During the lifetime of the Pathway project, our Pathway colleagues will write a blog regarding their vision on the project. Below, you will find the blogs of:
- Annet van Royen-Kerkhof - UMC Utrecht
- Ann-Sophie de Craemer – University of Ghent
- José M. Peinado – Universidad de Granada
- Farah Kools – UMC Utrecht / Nutricia Research B.v.
- Colby Benari – University College London
- Interview – young clinician-scientists
Driving Medical Innovation through interdisciplinarity: a role for the Clinician-scientists?
by Annet van Royen-Kerkhof
The domain of health care is rapidly changing. Medicine is going to face more and more complex problems, requiring multidimensional solutions. Examples of these complex problems are: the increase of obesity within the general population, leading to various chronic illnesses, such as diabetes and cardiovascular disease; vaccine refusal and subsequent increase of infectious diseases; end of life discussions in an era with abundant (costly) treatment options. In addition, the impact of climate change on health care is becoming more clear, and needs to be addressed. These problems cannot be solved by doctors or scientists alone, but need the involvement of other disciplines e.g. sociologists, economists, environmentalists and so on.
In the twentieth century, basic science evolved to a large extent inducing a lot of new research insights. This enhancement led to a proliferation of individual disciplines, mostly in silo’s. Beyond discussion, discipline‐specific training is critical for ensuring research excellence within fields. However, we are now in an era in which the need for cross-discipline research is increasing, acknowledging the inherent complexity of nature and society.
This means an urgent call to start bridging the disciplines and aim at interdisciplinarity. Interdisciplinary research collaboration means integrating insights and producing an interdisciplinary understanding. To be able to do this one must understand the language of another discipline, willing to really listen, ask questions.
Interdisciplinarity has its own set of unique challenges, ranging from communication issues to allocation of credits among a team. These aspects should be addressed and taken into account in the process of interdisciplinary collaboration. In Natures Special on interdisciplinarity (2015) it was noted, that interdisciplinary research takes time to have an impact, thus less attractive for funding agencies. Interdisciplinary work can have broad societal and economic impacts that are not captured by citations, which might be a drawback for young researchers, that in the current system will be judged by the citation index.
Luckily, more and more the high impact of interdisciplinary research is being acknowledged, as well as that for complicated problems interdisciplinary collaboration is required. While this change is taking place, the clinician-scientist can take position, namely clinician-scientists have the capacity to work in or lead interdisciplinary teams, they have already encountered hurdles, that might hamper true interdisciplinary research. The clinician-scientist is used to overcome issues of communication, allocation of credits, since this is part of daily practice, within a university, still with a disciplinary structure.
With this changing perspective, institutions can start to facilitate the training of clinician scientists, e.g. by interdisciplinary projects early in educational programs, so students are used to crossing boundaries and are trained to be open to other perspectives. Funding agencies should take into account the added value of interdisciplinary research for complex problems. Therefore I think, that from what might have been perceived as a difficult position, in the near future the clinician-scientist will be figure head of highly valued interdisciplinary teams, leading to innovative research.
About the importance of the Pathway project
by Ann-Sophie De Craemer
As a young clinician-scientist, I consider myself as the target audience for the Pathway project. A quick glance on my professional network proves the necessity of an educational program that supports clinicians in the development of a clinical-scientific career. The challenge is twofold: attracting and subsequently retaining competent clinicians in the scientific workforce.
Right from the start of the clinical training, candidate doctors should be made more familiar with the tense but fascinating interface between clinical practice and science. Nowadays we acquaint with some aspects of research during our clinical training, but few of us ultimately decide to pursue a scientific career. Being a medical doctor is felt as a very rewarding experience thanks to patient contact and direct clinical feedback. Afraid to be forced to abandon this core business, which is helping sick and disabled people, we often do not consider scientific research as a potential career option. Indeed finding the right balance between research activities and clinical practice is a common pitfall for clinician-scientists. On the other hand, the profession of a clinician-scientist is still rare and the career path is poorly defined. Caring for patients is an activity within our comfort-zone, whereas research (whether or not combined with clinical practice) represents a career full of uncertainties which leads to an indistinct professional status. Moreover, most countries do not offer an integrated training, so clinicians are forced to consecutively complete a medical and scientific training. Although these programs train them to become excellent medical doctors or qualified scientists, this effort takes several additional years of education at an age where personal life-changing events predominantly influence career decisions.
