIH loan repayment program,
  • a new limited competition small grant program (R03) for NIAMS K08 and K23 scientists,
  • NIH policies to improve success rates for new investigators,
  • the NIAMS Supplements to Advance Research (STAR) from Projects to Programs initiative for early-established investigators, and
  • the NIH K24 program to provide support for mid-career researchers who would like to serve as mentors in patient-oriented research.

Patient and Voluntary Organizations: Funding Opportunities and Resources

Patient and voluntary organization representatives discussed their organizations’ funding programs and resources for early stage investigators. Several of the organizations represented at the meeting offer grants for new and early-stage investigators. In some cases, the organizations also had award programs specifically to augment the NIH career development awards such as the Orthopaedic Research and Education Foundation’s general Mentored Clinician-Scientist Grant External Web Site Policy, the American Society for Bone and Mineral Research’s Rising Star Awards External Web Site Policy, and the Rheumatology Research Foundation’s K supplement and K bridge awards External Web Site Policy. Many of the organizations also offer networking and leadership opportunities for young investigators, as well as links to resources or networks, such as the Arthritis Foundation’s partnership with the Childhood Arthritis & Rheumatology Research Alliance External Web Site Policy.

Mentorship: Imparting the Joy of Research

Dr. John Stanley, an established investigator who has trained many researchers, provided some reflections on mentoring in science. A goal of mentoring is to impart the joy of science to trainees. He noted the importance of basic research, which often leads to unanticipated scientific and clinical advances, and provided several examples of unexpected outcomes of basic research discoveries. He emphasized the value of inquisitiveness and paying attention to detail.

Resources and Opportunities in the NIAMS and NIH Intramural Research Program

Dr. Richard Siegel, NIAMS Clinical Director, provided an overview of the NIH and NIAMS intramural research program. The NIH intramural program comprises approximately 9 percent of the NIH budget. The program, housed primarily on the NIH campus in Bethesda, Maryland, includes the largest biomedical research hospital in the world. The intramural research program is particularly conducive to high-risk, high reward science, long-term studies, rapid translation of discoveries into clinical trials, and rapid implementation of new breakthroughs and technologies. Dr. Siegel described the structure and staff of the NIAMS intramural research program and gave examples of current projects. He noted that NIAMS intramural investigators are key participants in the NIH Rheumatology Training program. Finally, he discussed ways in which extramural researchers can work with intramural scientists through training, collaborations, clinical networks, sabbaticals, or grants such as the Bench-to-Bedside and U01 partnership awards. He also talked about the NIH intramural Earl Stadtman Tenure-Track Investigators program to recruit researchers for NIH intramural tenure-track positions and the NIH Lasker Clinical Research Scholars program to grow the pool of talented clinical/translational researchers.

Focusing on the Present — How to Make the Most Out of Your K Career Development Award

Mentoring

Although all researchers with K awards have a primary mentor, many of them work with a mentoring committee. The K investigators noted that this expands their sources of non-monetary support; for example, some have mentors to advise them on scientific and technical issues related to their research as well as “career” mentors to provide advice on work-life balance and the intricacies of running a laboratory. Many of the K physician-scientists have at least one mentor from outside of their institution. Participants noted that it is important for individuals with K awards to have a regular schedule for meeting both with their mentor(s) and with the mentorship committee. Some organizations have found that a more formal mentoring structure is beneficial, and have developed mentoring metrics. Some institutions also facilitate K researchers meeting with each other on a regular basis to enable peer mentoring and networking.

Obtaining Additional Research Support

The NIH mentored K award provides salary and benefits, plus funding for research supplies. However, the funding is not sufficient to support a laboratory. To obtain more support, K awardees suggested requesting a startup package from the university that might enable one to hire a technician or buy supplies. The NIH offers small grants (R03, R21) that can provide additional funding. Some of the K scientists indicated that they are part of the staff of an NIH Center grant (e.g., P30, P50) at their institution, and receive some additional support via that mechanism. A number of the K investigators had funding from societies and foundations that offer programs for emerging clinician-scientists. Some have also received unrestricted private donations, which can be used to support a diverse set of needs. Persistence is key when pursuing funding.

Discussion: Planning a Successful Transition to the R01

Factors Affecting Transition to Independence

There was heterogeneity among the researchers with K awards in terms of the amount of institutional funding they were receiving and the amount of research training they had completed prior to obtaining their K awards. Many were working on projects within a mentor’s laboratory. A few received funding from their university or from private organizations that allowed them to begin running an independent laboratory. Nevertheless, even among K investigators with independent laboratories, few had applied for an R01. Many participants noted that the bar for obtaining NIH awards, whether they be K or R awards, had risen. A number of the researchers indicated they plan to submit an R01 application, but want to publish more papers before doing so.

Developing a Research Niche

Scientists working to transition from a K to an R award should look for new opportunities to develop research that is distinct from that of their mentor. Collaborations with individuals at other institutions or in other fields can help early-stage scientists to apply their skills and knowledge in a new way or to incorporate novel methods and technologies into their research. As investigators carve out their own niche, they should be discussing issues such as ownership of research and authorship with their mentors from the outset, while acknowledging that agreements may change and evolve over the course of a project. Having a third party involved in authorship and ownership discussions can be helpful. K researchers could also consider mapping out with the mentor early on what their first R01 application will look like including topics, skill sets, and how the work will be accomplished.

