Welcome to the Clinical Center Grand Rounds,
a weekly series of educational lectures for physicians and
health care professionals broadcast from the Clinical
Center at the National Institutes of Health in
Bethesda, MD.
The NIH Clinical Center is the world's largest hospital totally
dedicated to investigational research and leads the global
effort in training today's investigators and discovering
tomorrow's cures.
Learn more by visiting us online at http://clinicalcenter.nih.gov
TODAY I'M VERY PLEASED TO INTRODUCE A
GREAT FRIEND TO THE NIH AND A
GREAT ALUMNUS OF OUR PROGRAM
MARK GLADWIN WHO IN AUGUST OF
2022 WAS A POINTED THE VICE
PRESIDENT OF THE UNIVERSITY OF
MARYLAND SCHOOL OF MEDICINE.
MARK'S JOURNEY TO LEADERSHIP
STARTED AT THE UNIVERSITY OF
MIAMI IN 1985 WHERE HE WAS IN A
JOINT BACHELOR AND MD PROGRAM HE
STARTED TODAY DO HIS INTERNAL
TRAINING AT UNIVERSITY OF AND
THREE IMPORTANT THINGS HAPPEN
WHILE HE WAS THERE.
FIRST, HE BECAME A GREAT
CLINICIAN ENERGIZED BY HIS
INQUISITIVENESS ABOUT ALL THE
PATIENTS HE SAW AND THE SECOND
THING IS HE RECOGNIZED THAT
EDUCATION IS IMPORTANT AND FOR
THE SAKE OF HIS MEDICAL
STUDENTS, HE WROTE A BOOK CALLED
"MICROBIOLOGY MADE RIDICULOUSLY
SIMPLE" WHICH I SUSPECT EVERY
YOUNGER MEMBER IN THIS AUDIENCE
USED DURING THEIR SECOND YEAR OF
MEDICAL SCHOOL TO GET THROUGH
THEIR MICROBIOLOGY COURSE AND
PREPARE AND STILL REMAINS THE
BIBLE FOR MEDICAL STUDENTS IN
2023.
THE THIRD THING THAT HAPPENED IS
OF OREGON IS AND LYNN TOLD HIM
THAT HIS RESEARCH HE HAD COME TO
THE NIH.
AND FROM 1995, TO 2008, MARK HAD
A 13-YEAR CAREER AS A CRITICAL
CARE MEDICINE FELLOW AND HE
SPENT A YEAR AT THE UNIVERSITY
OF WASHINGTON DOING PULMONARY
BEFORE COMING BACK AND HE ROSE
FROM THE SENIOR STAFF TO THE
NSBI WHERE I TRANSFERRED TO BE
THE BRANCH CHIEF OF VASCULAR
MEDICINE AND THE PULMONARY
BRANCH.
WHILE HE WAS AT NIH, ON THE NEXT
SLIDE, MARK BENEFITED FROM A
NUMBER OF MENTORS.
HE REALLY HAD A TALENT FOR
FINDING PEOPLE WHO COULD BE
EFFECTIVE MENTORS, CHUCK AND JIM
EX TAUGHT HIM A LOT ABOUT THE
SCIENCE AND THE CLINICAL TRIALS.
GIGRIFF ROGERS WAS A MENTOR AND
ALAN SHECTOR IN UNDERSTANDING
HEMO GLOBAL BIOLOGY AND IT'S
STILL AN IMPORTANT ADVISORY
MARK.
MARK WAS SO SUCCESSFUL AT NIH,
THAT IN 2008, HE WAS RECRUITED
TO THE UNIVERSITY OF PITTSBURGH
WHERE AGAIN HE HAD A METEORIC
RISES WITH CRITICAL CARE
MEDICINE AND ULTIMATELY AS THE
CHAIRMAN OF THE DEPARTMENT OF
MEDICINE AND THEN AS I SAID
INITIALLY IN THE NEXT SLIDE, HE
WAS LAST AUGUST RECRUITED TO
UNIVERSITY OF MARYLAND WHERE HE
IS NOW THE VICE PRESIDENT DEAN.
I'D LIKE TO MENTION A FEW THINGS
ABOUT HIS CAREER.
FIRST OF ALL, MARK HAS ALWAYS, I
THINK, GOTTEN HIS MOST ENERGY
AND HIS MOST STIMULATION FROM
SEEING PATIENTS.
AND I VIVIDLY REMEMBER HIS
INTEREST OF SICKLE CELL DISEASE
AND HIS DESIRE TO UNDERSTAND THE
BIOLOGY OF THE DISEASE IS SO HE
CAN WORK ON BETTER BAYS TO
IMPROVE THE OUTCOME OF HIS
PATIENTS.
IT WAS PATIENTS WITH MOTIVATED.
MARK WAS AN EXPERT AT THE
BIOLOGY OF NITRIC OXIDE.
HE UNDERSTOOD ITS IMPORTANCE FOR
BLOOD FLOW TO THE BRAIN, THE
HEART, HE UNDERSTOOD THE
RELEVANCE TO SICKLE CELL AND
BECAUSE HE WAS A CLINICIAN, WHEN
HE SAW OTHER PROBLEMS LIKE
CARBON MONOXIDE POI POISONING, E
RECOGNIZED THIS BIOLOGY WAS
IMPORTANT TO OTHER CLINICAL
PROBLEMS LIKE FINDING A SOLUTION
WITH PEOPLE CARBON MONOXIDE
POISONING.
WHILE HE WAS AT NIH AND THE
UNIVERSITY O PITTSBURGH, HE HAD
THREE TALENTS.
HE KNOWS HOW TO ATTRACT PEOPLE,
BUILD TEAMS AND BUILD CENTERS.
AND THE UNIVERSITY OF PITTSBURG
HE BUILT A NUMBER OF VERY
SUCCESSFUL CENTERS THAT WERE
GREAT ABOVE BASIC SCIENCE AND
TRANCATIONAL MEDICINE.
HE WAS THE EXPERT AT LEADING
CLINICAL TRIALS FOR NHLBI AND HE
RECOGNIZED THAT, IN THE SCIENCE
HE DID, THE SCIENCE WAS ONLY
IMPORTANT IF HE COULD TRANSLATE
IT INTO ADVANCES FOR PATIENTS SY
STARTED A COMPANY THAT COULD
TAKE ADVANTAGE OF NEURO GLOBIN
AND SOME OF THE OTHER
DISCOVERIES TO MAKE THEM MORE
EFFECTIVE THERAPIES THAT
PATIENTS HE WAS SEEING.
THE TWO OTHER FEATURES THAT
CHARACTERIZE MARK, MARK IS THE
ONLY DEAN IN THE UNITED STATES
WHO IS MAKING ROUNDS IN THE ICU.
MARK HAS NEVER WANTED TO LEAVE
CLINICAL MEDICINE SO HE IS
INSISTED AS PART OF HIS CONTRACT
AT MARYLAND, THAT HE WOULD
ATTEND IN THE ICU FOR SIX WEEKS
EACH YEAR AND YOU CAN SEE HIM AT
HIS FIRST ROTATION TO CLINICAL
MEDICINE IS STILL HIS
FOUNDATION.
AND LASTLY, ON THE NEXT SLIDE,
MARK FEELS STRONGLY ABOUT
EDUCATING THE NEXT GENERATION.
MENTORING PHYSICIAN-SCIENTISTS
IS COMING HE HAD AN AMAZINGLY
SUCCESSFUL PROGRAM AT PITTSBURGH
AND SOMETHING THAT WE'D LIKE TO
TALK TO HIM ABOUT HOW WE CAN
WORK WITH HIM TO ENHANCE OUR
PROGRAMS HERE IN COLLABORATION
WITH MARYLAND.
SO I'M VERY PLEASED TO INTRODUCE
MARK WHO WILL TALK ABOUT
CREATING PHYSICIAN-SCIENTIST
SOMETHING HE HAS BEEN REALLY
SUCCESSFUL FOR OR WITH AT THE
UNIVERSITY OF PITTSBURGH AND
HOPEFULLY AT THE UNIVERSITY OF
MARYLAND.
THANK YOU FOR THAT VERY KIND
AND COMPREHENSIVE INTRODUCTION.
I REALLY APPRECIATE IT.
I WILL POINT OUT, 22 YEARS AGO,
I HAD THE HONOR OF BEING ASKED
TO PRESENT AT THE CLINICAL
CENTER GROUND UNDERSTAND AT A
POSTDOCTORAL CENTER AND TWO
HOURS BEFORE THE GRAND ROUNDS,
MY WIFE WENT INTO LABOR WITH OUR
FIRST CHILD, FLORA, AND HER
WATER BROKE AN HOUR AND A HALF
BEFORE THE GRAND ROUNDS.
I WENT OVER MY SLIDES WITH ALAN
AND HE TOLD ME
MARK, I'VE GIVEN A TALK BEFORE,
GET OUT OF HERE.
I LEFT AND FLORA WAS DELIVERED
AT 12:30, RIGHT IN THE MIDDLE OF
THE GROUND ROUNDS.
I'M HOPEFUL I CAN MAKE MY WAY
THROUGH THIS AND I THANK YOU FOR
THE HONOR OF SPEAKING TO THIS
GROUP.
WHAT I'D LIKE TO TALK ABOUT
TODAY IS LESSONS LEARNED FROM A
CAREER AT THE NIH CLINICAL
CENTER, REALLY LOOKING AT THE
PAST, THE PRESENT AND THE
FUTURE.
I LISTED MY GRANTS AS
DISCLOSURES.
I AM A P.I. ON A TRIAL WITH BEAE
WITH SICKLE CELL BUT THERE
AREN'T CONFLICTS RELATED IN THIS
PRESENTATION.
SO THERE ARE A NUMBER OF
CHALLENGES FACING PHYSICIANS
SCIENTISTS IN MODERN ACADEMIC
MEDICAL CENTERS.
AND NUMBER ONE, THERE'S
INCREASING INTENSE AND
COMPREHENSIVE MULTI-YEAR
CLINICAL TRAINING REQUIREMENTS
FOR FELLOWS.
CARDIOLOGY WITH CO CATS IMAGING
CERTIFICATES, A LOT OF OUR
FELLOWS WANT MULTIPLE OF THESE,
EXTRA YEARS FOR HEART FAILURE,
CARDIOLOGY, ELECTRO PHYSIOLOGY,
NUCLEAR MEDICINE.
MANY ARE EXTENDING TRAINING FOUR
TO FIVE YEARS WITHOUT PROTECTED
TIME FOR RESEARCH.
