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 WELCOME TO THIS MONTH'S GREAT TEACHER'S GRAND ROUNDS. OUR SPEAKER IS DR. EMMA MEAGHER, A SENIOR ASSOCIATE DEAN FOR CLINICAL RESEARCH AT THE PEARLMAN SCHOOL OF MEDICINE AND ASSOCIATE VICE PRO HOST AT THE UNIVERSITY OF PENNSYLVANIA IN PHILADELPHIA. COMPLETED HER INTERNSHIP AND RESIDENCY IN INTERNAL MEDICINE AT UNIVERSITY COLLEGE, IRELAND, 1991. POST GRADUATE TRAINING IN CARDIOLOGY AND PHARMACOLOGY AS A SENIOR LECTURER IN CARDIO VASCU BURGLAR MEDICINE IN THERAPEUTIC THERAPEUTI CS IN DUBLIN IN 18994. SHE DIRECTS THE PEARLMAN SCHOOL'S PHARMACOLOGY COLUMN, AND PROGRAM DIRECTOR FOR TRANSLATIONAL RESEARCH IN WHICH INVESTIGATORS STUDY THE COMPLEX ISSUES ASSOCIATED WITH CONDUCTING SOUND, TRANSLATIONAL SCIENCE. ALSO THE COPRINCIPLE INVESTIGATOR OF THE UNIVERSITY OF PENNSYLVANIA CLINICAL AND TRANSLATIONAL SCIENCE AWARD, POSTS THE DEVELOPMENT OF TRANSLATIONAL THERAPEUTICS. IN HER ROLE, HER RESEARCH INTEREST INCLUDES NOVEL THERAPEUTICS, AND CLINICAL PRACTICE FOCUSES ON CARDIOVASCULAR RISK MODIFICATION WITH AN ELSON MANAGEMENT OF DYSLIPIDEMIA, HYPER TENSION IN WOMEN'S COVEN HEALTH. AN ACTIVE MEMBER OF THE BOARD OF DIRECTORS AND CHAIR OF THE ORGANIZATION'S EDUCATION MENTORING COMMITTEE. IN APRIL SHE WILL BECOME THE PRESIDENT ELECT OF THE ASSOCIATE. THE RECIPIENT OF MANY AWARDS INCLUDING THE LYNN BACK FOUNDATION AWARD FOR DISTINGUISHED TEACHING IN 2005, ROBERT DID YOU KNOWING AWARD FOR EXCELLENCE IN 2010, BOTH FROM THE UNIVERSITY OF PENNSYLVANIA. AN RECEIVED THE ASSOCIATION OF MESH MEDICAL COLLEGE ROGER GLAZE YOU ARE DISTINGUISHED TEACHING AWARD IN 2014. NATIONAL RECOGNITION FOR SIGNIFICANT CONTRIBUTIONS TO MEDICAL EDUCATION. IN 2006 INDUCTED IN THE NATIONAL MEDICAL HONOR SOCIETY. SO IT'S MY GREAT PLEASURE TO WELCOME DR. MEAGHER, LECTURE ENTITLED JOYS OF DISCOVERY. [APPLAUSE] >> GOOD AFTERNOON. AND THANK YOU VERY MUCH FOR THE INVITATION TO COME HERE THIS MORNING. I'VE WORKED WITH FRED SEVERAL PROJECTS OVER THE YEARS AND I COULDN'T ASK FOR A NICER COLLABORATOR TO WORK WITH, SO IT'S A REAL HONOR FOR ME TO BE HERE AND TO HAVE THE OPPORTUNITY TO SPEAK WITH ALL OF YOU. THIS MORNING, I MET WITH A BUNCH OF INCREDIBLY INNER JETIC -- I CAN SEE SOME OF THE FACES HERE, MEDICAL STUDENTS TAKING A YEAR TO REALLY PURSUE THE VOWS OF DISCOVERY AND IF THERE IS ANY PART OF MY JOB THAT I MIGHT LIKE A LITTLE BIT MORE THAN ANYTHING ELSE, I HAD FUN THIS MORNING. THANK YOU VERY MUCH FOR YOUR TIME, ATTENTION, AND GREAT QUESTIONS. I WISH YOU ALL THE VERY BEST IN YOUR CAREER TO COME. I THINK THAT AS I REFLECT BACK ON THE FIRST STAGE OF MY CAREER, I'D LIKE TO SAY I'M NOWHERE NEAR DONE. I HOPE THAT I WILL BE LUCKY ENOUGH TO CARRY THAT THROUGH. I THINK THE ONE THING THAT I WOULD PREFACE ANY