That is the moment where an integrated training program for clinician-scientists should come into play. Within such formal curriculum, students should benefit from a combination of both clinical medicine and research training, including specific training to facilitate the process of translation in medicine. In the end, we want to educate experts who play a pivotal role in supporting partnerships between different (bio)medical disciplines. Emphasis should be put on job satisfaction and career opportunities opposed to uncertainties and difficulties within this career path.
Beside attracting clinicians to science, a second challenge lies in retention of educated and skilled translational medicine experts in their professional community. Long-term professional support is urgently needed to achieve this goal. The Pathway project aims at providing a mentorship program to respond to this need for a specific target group. Being a young clinician-scientist, I genuinely believe that advice or guidance from a mentor could be extremely helpful to tackle some of the obstacles we encounter early in our career. In addition, mentors could serve as role models for best career practices; examples of success stories. They represent a specific professional niche by which we can identify ourselves. Being able to join such a community of clinician-scientists underlines our unique and valuable role within the translational landscape.
Academic tutoring vs. mentoring. A Spanish perspective
by José M. Peinado
The word tutor has its origin in Latin, as the person that that orients, assists, or supervises, generally a student (or pupil), while the word mentor has its origin in Greek and its meaning is quite similar, i.e. the person who acts as guide and adviser to another person.
Over time, the figure of the tutor has been associated with the teacher, but mainly as a facilitator of learning, rather than as a source of knowledge. The role of tutors in PBL and (tutorial) small groups has been, for example, widely defined and used in the literature.
In Spain, and it could be said for most of southern European countries, the figure of the tutor is very old and well established, for example, in the legal world. However, in the University, despite its use for many years, the role of the tutor is unevenly understood. Although at the undergraduate level, all teachers must set, at the beginning of each academic year, a schedule of tutoring for their current students, the fact is that students usually request appointments with the teacher/tutor, only during evaluation periods, with the purpose, almost exclusively, to solve doubts regarding the matter. Under this system, tutor and teacher is, in fact, the same person with a sum of tasks, moving from lecturing and work in small groups, to a personal/tutorial contact with students. A little different is the figure of the tutor during initiation to research and doctoral studies. In this case, the tutor is responsible for the adequacy of the training and the research activity of the student to the principles of the program. In this way, the role of the tutor is clearly differentiated of the director of the doctoral thesis or research work, who is responsible of driving the whole research tasks performed by the pupil. Completely different is the well stablished role of the tutors during specialized clinical training. In this case, tutors develop a fundamental role in supervision of residents and take the responsibility to ensure the training competencies according to the stablished program. Tutors and particularly directors, use to have a direct responsibility on daily research/learning tasks of pupils and students.
In this (academic) context the mentor figure is barely used in Spain. In fact, not surprisingly, both words (tutor and mentor) are often used when the Spanish tem “tutor” is translated to English. Only recently, some business enterprises have begun to use “mentoring” programs, keeping the English term, to emphasized the difference with more classical tutorial programs. In these cases, the objectives are to improve skills, discuss professional issues, and retain and develop talent. So mentors share their experience and help the mentees to gain confidence broadening their views and perspectives, without maintaining a direct work or friend relationship. Furthermore, mentoring has an altruistic and generous component, while tutoring seems to be more part of the professional activities.
Part of the objectives of the pathway project are to develop a mentorship program template and a mentor profile with the objective to support and retain better clinician-scientist and make stronger research teams. Mentorship could not only be based on experience. It is necessary to define mentor skills, emphasizing the importance of listening, responsibility and mutual trust.
Success in research, like in a football team, relies not only in good ideas or budget, but also on a cooperative and respectful environment. Mentorship programs could play a very beneficiary role in science development, particularly in Spain, where the figures of the mentor/mentee have still a long way ahead.
 Problem Based Learning
 Also, few months ago, the university of Granada (Spain) implemented a new program named “mentoring for research”, with the aim to promote quality research by leveraging the expertise of Emeritus professors in research tasks, to cater for those less experienced researchers with specific needs.