THERE'S AN INCREASING LACK OF
FUNDED PROTECTED TIME FOR
INVESTMENT AND FUNDAMENTAL
RESEARCH STUDIES THAT ARE
NEEDED.
THERE ARE LIMITED AND HIGHLY
COMPETITIVE T-32 GRANTS THAT
SUPPORT THIS TRAINING AND I
THINK THESE GRANTS ARE KEY TO
SUCCESS IN THE EXTRAMURAL WORLD
AND I'LL TALK ABOUT THAT
STRATEGY.
THE T # 2 T32 AND K GRANTS THAR
YOUR SALARY HAS FIVE YEARS AS
FACULTY, BUT THOSE SALARIES ARE
MUCH LOWER THAN WHAT PEOPLE ARE
PAID FOR CLINICAL REIMBURSEMENT
IN THIS MODERN ERA.
THERE'S LIMITED
PHYSICIAN-SCIENTISTS ROLE MODEL
AT MANY INSTITUTIONS AS YOU WILL
HEAR ABOUT AND ESPECIALLY WOMEN
AND FACULTY THAT ARE UNDER
REPRESENTED IN MEDICINE AND
SCIENCE.
AND THERE'S SIP CAL CYNICAL
COMMUNICATION ABOUT CAREER IN
SCIENCE.
IT'S HARD TO GET GRANTS AND
BALANCE.
IT'S A LONG PATHWAY TO
INDEPENDENCE, THERE'S LESS
COMPENSATION COMPARED WITH
CLINICAL WORK.
THERE'S A REAL OPPORTUNITY FOR
US TO COMMUNICATE THE JOY, THE
FREEDOM OF TIME WITH A RESEARCH
CAREER, THE DIVERSITY OF THE
EXPERIENCE GOING FROM THE CLINIC
TO THE EDUCATIONAL SPACE TO THE
RESEARCH.
THERE'S ALSO A LACK OF UNIVERSAL
CULTURE ACROSS CLINICAL
DEPARTMENTS AROUND THE NEED TO
TRAIN PHYSICIAN-SCIENTIST.
THESE ARE OUR MANY CHALLENGES.
THIS IS DATA SHOWING THAT THE
NUMBER OF PHYSICIANS SCIENTISTS
IS STEADILY DECREASING OVER THE
LAST DECADE.
WE HAVE ALMOST 937,000 ACTIVE
PHYSICIANS AND ONLY 12,000 THAT
REPORT RESEARCH AT THE MAJOR
PROFESSIONALLAL ACTIVITY WITH
THE PERCENTAGE DROPPING FROM 1.6
TO 1.3%.
ONLY 121 OF OUR 155 MEDICAL
SCHOOLS HAVE MD-PH.D PROGRAMS
AND 450 ARE FUNDED THROUGH NIH
T32 TRAINING AWARDS.
KNOWN REPAYMENT PROGRAMS ARE
VITAL FOR THE DEVELOPMENT
PHYSICIAN-SCIENTISTS AND THESE
PROGRAMS WILL ASSIST GRADUATES
WITH RESEARCH CAREERS AND REPAY
50,000 UP TO THREE YEARS IN
RETURN FOR A COMMITMENT TO NIH
MISSION-RELATED RESEARCH AND
THIS IS RESTRICTED RESEARCHERS
AND SPECIFIC FIELDS OR NEED
BASED AND IN FACT, I RECEIVED
ONE OF THESE AWARDS FOR INTO
EVIDENCE-BASED SCHOLARSHIP WHICH
WAS ESSENTIAL TO MY STAYING THE
MANY, MANY YEARS THAT I NEEDED
TO DEVELOP A COMPETITIVE ABILITY
TOLL PERFORM BASIC SCIENCE
RESEARCH.
THESE AWARDS WORK.
IN RED WE SEE THE PERSIST APPS
OF RESEARCH IN PEOPLE FUNDED
WITH LONGER PAYMENT AWARDS
COMPARED TO THOSE NOT FUNDED.
YOU CAN SEE WE HAVE CHALLENGES
AT BOTH GROUPS BUT EVEN 15 YEARS
OUT, 24% OR SO REMAIN IN
RESEARCH COMPARED TO 7% IN THOSE
UUNFUNDED.
THESE AWARDS APPEAR TO HAVE THE
DECLINING IN ORANGE WE SEE
AWARDS GOING TO PH.D WHICH ARE
STABLE, A DROPPING IN AWARDS
GOING TO BOTHS MD ONLIES IN BLUE
AND EVEN A DROP IN THE PH.D
AWARDEES.
SO, WHAT ARE SOME OF THE LESSON
WE CAN LEARN ABOUT SUSTAINING
AND CAPTURING
PHYSICIAN-SCIENTISTS AND
RESEARCH AND I'D LIKE TO START
WITH WHAT THE NIH CLINICAL
CENTER TAUG TAUGHT US AND MUCH F
THIS DATA CAME FROM GREAT
INFORMATION THAT ROBERT SHARED
WITH ME, WHO HAS BEEN A BIG
PROPONENT OF THE ROLE OF THE
YELLOW BERET PROGRAM IN
ADVANCING PHYSICIAN-SCIENTIST.
SO, THE YELLOW BERETS WERE
PHYSICIANS FROM THE DOCTOR DRAFT
DURING THE VIETNAM WAR.
THESE WERE SUPPORTED THROUGH THE
BARRIE PLAN.
THIS PLAN ALLOWED GRADUATING
MDs TO DIVERT TO FIRST SERVICE
IN VIETNAM TO UNDERTAKE TWO
YEARS OF CLINICAL TRAINING
WITHOUT INTERRUPTIONS.
42,000 PHYSICIANS PARTICIPATED
AND THEY COULD HAVE SERVICE AS A
COMMISSION OFFICER IN THE NAVY,
ARMY, AIR FORCE, OR U.S.
PUBLIC-HEALTH SERVICE.
AND THE U.S. PUBLIC-HEALTH
SERVICE OPPORTUNITIES INCLUDED
THE NATIONAL INSTITUTE OF
HEALTH, CENTERS FOR DISEASE
CONTROL AND INDIAN HEALTH
SERVICE.
AT ITS PEAK IN 1970s, THERE IN
200 ASSOCIATE PER YEAR AT THE
NIH AND AS YOU CAN SEE HERE
AFTER THE VIETNAM WAR, THERE WAS
A DECLINE ALMOST TO ZERO BY THE
TIME I ARRIVED IN 1995 AT THE
NIH.
NOW, THIS PROGRAM LED TO A
LEGACY OF SUCCESS.
YELLOW BERETS WERE THREE TIMES
AS LIKELY TO BE A DEAN, TWO
TIMES AS LIKELY TO BE A
DEPARTMENT CHAIR, 1.5 TIMES AS
LIKELY TO ACHIEVE FULL PROFESSOR
RANK.
THERE WERE 64 ELECTED AND
NATIONAL ACADEMY OF SCIENCE AND
125 ELECTED TO THE INSTITUTE OF
MEDICINE, FOUR OF NINE NIH
DIRECTORS, 10 OF 122 NIH
INSTITUTE DIRECTORS AND 10 NOBEL
LAWYER ATS, SO WHAT CONDITIONS
IN THE '60s ENABLE THIS
UNPRECEDENTED SUCCESS.
THE VIETNAM WAR DROVE INTENSE
COMPETITION FOR THE ABSOLUTE TOP
TALENT IN THE NATION TO GO TO
THE NERVES NIH AND COMMIT TO BD
TRANSLATIONAL RESEARCH.
THERE WERE OUT STANDING MENTORS
AT NIH, BOTH PH.D AND MD.
THERE WAS RESEARCH EXPERIENCE
WITH FEW DISTRACTIONS.
THEIR EVENING COURSES WITH MANY
CUTTING-EDGE AREAS OF NEW BASIC
SCIENCE.
THERE WAS A FOCUS ON FUNDAMENTAL
BASIC SCIENCE RESEARCH HOWEVER,
THESE DISCOVERIES WERE STRONG
LEASE INFLUENCED DRUG
DEVELOPMENT AND MEDICAL PRACTICE
IN HUMAN HEALTH AND MEDICAL
STUDENTS WERE TAUGHT THE JOY OF
FINDING NEW FACTS FOR OVER
TURNING OLD ONES AND REALLY
LEVERAGING THE NEW REVOLUTION
AND THE LACK OF BIOLOGY.
SO WHAT CAN WE LEARN FROM THE
RESENT PAST AND THESE ARE REALLY
MY PERSONAL REFLECTIONS AND AN
ODYSSEY AS AN MD-ONLY
PHYSICIAN-SCIENTIST ARRIVING AT
THE NIH AFTER MY CLINICAL
TRAINING, WHICH WAS FROM '95 TO
'97 SO START NORTH 1997.
AND JUST BRIEFLY SHARE WITH YOU
THE OVERVIEW OF THE FOLKS IN MY
CAREER HAS BEEN ON THE
INTERSECTION OF NITRIC OXIDE AND
HEMOGLOBIN SIGNALING.
WHEN I CAME TO THE NIH IN 1997,
A PAM A DIME WAS DEVELOPING AND
NO WAS A MOLECULE AND IT'S
PRODUCED BY THE NO CELLS AND
DIFFUSES AS A MODEL OF A SMOOTH
MUSCLE WITH CAN DRYS WITH
DILATION.
THERE WAS A MYSTERY AND THAT WAS
HEMOGLOBIN WAS KNOWN TO SCAVAGE
NITRIC OXIDE AND PEOPLE SAID HOW
CAN COULD NOB WHEN THERE'S SO
MUCH HEMOGLOBIN IN BLOOD AND THE
SOLUTION WAS EMERGING THAT THERE
WERE DIFFUSION BARRIERS AROUND
THE RED CELL, AROUND THIS
CELL-FREE ZONE ALONG THE BLOOD
AND THESE DIFFUSION BARRIERS
REDUCE THE REACTION RATE OF NO
WITH HEMOGLOBIN BY A THOUSAND
FOLD.
WE SO DISCOVERED THAT DURING
HEMOLYSIS IT TOOK 1 EVERY 1,000
RED CELLS AND TWO TO FOUR PLASMA
HEMOGLOBIN TO SCAVAGE NITRIC
OXIDE, CREATE INSTABILITY AND
LEAD OVER TIME TO VAAS.