Balancing Research and Other Opportunities for Career Growth

Many of the scientists with K awards noted that they have taken on leadership of various programs and joined committees of particular interest within their institution. Although there is a tension between service to the department and the need to advance research and write grants, leadership roles provide insight and experience and can make a K awardee more valuable to the institution. At the same time, the transition to the R01 may mean less committed salary support, so researchers must also develop new strategies to cover their salary. Some researchers have addressed this challenge by obtaining multiple R01s and other NIH and/or foundation grants. Others form collaborations that provide some support. Some of the K scientists have taken on teaching responsibilities. Teaching experience helps researchers learn to communicate effectively and is often viewed positively during consideration for promotions. Investigators with K awards should also consider accepting speaking invitations. Giving talks increases a researcher’s visibility and can be an important way to attract postdocs to a nascent laboratory.

Closing Thoughts

At the end meeting, participants were given the opportunity to share their reflections on the forum or to raise topics that had not come up in the earlier discussions. The participants reflected on the length of time in training for physician-scientists and wondered if it could be reduced. Dr. Katz noted that the NIH is actively exploring this issue and possible ways to shorten the time to independence. The participants also noted that they had learned a great deal about resources available at the NIH and NIAMS. Dr. Katz explained that effectively publicizing such resources is a challenge for the NIH. However, the Institute’s website is an excellent resource for those wishing to learn about NIAMS policies, programs, and resources. The voluntary organizations can play an important role in helping the community learn about NIH resources. The participants noted that they would particularly enjoyed the presentation on the K award outcomes and indicated that they would be interested to see the data broken out by age, race, and sex. The group also mentioned the shift towards team science and the difficulty that this change presents for early-stage researchers who are trying to demonstrate that they can conduct independent research. Dr. Katz noted that the NIH has made it easier (e.g., by developing a new NIH biosketch template) for grant applicants to delineate their contribution to collaborative efforts.

Participants

AGARWAL, Sandeep, M.D., Ph.D., Baylor College of Medicine
AGRAWAL, Pankaj, M.D., Harvard Medical School
*BRESCIA, AnneMarie, M.D., Thomas Jefferson University
COSTENBADER, Karen, M.D., M.P.H., Harvard Medical School
*CRANE, Janet, M.D., Johns Hopkins University
*DEMORUELLE, Kristen, M.D., University of Colorado, Denver
EAKIN, Guy, Ph.D., Arthritis Foundation
HECKMAN, James D., M.D., Representing the Orthopaedic Research and Education Foundation Dartmouth-Hitchcock Medical Center
JONES, Lynne C., Ph.D., Representing the Orthopaedic Research Society
*KIM, Brian, M.D., Washington University School of Medicine
*KNIGHT, Jason, M.D., Ph.D., University of Michigan
KRONENBERG, Henry, M.D., Harvard Medical School
LEDER, Benjamin, M.D., Representing the American Society for Bone and Mineral Research
MARCHIOLO, Eryn, M.P.H., Representing the American College of Rheumatology, Rheumatology Research Foundation
MINNILLO, Rebecca, D.M., M.P.A., Society for Investigative Dermatology
*MYUNG, Peggy, M.D., Ph.D., Yale University School of Medicine
*SCUMPIA, Philip, M.D., Ph.D., University of California, Los Angeles
*SHELEF, Miriam, M.D., Ph.D., University of Wisconsin, Madison
SPINDLER, Kurt, M.D., Cleveland Clinic, Representing the American Academy of Orthopaedic Surgeons
STANLEY, John, M.D., University of Pennsylvania

*Indicates current NIAMS K08 or K23 awardees.

NIAMS STAFF

BAKER, Carl, M.D., Ph.D.
BOYCE, Amanda, Ph.D.
BURROWS, Stephanie Y., Ph.D.
BUSCHMAN, Justine, M.S.
CARTER, Robert, M.D.
CIBOTTI, Ricardo, Ph.D.
DRUGAN, Jonelle K., Ph.D., M.P.H.
GUPTA, Sarthak, M.D.
KATZ, Stephen I., M.D., Ph.D.
KESTER, Mary Beth, M.S.
KHAN, Shahnaz
KIM, Hanna, M.D., M.S.
LANGER, Mark
LEWANDOWSKI, Laura, M.D.
LIN, Helen, Ph.D.
LINDE, Anita M., M.P.P.
MANCINI, Marie, Ph.D.
MAO, Su-Yau, Ph.D.
MCGOWAN, Joan A., Ph.D.
MOEN, Laura K., Ph.D.
NELSON, Melinda
NICKS, Kristy, Ph.D.
SALAITA, Kathy, Sc.D.
SCHWARTZ, Daniella, M.D.
SERRATE-SZTEIN, Susana A., M.D.
SIEGEL, Richard M., M.D., Ph.D.
THACH, Yen
TYREE, Bernadette, Ph.D.
WILLIAMS, Randi
WITTER, James, M.D., Ph.D.