The Educhallenge as a versatile educational tool
by Farah Kools
The Graduate School of Life Sciences and Career Services of Utrecht University developed a new course in 2017 called ‘Co-Create: Life’s Professional Challenges’. This two-week full-time elective came forth from the ‘Educational Challenge 2015’ and the ‘EduChallenge 2016’ which were 2.5day hackathons during which small groups of students from different faculties were challenged to think about forms of educational innovation and to pitch their ideas in front of a professional jury. The format was elongated into a yearly full course schedule and focuses on solving a different real-world problem with each run brought in by the Municipality of Utrecht, thereby connecting the university with the city and directly utilizing academic knowledge for maximal societal impact. Students, staff, and other stakeholders have received these ‘Challenges’ with great enthusiasm, appreciating the strengths of interdisciplinary collaboration towards a shared goal while simultaneously helping students develop non-content related soft skills in preparation for their future.
Within the PATHWAY Project, the Educhallenge serves a similar purpose. It will be integrated into the yearly Eureka summer school, ‘Translational Medicine: Doing the Right Research Right’, hosted by Utrecht University which welcomes early career clinician-scientists and life-scientists from around the world to an intense week of sessions and discussions about the current (bio)medical research landscape. During one afternoon of the packed program, small groups of students will be challenged with existing complex medical issues and have to navigate the intricate translational minefield to come up with solutions that suit all stakeholders (patients, academia, industry, and policy). By looking at these issues from different perspectives, students are put in touch with real-world scenario’s that they will have to successfully transverse on their way to becoming successful translational scientists. Apart from bundling their diverse expertise, students also work on their individual professional soft skills making the Educhallenge a very versatile educational tool.
Mentoring for career success
by Colby Benari
When I am discussing career development with early career clinician scientists they almost always mention mentoring. It is great to hear that mentoring is becoming more accepted and valued for the benefits that it can bring. It was not long ago when in the UK mentoring was viewed as a remedial intervention. It was understood to be only useful when a scientist or clinician was not doing well in his or her career. Mentoring was a way for them to get back on the right track.
Now more and more clinician scientists understand that mentoring is essential even when you are doing very well. But there is still a misconception about what mentoring is and isn’t.
Often mentors and mentees (i.e. the person who is being supported by the mentor) think that mentoring is simply advice giving. While advice from a mentor can be very valuable, true mentoring supports mentees to make their own decisions rather than following the direction of the mentor. This difference is crucial and it means that mentees will be able to better support themselves in the future.
It can be difficult for mentors to stop giving advice during a mentoring session – especially because mentees often ask for it directly. Often the best thing that a mentor can do is ask good questions. A good question for a mentee is open, most importantly. An open question can’t be answered with just a ‘yes’ or ‘no’. It requires a longer answer that will provide an opportunity for the mentor to ask further questions.
Giving some advice is useful for mentees – as long as it is in the context of a discussion that encourages mentees to arrive at their own conclusions. Mentors should also make it clear that mentees do not have to follow the mentor’s advice. In fact, mentees should seek support from more than one mentor. This approach will help mentees to gather multiple perspectives and approaches to deal with problems.
Often mentees feel as though they have to take the advice that their mentor gives them. Mentors can play their part in ensuring that mentees are not obliged to take their advice and that mentees have a big enough pool of contacts to draw in if they need support.
Being an effective mentee
For mentees, asking for support from a more senior professional contact is the most difficult and intimidating part of a mentoring relationship. Mentees often put off seeking out mentoring support until they have a crisis to deal with or a big decision to make. Mentees would be much better off seeking support well before a crisis – especially as nobody is immune to difficult challenges in their career.
By seeking mentoring support early, mentees can establish a relationship with their mentor before they need urgent support. A good rapport between mentor and mentee is very helpful when a crisis situation arises
Once a mentoring connection has been established mentees should take charge of the relationship. After all, the relationship is based around the mentee’s need for support. Mentees should set up meetings with their mentor and suggest how frequently they would like to meet. Having a conversation at the start as to each person’s role in the logistics is very helpful.
Mentees should also come to the meetings with an idea of what they would like to discuss. A written agenda can be helpful but may be too formal in many circumstances. Just thinking ahead of time about what they want to achieve in the meeting sets the relationship up for success.
Developing a successful career as a clinician scientist can be challenging and mentoring is a great way to take a big step forward with confidence and support from someone who has been there before. Mentoring relationships require a thoughtful approach from both the mentor and mentee as well as good communication. With some effort and preparation mentoring can be hugely beneficial and accelerate clinician scientists’ careers.