THE SECOND DISCOVERY WAS THAT NO
TO BE OXIDIZED TO NORM NITRITE
AND IT FORMED NO THAT COULD BE
REACTIVATED WITH THE HEMOGLOBIN,
OTHER HEMO PROTEINS AND TO
GENERATE NITRIC OXIDE.
SO, A KEY TO MY TRANSITION WAS
THAT I HAD TO MOST FROM A
COMFORT ZONE TO SOMETHING
DIFFERENT AND I CALL THAT WHERE
THE MAGIC HAPPENS AND THAT
COMFORT ZONE WAS AN ORGAN HEALTH
SCIENCE UNIVERSITY CHIEF
CLINICIAN EDUCATOR TO LEARN AND
TO COMMIT TO TAKING A RISK AND
LEARNING CELL EX MOLECULAR
BIOLOGY AT THE NIH.
I THINK THAT THIS STEP REQUIRES
A COMMITMENT TO GO DEEP AND
UNDERSTAND FUNDAMENTAL SCIENCE.
THE SECOND PIECE IS THAT YOUR
MENTORS MATTER.
THIS IS PROBABLY ONE OF THE MOST
IMPORTANT THINGS AND HENRY
ALLUDE TODAY THIS AND I
BENEFITED FROM MANY IMPRESSIVE,
ABSOLUTELY COMMITTED PARTNERS IN
MENTORS AND THEY'RE ALL SHOWN
HERE AND I'LL TOUCH ON THEM AS I
MOVED THROUGH.
RICHARD GALLON, ALAN, JIM, GRIFF
ROGERS AND ALL OTHERS I'LL TALK
ABOUT AS I GO THROUGH MANY OF
WHICH ARE STIM AT THE NIH AND
THRIVING IN THE RESEARCH ARENA
SO JIM SHELLHAMMER AND HIS
TECHNICIAN, CAROLE LOGAN, TAUGHT
ME LESSONS.
FIRST OF ALL THEY WERE THE
ULTIMATE ROLE MODEL.
THE PHYSICIAN-SCIENTIST AND LAB
PARENTS.
THEY CARED ABOUT MY LIFE
HOLISTICALLY.
THEY TAUGHT ME THAT BOTH
GARDENING AND MOLECULAR BIOLOGY
WERE COOL.
THEY TAUGHT ME TO BE PATIENT,
SUPPORTIVE AND NURTURE AND IT
WILL WORKOUT.
THIS IS A LESSON THAT CARRIED ME
FORWARD AS I MENTORED PEOPLE
THROUGH THEIR CHALLENGES WITH
NEGATIVE DATA, NOT GETTING
GRANTS, AND THIS WAS AN
INCREDIBLE LESSON TO BE A
LEADER.
CAROLE ALWAYS TAUGHT ME PRE
LABEL AND ORGANIZE YOUR TUBES, I
LIKE TO MOVE FAST AND FURIOUS
AND WOULD GET IN TROUBLE.
JIM TAUGHT ME THAT TRUTH IS
DEFINED BY HAVING YOUR DATA
REPRODUCED BY OTHERS.
AND JIM'S MONTRA WAS DO JUSTICE
LOVE KINDNESS AND WALK HUMBLY.
ALAN HAD TOUGHER LESSONS.
HE ALWAYS THOUGHT BIG, HE
APPRECIATED WHAT THE IMPORTANT
QUESTIONS WERE IN SCIENCE AND HE
THOUGHT MY BEST WORK WOULD ARISE
FROM MY STUDIES IN NORMAL
VOLUNTEERS AND REALLY THE
DISCOVERY OF NITRITE CAME FROM
NORMAL VOLUNTEER STUDIES, HE
WANTED ME TO FOCUS ON THE
CLINIC.
HE HATED TRANSGENIC MICE AND
WHILE I DON'T AGREE WITH HIM
COMPLETELY, I HAVE TO SAY THAT
PEOPLE CAN -- THERE'S AN EASIER
PATH TO GO TO ANIMAL MODELS.
YOU HAVE TO WORK HARDER TO
DEVELOP RIGOROUS METHOD OLE GEEZ
APPLIED TO HUMAN STUDIES.
AND HE THOUGHT CRITICALLY AND HE
QUESTIONED EVERYTHING.
SO ANOTHER LESSON FROM MY TIME
AT NIH IS ASK IMPORTANT
QUESTIONS AND FIND CO MENTORS
AND TECHNOLOGY TO ANSWER THEM.
AND THE QUESTION THAT I BECAME
INTERESTED, AFTER ABOUT TWO AND
A HALF YEARS, OF DOING CELL
CULTURE.
I WAS INTERESTED IN THE QUESTION
IS THERE ENDOCRINE OF NO.
WE KNEW WHEN YOU INHALED IT AS A
THERAPY, THAT THERE WAS NO BLOOD
PRESSURE EFFECT.
THAT THE NO IS LARGELY
INACTIVATED BY REACTION WITH
BLOOD.
HOWEVER, THERE WAS SOME DATA
SUGGESTED THAT THERE WAS A
SUBTLE PERIPHERAL DELIVERY OF
NO.
THE BEST DATA CAME FROM WORK BY
PAUL CUBES IN PUBLISHED IN THE
JCI WHERE HE LOOKED AT CATS.
HE INFUSIONED INTO THE CAT
INTESTINE AN NO INHIBITOR L-NAME
AND THERE'S A DROP IF BLOOD
FLOW.
THIS IS A DECREASE IN DIAMETER
AND IF HE WAS LIVING INHALED NO
AT THE SAME TIME IT WAS
ABROGATED AND SOMETHING WAS
CARRIED IN BLOOD TO TRANSDUCE
THAT NO SIGNAL.
IT COULDN'T BE NO BECAUSE THE
HALF LIFE OF NO IS TOO SHORT FOR
EVEN AN ARTERY-TO-VEIN TRANSIT
TIME.
TO ANSWER THESE QUESTIONS, I HAD
TO LEARN TO EMBRACE FUNDAMENTAL
BASIC SCIENCE AND COMPLIMENT
TRANSLATIONAL TOOLS SO I ARGUE
WE HAVE TO REALLY PUT THAT
INVESTMENT IN LEARNING THESE
TECHNOLOGIES.
WHETHER IT'S CHEMISTRY,
MOLECULAR BIOLOGY AND BEDSIDE
TOOLS ON THE RIGHT.
I REALLY FOCUSED ON CHEMISTRY
MASS SPECK, IMAGING, WRITE BY
TAKING ON ANOTHER MENTOR,
RICHARD CANNON, BLOOD FLOW.
I ALSO DID SOME WORK WITH MRI
DEPEDEPENDENT FLOOD PLOW, IMAGIG
BLOOD FLOW BUT THE MAIN WAS
BLOOD FLOW W Dr. CANNON, HE
TAUGHT ME HOW TO ONE THESE VERY
FOCUSED, 18-PATIENT TRIALS.
WE PUT CATHETERS IN THE ARTERY
AND INFUSED A INHIBITOR AND THEN
WE REPEAT THAT WITH INHALED NO
TO LOOK AT THAT CUBES EXPERIMENT
IN HUMANS AND IF YOU FOCUS IN
THE LOWER-LEFT, WE ESSENTIALLY
SAW THE SAME THING IN HUMANS.
THAT WHILE BREATHING ROOM AIR,
IF WE BLOCK NO SYNTHESIS WITH
L-NMMA OUR BLOOD DEGREE DROPS
25%.
IT'S CONTROLLED BY NO PRODUCTION
FROM NAS.
WHEN YOU BREATHED NO IT WAS
ABROGATED AND THIS WAS ALSO SEEN
WITH EXERCISE.
SO SOMETHING WAS BEING CARRIED
IN BLOOD.
AT THAT POINT I REALLY DOUBLED
DOWN ON CHEMISTRY.
I WAS ABLE TO TAKE SOME NO
DETECTION EQUIPMENT THAT WAS
AVAILABLE IN THE DEPARTMENT AND
BEGAN PARTNERING WITH CHEMISTS,
STUDYING PAPERS, TRYING TO
MEASURE NO MODIFIED SPECIES IN
BLOOD AND DEVELOPED ASSAY FOR
SNOWMOBILE HEMOGLOBIN AND I
MEASURED NIEHS TRIED AS
BOOKKEEPING BECAUSE EVERYONE AT
THE TIME KNEW THAT IT WAS INERT
AND TO OUR SURPRISE, DURING
EXERCISE, DURING L-MNA INFLATION
THERE'S A CONSUMPTION FROM
ARTERY-TO-VEIN.
AS IT IT WEPT FROM THE ARTERY TO
THE VEIN THE LEVEL DROPPED MUCH
LIKE OXYGEN DROPS.
OXY HEMOGLOBIN CONCENTRATION
RESPONSE IF YOU MULTIPLY THAT
GRADIENT TIMES BLOOD FLOW IT'S
THE CALCULATION OF CONSUMPTION
THERE WAS ALWAYS CONSUMPTION OF
NITRATE AND IT WENT UP WITH
EXERCISE SO WE BEGAN TO ASK THE
QUESTIONS AND THIS WAS A PAPER
THAT I PUBLISHED, THAT WAS VERY
CONTROVERSIAL.
COULD NITRATE REGULAR BLOOD FLOW
AND EVENTUALLY WE DID ANOTHER
TRANSLATIONAL STUDY AND WE GOT
NITRATE FROM THE ANECDOTES KIT
AND RIGHT THERE IN THE CLINICAL
CENTER, WE INFUSED NITRATE AND
EVEN AT NEAR PHYSIOLOGICAL
CONCENTRATIONS, WE SAW VASE
ODILEATION IN 10/10 VOLUNTEERS,
WE SAW DILATION AT REST DURING
INHIBITION AND DILATION WITH
EXERCISE.
AND THIS OCCURRED AT THE NEAR
PHYSIOLOGICAL LEVELS OF NIEHS
TRITE.
ONE DAY I ASKED HER TO PLOT THE
AMOUNT OF NO THAT WAS FORMING
FROM ARTERY TO VEIN IN OUR
PATIENTS VERSUS THE OXY
HEMOGLOBIN CONCENTRATION AND SHE
SAW THIS RELATIONSHIP THAT FROM
ARTERY TO VEIN THERE WAS A
FORMATION TO THE HEMOGLOBIN THAT
APPEARED TO BE CORRELATED WITH
DROPPING OXYGEN SATURATION AND
SO THERE WAS A RELATIONSHIP
BETWEEN LOW OXYGEN SATURATION OF
HEMOGLOBIN AND IN THE VEIN AND
THE CONVERSION OF NITRITE TO NO
BOUND TO THE HEMOGLOBIN AND THAT
BROUGHT US TO OLD PUBLISHED DATA
FROM BROOKS AND DOYLE AS FAR AS
1936 THAT THIS WAS THIS
WELL-KNOWN SECOND ORDER
REACTION.
WELL ACTUALLY IT REALLY WAS
FORGOTTEN IN SCIENCE, BUT
NITRITE PLUS DESOXY HEMOGLOBIN
THERE'S AN ELECTRIC TRANSFER SO
YOU HAVE MET HEMOGLOBIN AND YOU
MAKE NO.
THAT NO COULD BE POUND TO
ANOTHER DEOXY HEMOGLOBIN TO MAKE
THE NO HEMOGLOBIN WE THOUGHT WE
MIGHT DETECT AS A SO SIM TER OF
THIS REACTION OCCURRING FROM
ARTERY TO BRAIN.
I WAS STRUCK BY THE PHYSICAL
LOGIC SIGNIFICANCE OF THIS
REACTION BECAUSE IT REQUIRES
DEOXYGENATION OF HEMOGLOBIN SO
IT CAN BE REGULATED AND IT WAS
HYPOXIC SENSITIVE AND IT
REQUIRED A PROTEIN SO IT HAD
METABOLIC SENSING AND IT MADE NO
WHICH IS A DILATER SO COULD THIS
BE DRIVING HYPOXIC BASE'
DILATION AND WITHOUT GOING INTO
DETAIL THE CHEM TREE WAS A
LITTLE MORE COMPLICATED IN THAT
IT IS A SECOND ORDER REACTION
BULL IT'S REGULATED SO THE
REACTIVITY OF NITRITE IS HIGHEST
WITH THE A STATE SO THE INTENSE
DROPS AS HEMOGLOBIN GOES FROM R
TO T BUT THE AVAILABLE HEMES
INCREASES AS YOU DEGOX AGAIN
EIGHT THE HEMES SO YOU GET A
RATE OF INOWE PRODUCTION AROUND
THE P50 AND IDEAL SITE FOR
SENSING AND HYPOXIC BASE OWE
DILATION.
SO ANOTHER LESSON LEARNED WAS
COLLABORATIVE PEER NETWORKS AND
WHILE I HAD INCREDIBLE MENTORS I
ACCUMULATED PARTNERS IN THE
CHEMISTRY WORLD.
I WAS SORT OF THE COUNTRY LUNG
DOCTOR AND I IDEA PERSON BUT I
HAD INCREDIBLE CHEMISTRY.
DANNY KIM SHAPIRO IS THE CHAIR
OF BIOPHYSICS AT WAKE FOREST
TODAY AND RAKE IS SS PA SELL,
NEIL HOG, CLAUDE WHY MORRIS,
DAVID WINK, KATRINA MIRANDA AND
THESE PEOPLE TAUGHT ME CHEMISTRY
AND WERE GREAT PARTNERS IN THESE
DISCOVERIES.
THE LAST LESSON FROM MY
INTRAMURAL EXPERIENCE IS I THINK
IT'S IMPORTANT TO INVEST TIME
AND RESOURCES IN RARE PATIENT
COHORTS AND UNMET NEED.
THAT'S ONE ONE OF THE GREATEST
OF THE NIH IF YOU THINK OF LAMB
COHORTS, MEL A THEM A COHORTS
AND SOMETHING THAT PROBABLY
REQUIRES MORE INVESTMENTS.
AND I BECAME VERY INTERESTED AS
A SIDE PROJECT AGAIN, IN SICKLE
CELL DISEASE AND HENRY PUSHED ME
TO RUN THIS SIDE PROJECT AND
INTRODUCED ME TO GRIF ROGERS AND
ALAN AND WE DID A SMALL STUDY OF
SCREENING.
195 PEOPLE IN THE WASHINGTON
BALTIMORE REGION WITH TRANS
THORACIC ECHO CARDIO GRAM AND WE
COVERED THAT PULMONARY
HYPERTENSION IS ESTIMATED BY
ECHO WAS A MAJOR RISK FACTOR FOR
DEATH AND OUR PATIENTS WITH
SICKLE CELL DISEASE AND COUNT
LESS STUDIES WERE PUBLISHED FROM
THIS COHORT BUT THIS IS ONE OF
OUR STUDIES JUST SHOWING THAT
THIS IMPACT OF HAVING PULMONARY
HYPERTENSION ON THE PROBABLE A
LOT OF SURVIVAL OVER EIGHT
YEARS.
YOU KNOW, ONLY 40% OF PATIENTS
WITH PULMONARY HYPERTENSION
SURVIVING THAT LONG AND THE
PROBABILITY OF SURVIVING TO AGE
60, ONLY 40% OF OUR ADULTS
SURVIVAL TO AGE 60 AND 80%.
THE RISK RATIO FOR DEATH
ASSOCIATED WITH AND ECHO
ESTIMATE OF PULMONARY
HYPERTENSION IS 10.
ONE OF THE HIGHEST RISK FACTORS
FOR DEATH IN PATIENTS WITH
SICKLE CELL DISEASE.
WE ALSO FOUND IN THESE CLINICAL
STUDIES, THAT HEMA LIDIC ANEMIA
LEAD TO A CONSTELLATION OF
SYMPTOMS AS PATIENTS GOT OLDER.
THIS IS ANEN DOUGH OR SUB
PHENOTYPE OF SICKLE CELL.
CHRONIC KIDNEY DISEASE, LEG
ULCER, HAS THE DEATH.
GRIFF ROGERS, WALKING IN THE
HALLWAY ONE DAY, I WAS TELLING
HIM ABOUT MY THEORY AND THE LINK
TO PULMONARY HYPERTENSION AND HE
SAID YOU KNOW, MARK, PATIENTS
WITH SICKLE CELL AND GET LEG
ULCERS ALSO YOU SEE IF LEG
ULCERS IS ASSOCIATED WITH HEM
OLE SIS AND IT IT RETURNS OUT
THIS IS ONE OF THE MOST STRONGLY
ASSOCIATED PHENOTYPES OF CHRONIC
IS LEG ULCERS.
THIS COHORT WORK IS CONTINUED TO
DRIVE RESEARCH.
THIS IS THE RECENT STUDY FROM
THE NIH RESEARCH GROUP WHERE
THEY LOOKED AT MACHINE LEARNING
PREDICTORS OF RISK OF DEATH AND
YOU CAN SEE THIS A VARIABLE
IMPORTANCE FOR DEATH BUT YOU CAN
SEE THE DOMINANCE OF THE PULL
MINNAAR HE'S HYPERTENSION AND
THE RIGHT SYSTEM I CAN PRESSURE
AND ALSO MEASURES THE DNP WHICH
PREDICTS HYPERTENSION, CHRONIC
KIDNEY KISS SEIZE AND HEART
DISEASE AND PARAMETERS BY ECHO
AND MEASURES OF YOU CAN SEE THE
SIDE COUNT HERE.
AND THEY I AM PROVED, THIS IS
THE ECHO PREDICTORS OF DEATH ON
THE RIGHT AND THEY IMPROVED ON
THAN THIS WITH THIS MACHINE
LEANING RISK RISK SCORE.
SO THIS NIH SICKLE CELL AND MULL
MINNAAR' HYPERTENSION PROGRAM
LEAD 250 DOWNSTREAM
PUBLICATIONS, MULTIPLE LEADERS
IN THE SICKLE CELL FIELDS
CENTERS OF EXCELLENCE AROUND THE
COUNTRY TRAINED AT THE NIH
DURING THOSE YEARS AND ALMOST
FIVE MAJOR CLINICAL TRIALS IN
ONE OF THEM IS RUNNING NOW IT'S
A VERY LARGE 22-CENTER STUDY
SPONSORED BY THE NATIONAL HEART
LUNG AND BLOOD INSTITUTE THAT'S
LOOKING AT CHRONIC AGGRESSIVE
EXCHANGE TRANSFUSION VERSUS
STANDARD CARE.
FOR PATIENTS AT THE HIGHEST RISK
OF DEATH AND THE DEVELOPMENT OF
EARLY CROP I CAN K CHRONIC KIDN.
SO WHAT ARE THE LESSONS OF THE
PRESENT?
THAT WE LEARN FROM THE
EXTRAMURAL WORLD AND HERE I'LL
BE SHARING SOME INFORMATION THAT
MAY NOT BE AS FAMILIAR TO YOU
AND THAT IS HOW HAVE WE
LEVERAGED STRATEGIES TO DEVELOP
PHYSICIAN-SCIENTISTS AT THE
UNIVERSITY OF PITTSBURGH.
NOW, THE UNIVERSITY OF
PITTSBURGH HAS BECOME AN ELITE
INSTITUTION.
THE DEPARTMENT OF MEDICINE
THERE, THESE ARE THE DIVISIONS,
WE'VE ALSO BUILT TWO MAJOR
RESEARCH INSTITUTES, THE LED BY
STEVEN CHAP AND THE AGING
INSTITUTE LED BY -- I'M HAVING A
PLANK I'LL COME BACK TO THAT.
WE HAVE 750 FACULTY AND WE HAVE
335 RESIDENTS AND FELLOWS,
116ACG FELLOWS SO LARGE FACULTY
AND WE'RE REALLY IN THE TOP 10
SIZE FOR DEPARTMENTS OF MEDICINE
AND ALSO VERY STRONG RESEARCH
AND 64 RESEARCH CENTERS AS HENRY
MENTIONED AND NUMBER EIGHT IN
THE NATION BY BLUE RIDGE FOR NIH
FUNDING AND THEN VERY, VERY BIG
OUT PATIENT AND IN PATIENT
WORLD.
IN THE EXTRAMURAL WORLD WE FOCUS
ON GRANT RESOURCES TO SUPPORT
PHYSICIAN-SCIENTIST.
THESE GRANTS ARE THE T TO F TO K
TO R.
SO THE T IS A TRIP IS TRAINING T
PROTECTS TIME AFTER YOU ARE A
FELLOW FOR RESEARCH, LIKE I DID
AT THE INTRAMURAL PROGRAM OR FOR
GRAD STUDENTS OR POSTDOC PH.D
FELLOWS.
IT PROTECTS TIME EARLY IN
TRAINING AND F IS AN INDIVIDUAL
AWARD SO T IS INSTITUTIONAL, YOU
WRITE THESE, AS A DEPARTMENT OF
CARDIOLOGY, FOR EXAMPLE, AND F
WOULD BE AN INDIVIDUAL T.