Pathway Interview With Margaret Chang And Aarushi Bansal
A perspective of a clinician-scientist: ‘’I think it's a difficult career to have, which is readily accepted by everyone’’
During the Utrecht University Translational Medicine: Doing the Right Research Right summer course, we asked two participants and (future) clinician-scientists to share their vision on our Pathway project.
Aarushi Bansal is a medical student at the University of Toronto. She is a member of the Kidney Health Education and Research group, affiliated with the Multi-Organ Transplant Program at the University Health Network. Aarushi is not yet a clinician-scientist as she is still a medical student, however she is very much interested in being involved in research in some way. ““I think research is a really important part of my medical training, so I definitely think it could be something I might integrate with my clinical work in the future.’’ Aarushi states that wearing two hats can be quite challenging. “It is balancing between two worlds because scientists and medical doctors often speak different languages, but collaboration can help facilitate communication between the two.’’
Margaret Chang (M.D., Ph.D.), is a paediatric rheumatology fellow at Boston Children’s Hospital. She received her M.D. and Ph.D. degrees from the University of California, Los Angeles and she completed her paediatric residency training in the Boston Combined Residency Program at Boston Children’s Hospital. Margaret is a clinician-scientist and underlines the difficulty of this career. “It's a difficult career to have and you need a lot of support to be successful. This isn’t always understood or accepted. For example, how much grant money you bring in will determine how much protected time you get from a hospital to do research. There are demands on all sides and it’s a struggle to try to be successful in both fields as your attention is pulled in so many different directions’’
One of the objectives of the Pathway project is to create efficient, sustainable and attractive career pathways for clinician-scientists. Aarushi and Margaret both believe that those career pathways would be very helpful for (young) clinician-scientists. Margaret states “There are pathways that are not always clear or upfront for people who are not especially in MD/PhD tracks. I actually did have several classmates that started out as MD's, decided they liked research better, and then switched to a different pathway or did it on the side. So there are these options available, however not everyone knows about it. This is something that I think we should try and make more apparent’’. Although Margaret is very positive about showcasing the career pathways, she also stresses the importance of being flexible and to be able to deviate from the path. ‘’There is a lot of pressure of being groomed to go into academia, even for someone for whom this is not exactly the pathway he/she wants to take. I feel like some of my colleagues who decided not to do academic research admitted to a lot of guilt about failing the system, which I think is a shame. There are many important roles that need the perspective of a clinician-scientist and we all thrive in different settings.’’
A mentorship program for clinician-scientists does not exist yet in Europe and could help (young) professionals navigating their careers to make important choices in life. Having a mentor is actually normal for Margaret and Aarushi and they both stress its importance. Both address that you should have a mentor at every stage of your career and that the career level of the mentor should also be diverse, including peer mentors. Aarushi mentions ‘‘’Some mentoring relationships can last throughout your life and career, while others may be important for only a certain period of time. It is natural for the needs and goals of both the mentor and mentee to change over time and can lead to both parties seeking out new relationships. In the best cases, these have the potential to transform into professional friendships. As such, a mentorship programme should not be defined by a predetermined timeline’’. Margaret addresses the importance of also having a mentor who is not involved in your career pathway. ‘’It is important to have multiple mentors, including a mentor who doesn't work with the same people you work with or who is not involved in your job performance. The relationship with your mentor must feel like a safe space. This mentor should be someone you can talk to and commiserate about problems with and who gives suggestions to move forward’’
Both summer school participants believe it would be helpful if the Pathway project team would come up with a mentorship programme for clinician-scientists. Margaret advises the Pathway team to switch mentors if a mentee doesn't click with his or hers, because it can turn the mentee off from benefitting from the programme.
Choosing and following a career path can be challenging. Aarushi finds it hard to say where she sees herself in 5 years. ‘’In the next few years, I will have to decide what I want to do clinically, and see if this lines up with the research I have been doing. If it doesn't, it will bring me to a bit of a crossroad. That’s something I think about often. However, the research I am involved in currently (identifying patient reported outcomes and measures among patients with chronic disease) is very relevant and could be brought into many different clinical settings. The knowledge and skills I have gained from conducting research can absolutely be translated into any setting’’. Margaret has a more defined career path and hopes to be running a lab and academic hospital as well as practising pediatric rheumatology.
We wish Aarushi Bansal and Margaret Chang all the best in their future careers!