A K IS A CAREER DEVELOPMENT
AWARD.
YOU HAVE TO BE ASSIST APARTMENT
PROFESSOR AND IT'S FIVE YEARS
AND 100,000 A YEAR AND THESE ARE
OFTEN PHYSICIAN-SCIENTISTS
RESTRICTED ALTHOUGH SOME
INSTITUTES ALLOW PH.D SCIENTISTS
TO HAVE THESE AND THE R IS THAT
INDIVIDUAL CAREER DEVELOPMENT
AWARD.
AND MY APOLOGY, I HAD A MINI
TORN IF YOU ARE LISTENING I LOVE
YOU AND FORGIVE ME.
SO WE REALLY FOCUSED ON T32.
BY THE TIME I LEFT, WE HAD 13
FUNDED T32s ACROSS THE
DEPARTMENT OF MEDICINE AND YOU
CAN SEE ALL THE PIs HERE.
WE WERE WORKING ON RENEWING THE
GERIATRIC AGING ONE WHICH TORN
IS IS THE P.I. ON AND THEN
THERE'S OTHER TRAINING GRANTS
THAT FOCUS ON DEVELOPING
PHYSICIAN-SCIENTIST AND THEY
HAVE MANY, MANY LETTERS BUT I'LL
JUST HIGHLIGHT THE K12 AND THE
KL2.
THOSE ARE LIGHT Ks EARLY
ASSIST APARTMENT PROFESSOR
PHYSICIAN-SCIENTIST CAREER
DEVELOPMENT AWARDS FOR FIVE
YEARS AND THEY'RE INSTITUTIONAL
MEANING THAT YOU CAN PEAK AT THE
INSTITUTIONAL LEVEL FOR THOSE.
THERE'S AN INTERESTING ONE, A
K24.
A K24 ACTUALLY FUNDS A MENTOR
FOR 50% TIME TO MENTOR.
THOSE ARE VERY NICE GRANTS.
AND THERE'S A NEW R38 PROGRAM
WHICH ACTUALLY FUNDS LATE
PLOOMERS AND RESIDENCY SO A YEAR
OFF DURING RESIDENCIES AND IF
YOU WEREN'T AN MD-PH.D TO ENGAGE
IN RESEARCH.
AND THIS INVESTMENT PAID OFF.
SO BY THE TIME I LEFT, WE
ACTUALLY HAD 40K AWARDEES, THESE
ARE PHYSICIAN-SCIENTISTS WITH
EARLY CAREER DEVELOPMENT AWARDS.
THIS IS AMONG UP WITH OF THE TOP
IN THE NATION.
WE HAD 55 TOTAL CAREER
DEVELOPMENT AWARDS IF YOU COUNT
VA CAREER DEVELOPMENT AWARDS,
AMERICAN HEART CAREER
DEVELOPMENT AWARDS AND OTHER
ONES.
AND WE HAD 266 TOTAL NIH AWARDS
LEADING INTO 1,600 PUBLICATIONS
AND AGAIN OUR RANKING SIX TO
EIGHT IN BLUE RIDGE.
NOW THESE T32 A LINE AROUND
INTEGRATION AND COLLABORATION
AND IN NHLBI WE HAD A LUNG T32
AND YOU SEE THE DISEASE FOCUS.
WE HAD A HEART T32, A BLOOD T32
AND A SLEEP T32 AND PEOPLE COULD
PARTICIPATE ACROSS AND BREAKDOWN
SILOS BETWEEN DEPARTMENTS
DIVISIONS FOR EXAMPLE.
AND THE FOCUS WAS ON
MILESTONE-DRIVEN MENTORING.
AND I THINK THIS IS ONE THING
THE NIH COULD LEARN.
WHEN I WAS A FELLOW, YOU KNOW, I
JOKED THAT TO BE A BASIC SCIENCE
RESEARCH WE PUT SOMEONE IN A
BASIC SCIENCE LAB AND WE CLOSED
THE DOOR, LOCK IT IT AND LET
THEM OUT IN THREE YEARS TO BE A
CLINICAL SCIENCE INVESTIGATOR,
YOU GET A MASTERS IN
PUBLIC-HEALTH.
I THINK NOW WE HAVE TO
APPRECIATE THAT THE PRESSURES
AND THE TIME LINES FOR OUR
TRAINEES ARE TIGHTER, SO WE HAVE
TO HAVE MORE STRUCTURE.
SO, FOR EXAMPLE, IN FIRST
YEAR-AND-A-HALF OF THE PULMONARY
SO WE CHOSE A MENTOR SO THEY'RE
WORKING WITH A MENTOR BEFORE
THEY HIT THEIR PROTECTED TIME
AFTER A YEAR AND A HALF.
THEY DO A TWO-WEEK FUND MENTAL
OF RESEARCH COURSE.
THIS IS TEACHING THEM A HALF A
DAY OF LAB-BASED FUNDAMENTALS
AND HALF A DAY OF DIDACTIC.
YOU KNOW, WHAT RNCA SEEK IS ASK
EX PCR AND BIO STATS, AND THEN
THEY SATURDAY A SIX-MONT S STARA
LITTLE BIT.
WE TRY TO GET THEM TO PRESENT
THEIR FIRST RESEARCH
PRESENTATION, EVEN THOUGH THEY
HAVEN'T DONE A LOT OF RESEARCH
AND GO TO A NATIONAL MEETING
WITH AN ABSTRACT.
THERE'S NOTHING MORE EXCITE TO
GO GO TO A NATIONAL MEETING AND
REALIZE THERE'S A BIG BEAUTIFUL
WORLD OF SCIENCE OUT THERE.
THEY START FULL-TIME RESEARCH,
ALTHOUGH THEY HAVE A CLINIC THEY
CAN GET ADVANCE TRAINING, IF
THEY WANT AND WE START A GRANT
WRITING.
EVERYBODY IN OUR FELLOWSHIPS
DOES A T32 TRAINING GRANTOR AN
F32, EXCUSE ME.
SO THEY'RE ON THE T32 BUT THEY
SUBMIT AN F32.
ONE IS THAT CREATES MORE SLOTS
FOR US IN THE T32 FOR OTHER
PEOPLE AND THEY LEARN TO WRITE A
SIX-PAGE GRANT.
AND WE MAKE IT ACCESSIBLE AND
NOT SCARY AND FOR TWO MONTHS
THEY JUST WORK ON THEIR AIMS
PAGE.
FOR ANOTHER MONTH THEY WORK ON
THEIR BACKGROUND AND
SIGNIFICANCE FOR ANOTHER MONTH
IT'S THE RESEARCH PLAN AND THE
CAREER DEVELOPMENT SUPPLEMENTS
AND THEY HAVE IT AT NIGHT OVER
PIZZA AND WE HAVE PEOPLE THAT
ARE ON STUDY SECTIONS MENTORING
THEM SO THEY LEARN T ANTI-SEMITC
LEARN TO WRITE ANDREVIEW THESE .
YOU CAN SEE THERE'S MILESTONES
HIGHLIGHTED AND I TOUCHED ON
MANY OF THESE MILESTONES.
WE ALSO HAD SOME VERY UNIQUE
THINGS LIKE FDA ROTATIONS AND
NIH ROTATIONS, INDUSTRY RND FOR
PEOPLE THAT ARE IN AN
ENTREPRENEUR DRUG DEVELOPMENT
PATHWAY AND WE LOOKED FOR EARLY
PUBLICATION IN ABSTRACTS AND
AGAIN THIS F32 APPLICATION BEING
REQUIRED.
THE OTHER IMPORTANCE IS
DEVELOPING NETWORKS SO THERE'S A
NURTURING SUPPORTIVE ENVIRONMENT
OF LIKE MINDED PEERS THAT YOU
ARE NOT THAT MINORITY PERSON IN
A MAJORITY CLINICAL ENTERPRISE
AND WE CALLED THE K AWARDEE TO
OUR ADVANCEMENT TRAINING
PROGRAM.
AND AGAIN THIS WAS A NETWORK.
I THINK THIS HAD 54 PEOPLE WHEN
I LEFT.
WE INVESTED A PROGRAM AND
1,500,000 A YEAR OF HARD MONEY
THAT PEOPLE COULD APPLY FOR A
GRANT AND THE GRANT WAS FOR
SOMETHING THAT WOULD BE
INDEPENDENT OF THEIR PI GIVING
THEM SOME ADVANTAGE FOR THEIR
NOT R SUBMISSION.
IT MIGHT HELP THEM MAKE A NEW
CRISPR 9 MOUSE OR HELPING A
TECHNICIAN TO DO MORE WORK OR
HALF A COORDINATOR TO GET
TRANSLATIONAL THINGS GOING.
AND THEY HAD REGULAR MEETINGS
TOGETHER AND VISITING SPEAKERS,
MOCK STUDY SECTIONS AND AGAIN A
COMMUNITY OF NETWORK OF LIKE
MINDED PEOPLE.
SO, WHAT ABOUT OUR FUTURE.
I'M SHARE OUR EXPERIENCES FROM A
COMPETITIVE BURROW WELCOME
FOUNDATION GRANT THAT Dr.
RICHARD STEIN MAN AND I WERE
AWARDED AND THIS WAS INNOVATIONS
AROUND TRAINING MD-ONLY
PHYSICIAN-SCIENTISTS AND IN THE
WORLD OF EXTRAMURAL RESEARCHERS
THERE'S BEEN A BIG PUSH TOWARDS
FOCUSING ON MD-PH.D SCIENTISTS
BUT WE CAN'T FORGET PEOPLE LIKE
ME, LATE BLOOMERS, AND I FIND
THAT THE MD-ONLY SCIENTISTS ARE
MORE PASSIONATE ABOUT RESEARCH
AND MORE COMMITTED BECAUSE THEIR
INTEREST IS OCCURRING MAYBE AT A
DIFFERENT STAGE IN LIFE.
IT WAS FOCUSED AROUND PILOT
INNOVATIONS.
WHAT IS INTERESTING ABOUT THIS
PROGRAM, WE WERE GOING TO TRAIN
RESIDENTS IN PROTECTED RESEARCH
TIME OR FELLOWS DURING THEIR
PROTECTED RESEARCH TIME FROM
SEVEN SPECIALITIES.
AND THERE WAS HIGH ENGAGEMENT
WITH THE SCIENTISTS -- I'M
SORRY, PHYSICIAN-SCIENTIST
SURGEONS.
NOW, PHYSICIAN-SCIENTIST
SURGEONS ARE THE MOST RARE BREED
AND IF YOU BECOME A
PHYSICIAN-SCIENTIST SURGEON I
THINK THE WORLD IS AT YOUR FEET.
I TRY TO ENCOURAGE PEOPLE IF YOU
WANT TO BE A LEADER AND THE BEST
PATH AND THERE'S A REAL UNMET
NEED HERE.
AS I'LL TELL YOU, WE LOOKED TO
IDENTIFY BARRIERS, PERCEIVED
BARRIERS TO SUCCESS COMING FROM
OUR YOUNG PEOPLE AND THEN WE
DEVELOPED INNOVATIVE PROGRAMMING
TO ADDRESS IT AND AS YOU ARE
GOING TO HEAR, THAN ENDED UP
BEING INSECURE TEASE ABOUT
FINDING MENTORS, WORK-LIFE
BALANCE, LAB SUPPORT DURING
CLINICAL ROTATIONS AND
RESILIENCE OR GRIT.
AND SO WE SURVEYED 143 RESIDENTS
AND FELLOWS IN OUR ACADEMIC
TRACKS AND THIS WAS REALLY THE
WORK OF RICHARD STEINMAN.
AND WE ASKED THEM, WHAT'S
EXTREMELY INFLUENTIAL TO YOU.
THEY HAD A LONG LIST.
WE EXPECTED IT WOULD BE ABOUT
GRANTS AND PAY.
THEY GAVE US DIFFERENT ANSWERS.
GRANTS AND PAY WAS THERE.
BALANCING THE CLINICAL AND
RESEARCH RESPONSIBILITIES.
HOW AM I GOOD AT BOTH.
THAT WAS A TOP CONCERN.
HOW DO I HAVE THE MASTERING NEED
OF THE RANGE OF EXPERTISE WITH
STATISTICS TO BASIC SCIENCE AND
TO GRANT WRITING AND TO
PROTOCOLS.
HOW DO I BALANCE PERSONAL AND
PROFESSIONAL RESPONSIBILITIES
AND FIND MY NICHE, YOU KNOW,
RELATED TO MENTORING.
SO WE BUILT A VERY INNOVATIVE
PROGRAM I HAVE TO SAY.
WE BUILT IN FOR EXAMPLE,
EXECUTIVES COACHING AND LOOKING
AT RESILIENCE AND HOW DO WE
PREPARE PEOPLE WHEN THAT GRANT
IS REJECTED WHEN THOSE HAVE THAT
FIRST OR SECOND CHILD.
THOSE INTERRUPTIONS THAT CAN
OVERWHELM YOU AND REALLY
BUILDING ON THAT RESILIENCE.
WE LOOKED AT WORK-LIFE BALANCE.
WE CREATED A FUND FOR CONCIERGE
SERVICE AND TIME MANAGEMENT
SUPPORT AND NOW THE MOST POPULAR
THING WAS A HOUSE CLEANER.
THAT ALMOST EVERYBODY WANTED
SOMEONE TO CLEAN THEIR HOUSE.
ONCE A WEEK CLEANING SERVICE
COULD BE OFF THEIR PLATE TO
ALLOW THEM FOCUS ON THEIR
FAMILIES AND THEIR RESEARCH.
WE CREATED WEEKLY GRANT WRITING
GROUPS AND WE JUST HAD EXTENSIVE
MENTOR-MENTEE MARRIAGE PROGRAMS,
AND CONFLICT RESOLUTION IN CASE
DISCUSSION PROGRAMS.
AND WE HAD BIO STATS BOOTCAMP
AND RIG OR TRAINING AND THE BIO
STATS PROGRAM SUPPORTED THEM FOR
THEIR PAPERS.
AND WE HAD MENTORING TEAMS, WHEN
PEOPLE GO BACK IN THE CLINIC WE
HAVE A HALF TIME TECHNICIAN
RUNNING THEIR WORK WHILE THEY'RE
IN AND OUT OF THE SURGICAL
ROTATIONS THAT THEY HAVE TO GO
BACK TO.
HOW DID THIS DO?
WOMAN IT'S EARLY AND THE PROGRAM
IS STILL RUNNING.
THESE SCHOLARS WERE PRODUCTIVE.
THEY OBTAINED MULTIPLE GRANTS
LISTED HERE AND THE FIRST
AUTHORSHIP, THEY'VE GOT ABOUT
THREE PUBLICATIONS PER SCHOLAR
AND BASIC SCIENCE TO
PUBLICATIONS.
EXTREMELY PRODUCTIVE IN TERMS OF
PUBLICATIONS AND WE ALSO
IDENTIFIED IN OUR SURVEY A
GENDER GAP IN CONFIDENCE AT THE
START OF PHYSICIAN-SCIENTIST
TRAINING.
THERE WERE 36 MEASURES OF
SELF-EFFICACY ACROSS THESE
RANGES AND A 10 IS A HIGH
CONFIDENT LEVEL.
YOU CAN SEE WE SAW SIGNIFICANT
DIFFERENCES BETWEEN MALE AND
FEMALE.
THESE ARE MD-PH.D STUDENTS AND A
PROTECTED YEAR AND
PHYSICIAN-SCIENTIST TRAINING
THEY'RE A YEAR OF RESEARCH
BETWEEN THEIR SECOND AND THIRD
YEAR OF MED SCHOOL.
WE SAW THIS ALSO IN OUR
RESIDENTS AND FELLOWS.
HOMICIDE.
THIS IS
ALL HIGHLY SIGNIFICANT
DIFFERENCES AND SOME NUMERICAL
DIFFERENCES PERSISTED BUT YOU
CAN SEE THAT DIFFERENCE BECAME
LESS SIGNIFICANT.
SO, JUST TO CONCLUDE, DO WE HAVE
AN OPPORTUNITY TO LEVERAGE THE
NIH AND THE UNIVERSITY OF
MARYLAND NOW THAT WE'RE SO
CLOSE?
OUR STRENGTHS IN A VITAL
PARTNERSHIP, FOCUSED ON TRAINING
THE NEXT GENERATION OF
PHYSICIAN-SCIENTIST?
AND IF YOU DON'T MIND, I'LL DO
AN NIH SWAT ANALYSIS AT RISK OF
PICKING A FIGHT WITH SOME OF
YOU.
I'M HAPPY TO HEAR YOUR FEEDBACK.
I FEEL THAT WHAT THE NIH HAS IS
AN INTERNATIONAL REPUTATION AND
AN ELITE STATUS IN THE HISTORY
OF MEDICINE AND SCIENCE.
THE NIH HAS REMARKABLE MENTORS
AND TECHNOLOGY AND NEW
TECHNOLOGY CUTTING EDGE
TECHNOLOGY, THE CLINICAL CENTER,
CLINICAL OPPORTUNITIES IN CORE.
THE NIH HAS STRONG SCIENCE
FOCUSED ENVIRONMENT WITH RICH
BASIC SCIENCE AND THE NIH HAS
THE CLINICAL CENTER WHICH IS IS
I THINK UNMATCHED AND AN ABILITY
TO LEVERAGE T1 CAPACITY TO
BEDSIDE CAPACITY.
THE NIH CAN BE VERY FAST.
HENRY MASUR TOOK ADVANTAGE WHEN
THERE WAS AN OUTBREAK, OBVIOUSLY
THE NIAD HAS EX EMPTIED THIS.
THERE'S AN ABILITY TO RAPIDLY
PIVOT WITH NEW OUTBREAKS.
YOU DON'T HAVE TO WAIT ON GRANT
FUNDING TO PIVOT TO AN EMERGING
CHALLENGE AND THEN THERE ARE
RESOURCES FOR PROTECTED TIME.
YOU KNOW, I HAD THE ABILITY
WITHOUT WRITING A T32 OR AN F TO
STAY.
THAT LENGTH OF TIME NEEDED AS A
POSTDOC FELLOW TO MAKE THE
PROGRESS THAT I SHARED WITH YOU.
BUT THERE'S ALSO WEAKNESSES.
THE NIH HAS A LIMITED TALENT
PIPELINE AND I MEAN MEDICAL
STUDENTS, RESIDENTS AND FELLOWS.
THE NIH HAS LIMITED GRANT
WRITING AND CAREER DEVELOPMENT
PATHWAYS.
THE INTRA TO EXTRAMURAL
PATHWAYS.
YOU HAVE THE K22 WHICH IS VERY
SUCCESSFUL.
BUT THESE OPPORTUNITIES COULD BE
EXPANDED.
THERE ARE LIMITED LARGE PATIENT
COHORTS AND SOME OF THOSE ARE
DWINDLING OVER TIME, THERE'S
LIMITED IN DATASETS.
WE'RE IN THE WORLD OF DATA AND
THOSE DATASETS CAN BE LIMITED.
FIXED BUDGETS CAN OFTEN LIMIT
CAREER GROWTH OF EARLY AND MID
CAREER INVESTIGATORS AND I
ALWAYS JOKED WITH PEOPLE, IT WAS
A COMMON JOKE AT NIH THE ONLY
WAY YOU MOVE UP AS A YOUNG
PERSON IS SOMEONE NEED TODAY DIE
OR THERE WAS AN ETHICS SCANDAL
AND OFTEN I WAS GIVEN LEADERSHIP
WHEN CHANGES OCCURRED IN
LEADERSHIP AND WE'D LIKE YOUNG
PEOPLE TO MOVE UP THAT LADDER.
IN STRAT MURAL WORLD YOU COMPETE
IN A BIG POOL OF LEADERSHIP AND
RO1 AND K GRANTS THAT GIVE YOU
THAT FIRST FACULTY STEP.
ALTHOUGH YOU GET LESS RESOURCES
AT EACH STEP AND A LIMITED
ABILITY TO LEVERAGE CLINICAL
RESOURCE THIS IS PATIENTS.
WHEN I DO A CLINICAL TRIAL, I
CAN PAY FOR A LOT OF IT THROUGH
TESTING AND SUPPORT AND AT THE
ENOUGH ALL OF THOSE RESOURCES
HAVE TO BE COVERED CENTRALLY.
SO HOW COULD WE FORM AN ALLIANCE
AND COLLABORATE MORE AND I'M
GOING TO VISIT NIH TOMORROW AND
I'D LOVE TO BRAINSTORM ABOUT
THESE THINGS.
COULD THE UNIVERSITY OF MARYLAND
BRING MED STUDENTS TO CAREER
DEVELOPMENT TRACKS.
WE WOULD LOVE TO DO THAT.
WE'RE THE MAJOR PUBLIC
UNIVERSITY IN THE REGION, THAT'S
OUR RESPONSIBILITY.
CAN WE BRING OUR LARGE DATASETS
AND PATIENT COHORTS O
COLLABORATIVE RESEARCH PROGRAMS
AND I'LL POINT OUT THAT WE JUST
LAUNCHED A VERY EXCITING NEW
UNIVERSITY MARYLAND INSTITUTE
FOR HEALTHCARE COMPUTING.
WE HAVE A $56 MILLION INVESTMENT
AND WE'LL BE BUILDING A MAJOR
HEALTHCARE COMPUTING LEARNING
HEALTH-CARE SYSTEM RIGHT NORTH
OF YOU AT THE WHITE FLINT NORTH
BETHESDA METRO STOP.
THAT PROGRAM, WE'LL TAKE THE
DATA COMING FROM THE UNIVERSITY
OF MARYLAND SYSTEM OF HOSPITALS,
2 MILLION UNIQUE PATIENT
ELECTRONIC HEALTHCARE RECORDS
AND THAT DATA IS DEIDENTIFIED,
RUN THROUGH HONEST BROKER SYSTEM
FOR REAL WORLD DATA, REAL WORLD
ANALYSIS.
NOW THIS IS GOING TO BE AN
IMPORTANT INITIATIVE BECAUSE
MANY OF OUR A.I. BASED ANALYSIS
AND OUR POPULATIONS ARE BIAS
THAT THOSE DON'T HAVE DIVERSE
POPULATION AND IN MARRY LAPPED
MAR LAND WE'REPROUD 30% OF UNDEN
MEDICINE.
AFRICAN AMERICAN, LA TEEN X AND
WE HAVE AN OPPORTUNITY TO USE
AND LEVERAGE HEALTHCARE
COMPUTING TO PROVIDE BETTER
POPULATION HEALTH, BETTER
INTERVENTIONS AND BETTER
ANALYSIS OF RISK AND SUPPORT FOR
THE FUTURE.
SO WE'RE VERY EXCITE BESIDE THIS
PARTNERSHIP AND WE LOOK FORWARD
TO PARTNERING AND WE'D LOVE NIH
TO BUILD A FLOOR ABOVE US AT THE
SITES WE'RE MOVING INTO.
WE CAN HAVE SHARED FACULTY
MENTORS, CLINICAL AND BASIC
PARTNERSHIPS.
WE CAN PROVIDE CLINICAL EXPOSURE
OF OPPORTUNITIES FOR SHARED
RECRUITS.
PHYSICIAN-SCIENTIST SURGEONS AT
THE NIH NEED CLINICAL OPERATING
TIME AND CAN WE PROVIDE THAT
THROUGH UNIQUE PARTNERSHIPS?
THE NIH CAN PROVIDE ACCESS TO
FUNDS FOR PROTECTED TIME,
TECHNOLOGIES, FACULTY POSITIONS
FOR SUCCESSFUL TRAINEES AND SO
I'LL END WITH HOW DO WE CREATE
SUCH PROGRAMS THAT FUND THIS AND
BREAKDOWN OUR EXISTING
REGULATORY BARRIERS TO SUCH
PARTNERSHIPS?
AND THEN I'LL CONCLUDE JUST WITH
A POINT OF OPTIMISM AND A CALL
FOR ACTION, WE LIVE IN JUST THE
ABSOLUTE MOST EXCITING PLACE TO
BE AND THAT'S ACADEMIC MEDICAL
CENTERS AND WE ARE SORT OF
HAVING THE RESPONSIBILITY IN THE
PRIVILEGE THE WAY THE NIH
CONFRONTED OF AIDS EPIDEMIC AND
THE EPIDEMIC DEVELOPING RNA
VACCINES AND THE WAY WE ADD
MARYLAND WE AT THE TIMED 20% OF
ALL THE CITIZENS THAT WERE
TESTED IN THE STATE OF MARYLAND
AND WE WERE THE FRONTLINES AND
OUR ERs, OUR CLINICS, OUR
HOSPITALS, OUR ICU AND WHAT ARE
THE GENERATIONAL CHALLENGES FACE
OUR YOUNG PEOPLE AND BECAUSE
THIS IS WHAT WE INSPIRE THEM
WITH AND I THINK IN OF THESE ARE
LISTED HERE AND THE OBESITY AND
METABOLIC SYNDROME EPIDEMIC LIKE
SMOKING AFTER WORLD WAR II.
A WARM CONNECTED WORLD WITH
EMERGING PATHOGENS AND MIKE
MICROBIAL RESISTANCE AND AGING
EPIDEMIC AND THE OPIOID AND
ADDICTION EPIDEMIC IN ALL ITS
FORMS AND THIS DISRUPTIVE
EMERGENCE OF BIG DATA
INFORMATION TECHNOLOGY AI AND
PRECISION MEDICINE AND HOW DO WE
MENTOR OUR YOUNG PEOPLE TO
LEVERAGE THE NEW TECHNOLOGY TO
ADDRESS THESE GENERATIONAL
CHALLENGES AND SO WITH THAT I'LL
STOP AND I'LL UNSHARE AND TURN
THIS OVER FOR THE NEXT 11
MINUTES WE HAVE TIME FOR
DISCUSSION, FEEDBACK AND
QUESTIONS.
>>THAT'S A GREAT CHALLENGED TO
PRESENT TO US IN TERMS OF WHAT
WE MIGHT TAKE ADVANTAGE OF.
ONE OF THE QUESTIONS THAT AGAIN
SOME OF THE PEOPLE HAVE
IDENTIFIED THEMSELVES, BUT JACK
BENNETT WANTED TO KNOW, IN TERMS
OF MENTORS, WHAT DO YOU THINK AN
IDEAL MENTOR-COMMITTEE SHOULD
BE?
SOMEONE IN THE LAB, SOMEONE
OUTSIDE THE LAB?
WHAT DO YOU NEED FOR SCIENTIFIC
AND PROFESSIONAL DEVELOPMENT?
>>Dr. Mark T. Gladwin: WELL,
I'M EMBARRASSED TO SHARE MY
PERSPECTIVES WITH Dr. BENNETT
BECAUSE HE IS OBVIOUSLY ONE OF
THE GREAT MENTORS.
I WOULD SAY THAT ONE THING WE'VE
DONE AND ENCOURAGED, THAT
ORGANICALLY YOU PROMOTED IN YOUR
FACULTY, PROMOTED AT THE NIH IN
THE CRITICAL CARE DEPARTMENT,
WAS CO MENTORSHIP MODELS.
SO WE THINK IT'S IMPORTANT TO
HAVE ONE MENTOR WHO HAS REAL
OWNERSHIP AND RESPONSIBILITY FOR
THE MENTEE.
SOMEONE WHO WILL SHARE IN THE
FINANCIAL SUPPORT AT THE LAB
LEVEL, SHARE RESOURCES, WHETHER
IT'S ON THE CLINICAL SPACE, IT'S
COORDINATORS AND IN THE BASIC
LAB AND IT'S TECHNICIANS AND
COST OF COLONIES AND MICE.
YOU KNOW, THIS IS SOMEONE WITH A
REAL COMMITMENT AND THAT IS
RESPONSIBLE FOR THE
MILESTONE-DRIVEN PROGRESS.
BUT THEN IT'S NICE TO HAVE OTHER
MENTORS.
MAYBE SOMEONE THAT MENTORS ON
THAT CLINICAL LANDSCAPE LIKE
RICHARD CANNON DID FOR ME OR
SOMEONE ALONG THE CAREER
DEVELOPMENT PATHWAY WHICH YOU
HENRY, DID FOR ME.
WHAT WE TRY TO DO IS COME UP
WITH A MENTORSHIP COMMITTEE AND
WE ASK ALL TRAINEES THAT THEY
NEEDED A STATED MENTORSHIP
COMMITTEE.
THE F32 AND K GRANTS REQUIRE A
MENTORSHIP COMMITTEE SO FOR
EXAMPLE, I MENTOR A LOT OF
PEOPLE TO Ks WITH YOU PEOPLE
ASK ME AREN'T YOU TOO BUSY TO DO
THAT SO I HAVE A CO MENTOR AND
WE ARGUE IN OUR CAREER
DEVELOPMENT PLAN HOW I'M
ABSOLUTELY COMMIT TODAY THIS
MENNITY AND I HAVE A TRACK
RECORD OF SUCCESS BUT BECAUSE OF
TIME LIMITATIONS I HAVE A VERY
ENGAGE CO MENTOR WHO IS YOUNGER,
IN THE LAB ALL THE TIME.
SO I LIKE EVEN IF YOU LOOK AT
JIM SHELLHAMMER, I WAS IN A LAB
WITH TWO FELLOWS FROM CHINA.
Dr. YAO WAS MY DAY-TO-DAY
MENTOR.
SHE TAUGHT ME EVERYTHING ABOUT
MOLECULAR BIOLOGY.
SO I SAW CAROLE THE LAB MANAGER
AND YAO AS MY CO MENTORS.
>>OF COURSE WE ENCOURAGE
EVERYBODY TO SEND IN QUESTIONS.
ANOTHER ISSUE THAT'S COME UP IS,
YOU KNOW, FELLOWSHIPS ARE SEEN
AS TWO YEARS, THREE YEARS, FOUR
YEARS, WITH ONLY A YEAR OR TWO
FOR RESEARCH.
DO WE HAVE TO RETHINK HOW WE
FUND THOSE BECAUSE YOU'VE DONE A
GREAT JOB APPLYING FOR T GRANTS
AND IT'S VERY COMPLICATED
PROCESS AND DOES NIH NEED A MORE
COMPREHENSIVE PROCESS SO IF IT''
YEAR TO GET RESEARCH TRAINING
DURING YOUR QUOTE FELLOWSHIP?
>>Dr. Mark T. Gladwin: YES SO,
THE T32 ALLOWS FOR UP TO THREE
YEARS OF SUPPORT.
AND HOWEVER, THEY'RE VERY
COMPETITIVE TO GET AND YOU DON'T
GET THAT MANY SLOTS.
SO OF COURSE TIMES, PROGRAMS
LIKE HOPKINS, THEY'RE JUGGLING
PEOPLE.
THEY'RE COVERING THEM ON A
CLINICAL SUPPORT FOR A
YEAR-AND-A-HALF AND THEN THEY
PUT THEM ON THE T SUPPORT AND
THEY DON'T HAVE ENOUGH T32 SLOTS
SO MUCH TIMES THEY'RE ONLY
GIVING PEOPLE TWO YEARS
PROTECTED TIME.
I ABSOLUTELY AGREE, IN THE
MODERN ERA, THE COMPLEXITY OF A
COMPETITIVE JCI CIRCULATION
PAPER, REALLY REQUIRES, EVEN FOR
SOME SOMEONE WITH EXTENSIVE
BACKGROUND RESEARCH EXPERIENCE
IN A BIG LAB, REQUIRES YEARS.
SO I THINK THERE'S TWO ANSWERS
TO THE QUESTION.
ONE IS YES AND WE NEED TO
PROTECT PEOPLE AND WE ALWAYS NOT
SAID THAT ONE OF THE STRENGTHS
OF OUR PULMONARY DIVISION AND
DEPARTMENT OF MEDICINE THAT WE
GUARANTEED UP TO THREE YEARS OF
REAL PROTECTED RESEARCH TIME AND
AFTER THAT, WE WOULD PUT PEOPLE
IN HIGH REVENUE CLINI CLIN ROTAS
SO THEY CAN OFFSET THEIR TIME.
THE OTHER THING IS WHILE THEY
WERE ON THE T32, WHEN THEY WERE
BOARD ELIGIBLE, THEY STILL COULD
DO TWO MONTHS OF CLINICAL WORK
TO SUPPLEMENT THEIR PAY SO WE
TRIED TO GET PAY UP TO BE MORE
COMPETITIVE BECAUSE A LOT OF
PEOPLE DON'T WANT TO DO FOUR
YEARS AT A 50 TO 60,000 SALARIES
SO YOU HAVE TO CREATE THOSE
ADDITIONAL REVENUES.
SO I THINK HAVING MORE TIME IS
VITAL.
A LOT OF BRILLIANT PEOPLE THAT
WANT TO BE PHYSICIAN-SCIENTIST
TIME OUT.
WE HAVE TO HAVE MORE TIME AND
GET THE PAY UP IN THE T32.
>>THAT'S A GOOD SEG WAY TO
STEVE HOLLAND WHO WANTS TO KNOW,
IS TRAINING TOO LONG?
BECAUSE AS YOU ARE JUST
ALLUDING, THE TIME YOU PUT IN,
THE SLOW SALARY AND UNCERTAIN
FUTURE IS VERY DAUNTING.
WHAT'S YOUR ADVICE ABOUT THAT?
>>Dr. Mark T. Gladwin: YEAH,
STEVE, GREAT QUESTION.
YOU KNOW, THIS IS REALLY
INTERESTING.
I COMPLETELY AGREE.
I WAS A SIX-YEAR MEDICINE
STUDENT LIKE AND THEY GOT RID OF
SIX YEAR MEDICINE PROGRAMS
BECAUSE WE WERE TOO IMMATURE AND
THEY WENT TO SEVEN YEARS AND WE
WERE STILL TOO IMMATURE AND
THEY'VE AGAIN TO EIGHT.
THE SIX-YEAR PROGRAM ALLOWED ME
TO MOVE QUICKLY.
I STILL WAS ABLE TO ACHIEVE
RESIDENT BUT I COMMITTED, I WAS
A RESEARCH FELLOW AND IT SEEMED
LIKE 10 YEARS AT THE NIH.
I WAS ABLE TO MOON LIGHT FOR
EXTRA MONEY WHICH I DID AT
PROVIDENCE HOSPITAL A WEEKEND A
MONTH IN WASHINGTON.
THE PROBLEM NOW IS EVERYBODY
WANTS MORE RIGOR AND TRAINING
AND THERE'S A STRONG FOCUS ON
ADDITIONADDITIONED ADVANCES TRAD
THE CARD ALG CARD OWE GEE IS PUD
TO A EXTREME.
THERE ARE CO CATS 1, 2, 3, 4 AND
MANY CARDIOLOGY FELLOWS WANT
MULTIPLE, THEY WANT TO DO MULTI
MODALITY IMAGING, THEY WANT
ECHO, MRI SO THEY DO MULTIPLE CO
CATS AND THEN THEY WANT TO DO
EXTRA YEARS.
THEY RUN OUT OF TIME TO DO
PROTECTED RESEARCH ON A T32.
EITHER WE HAVE TO PAY MORE FOR
THE T32 AND ADD THE LOAN
REPAYMENT OR EXCEL.
I TRY TO MENTOR PEOPLE IF YOU
WANT TO BE A LEADER IN
CARDIOLOGY, YOUR BEST WAY
FORWARD IS TO DO GENERAL CARDS
WITH IMAGING AND ECHO IMAGING,
ET CETERA, AND THEN GO QUICKLY
INTO THE PROTECTED CLINICAL TIME
AND GET YOUR K.
IF YOU ARE A K FUNDED
CARDIOLOGIST OR GASTRO
INTROOLOGIST OR SURGEON, YOU CAN
GET ANY JOB IN THE COUNTRY AND
PEOPLE WILL OFFER YOU 1.5 TO
2 MILLION TO START UP YOUR LAB.
IT'S COMPETITIVE NOW TO GET
CARDIOLOGY GI, SURGEONS WITH
Ks.
>>CINDY DUNBAR HAS A NUMBER OF
QUESTIONS.
ONE IS WHAT'S THE BEST TIME TO
ENGAGE STUDENTS OR RESIDENTS OR
FELLOWS IN RESEARCH SO THEY
START AT I A POSTBAC AND THEY
START THE FIRST PART OF A
MULTI-FACETED QUESTION?
>>Dr. Mark T. Gladwin: LET ME
ANSWER THAT ONE QUICK.
FIRST OF ALL, THERE IS IS DATA
ABOUT STICKINESS THAT THERE IS
DATA, I'M NOT ACTUALLY YORK HAVE
THE CITATIONS BUT THERE'S BEEN
ANALYSIS FROM HOWARD HUGHES AND
OTHER GROUPS THAT THE PREDICT OR
OF DOING RESEARCH IS ENGAGING
PEOPLE IN RESEARCH AT ALL
STAGES.
SO THAT PRE YEAR TO YEAR AT THE
NIH, SUMMER RESEARCH, BUT HAVING
SAID OF THAT, THERE'S THIS
CHALLENGE GOING BACK AND FOURTH
AND THE MOVEMENT EFFECTIVE TIME
TO DO RESEARCH IN THE FLOW IS
THE PROTECTED TIME DURING A
FELLOWSHIP.
BECAUSE YOU ARE PRETTY MATURE,
YOU HAVE COMPLETED YOUR
CERTIFICATION SO YOU CAN MOON
LIGHT, YOU CAN BE AN EARLY
FACULTY BUT YOU CAN REALLY GET
T32s FOR THOSE POSTBAC T32s
AND YOU ARE CLOSE TO THE END SO
YOU CAN GET CAUGHT UP IN THAT
EXCITEMENT.
THE MD-PH.D, NOT ALL OF THEM GO
INTO RESEARCH BECAUSE THEY DO
THE MD PH.D BUT THEN THEY HAVE
AHEAD OF THEM A RESIDENCY AND
FELLOWSHIP.
THE DATA DOES SHOW STICKINESS
AND MD-PH.D, P IS STPs,
MSPPs, SUMMER ROTATIONS AND
THE OTHER THING IS EXCITE THEM
HAVING THEM GO TO MEETINGS, THEY
HAVE TO, THE MENTOR HAVE TO GIVE
THEM A LITTLE EARLY SUCCESS,
SEEN IF IT'S HELPING THEM WITH
THAT FIRST ABSTRACT SO THEY GET
TO GO TO THAT MEETING.
>>THERE'S SEVERAL QUESTIONS AND
WE'LL MAKE THESE THE LAST.
YOU MENTIONED YOUR VERY CREATIVE
PROGRAM.
YOU SEE SOME MD-PH.D AND SOME
MDs WHO GET BURPED BURNED OUT D
DON'T WANT TO ENGAGE.
ANYTHING MORE TO SAY OTHER THAN
YOU CREATED A WELL-FUNDED
PROGRAM AND NOT EVERYBODY I CANO
THAT?
>>Dr. Mark T. Gladwin: SO
OBVIOUSLY THERE'S PASSION AND
AMBITION, RIGHT.
YOU HAVE TO HAVE THAT PASSION
AND AMBITION THAT ALL OF YOU
HAVE.
I DO THINK THIS RESILIENCE IN
GRIT, THE CLINICAL WORLD SO
SUPPORTIVE.
YOU GO INTO THE ICU AND PATIENTS
LOVE YOU AND YOU SEE IMMEDIATE
RESULTS AND RETURNS ON
INVESTMENTS.
YOU ARE A LEADER AND THEN YOU GO
TO THE LAB AND AS YOU KNOW, I
JUST PUT IN AN RO1 RENEWAL AND
DIDN'T GET IT.
IT'S ALWAYS EVERY PAPER YOU
SUBMIT GETS PEER-REVIEWED AND
YOU ARE CHALLENGED AND THE
NATURE OF SCIENCE IS TO
CHALLENGE.
I DO THINK THAT THE THING WE DID
WITH THE BURROWS THE COACHING IS
INTERESTING.
MORE AND MORE PEOPLE ARE TAKING
ON COACHING AT THE LEADERSHIP
LEVEL AND THERE'S GROUP
COACHING.
SO THAT WAS ONE THING WE DID TO
TRY TO HELP PEOPLE TO PREPARE
FOR THAT RESILIENCE AND HOW DO
YOU DEAL WITH THAT REJECTED
PAPER AND THAT REJECTED GRANT
AND A LOT OF PEOPLE STRUGGLED
WITH OCD, ADHD, A LOT OF OUR
MOST SUCCESSFUL PEOPLE HAVE
THOSE THINGS.
SO, I THINK THIS IDEA OF
COACHING AND RESILIENCE SHOULD
BE ADDED.
THANK YOU SO MUCH THESE ARE
GREAT QUESTIONS AND I WISH I
COULD STAY FOR ANOTHER HOUR AND
ANSWER THEM ALL AND I KNOW WE'RE
RUN A TIGHT TIMELINE BUT THANK
YOU.
>>THANK YOU SO THE AUDIENCE FOR
BEING SO ENGAGE AND WE LOOK
FORWARD TO SEEING MARK A LOT
MORE ON CAMPUS.
THANK YOU, VERY MUCH, EVERYBODY.