COMMENTS THAT I MAKE TODAY, I HAVE NO IDEA I WILL BE DOING WHAT I'M DOING TODAY WHEN I STARTED OUT NOW, I HATE TO ADMIT THIS, NEARLY 30 YEARS AGO. THAT'S THE FUN THING ABOUT THE OPPORTUNITIES THAT ARE PRESENTED TO US THROUGHOUT OUR CAREER, AND IT'S WHETHER WE HAVE THE GUMPTION TO TAKE HOLD OF THOSE TUNES AND RUN WITH THEM. SO WHAT I THINK I WOULD LIKE TO TRY TO DO IS WEAVE A STORY HERE OF JUST ONE PATHWAY, ONE APPROACH TO A CAREER BUT FOCUS ON THIS IDEA OF TRANSLATIONAL SCIENCE AND THE OPPORTUNITIES THAT IT PRESENTS FOR US AS A GROUP OF INNOVATORS. AND IF YOU THINK BACK OVER THE PAST DECADE THE TERM TRANSSATIONAL SCIENCE DIDN'T EXIST. MAYBE 7 YEARS TIM GEITHNER AFC PATIENT ORIENTED -- YEARS AGO IT WAS PATIENT ORIENTED RESEARCH. PEOPLE WOULD SAY WHAT IS THAT? THEN ALONG CAME TRANSLATIONAL SCIENCE, AND PEOPLE SAID WE'VE BEEN DOING THIS ALL OUR LIVES. WHY PUT A NAME TO IT? IN THE ENVIRONMENT WHERE DISCOVERY IS OCCURRING INCREASINGLY FREQUENTLY WITHIN THE ACADEMY AND ASSOCIATED AREAS, AND THERE IS BALANCE IN DISCOVERY BETWEEN THE FOR PROFIT AND NOT FOR PROFIT SECTORS. AND ALONG WITH THAT COMES AN OPPORTUNITY FOR US TO PREPARE THE NEXT GENERATION OR THE NEXT WORKFORCE THAT IS GOING TO BE ABLE TO CARRY DISCOVERY THROUGH TO FRUITION, WITH THE ULTIMATE SHARED GOAL OF IMPROVING THE HUMAN CONDITION. ABOUT 7 YEARS AGO, A LITTLE BIT SHY OF 7 YEARS AGO, I WAS PART OF A STRATEGIC PLAN FOR THE UNIVERSITY OF PENNSYLVANIA WHERE WE HAD A CONVERSATION AROUND WHAT WAS THE DIRECTION THAT WE WANTED TO GO IN. AND THIS SORT OF CAPTURES IT ALL. WHEN WE CAME TO A CONCLUSION THAT WE WANTED OUR SWEET SPOT TO BE TRANSLATION FROM BENCH TO BEDSIDE, THAT THAT WAS A PRIMARY FOCUS OF OUR ENDEAVORS WHICH, FOR SOMEBODY LIKE ME WHO HAS MIXED ARENA OF WORK FOR A LONG PERIOD OF TIME WAS MUSIC TO MY EARS. I SAW UNBELIEVABLE POTENTIAL FOR ACTIVITIES THAT WOULD BRING ALL OF OUR INVESTIGATIVE COMMUNITIES TOGETHER. AND I THINK THE SORTS OF QUESTIONS THAT WE ASK AND CERTAINLY WE ENCOURAGE OUR TRAINEES TO ASK, IS WHAT ARE WE DOING? WHAT ARE WE DOING IT, HOW DO WOE DETERMINE WHETHER WE'RE SUCCESSFUL? AND THE ANSWER TO THAT QUESTION IS HIGHLY INDIVIDUAL. SO I'M NOT GOING TO EVEN TRY AND ADDRESS ONE AND TWO BECAUSE IT'S GOING TO BE DIFFERENT FOR EACH OF YOU, AS YOU CAN CONSIDER DIFFERENT ATTRIBUTES OF SUCCESS. BUT WHAT I AM GOING TO TRY TO ADDRESS THE LATER 2, WHAT ARE THE DETERMINANTS OF SUCCESS, AND HOW CAN WE AS MAYBE THE MID CAREER OR SENIOR CAREER INDIVIDUALS FORMULATE WHAT SUCCESS OR OPTIMIZING WHAT SUCCESS WILL LOOK LIKE FOR THOSE STILL IN THEIR TRAINING PERIOD. SEVERAL YEARS AGO I WORKED WITH A GROUP OF MY CREEINGS FROM SEVERAL CTSA INSTITUTIONS TO DO AN EVALUATION OF WHAT DETERMINANTS OF SUCCESS WERE, RECOGNIZING THAT IT IS A HIGHLY NEBULOUS TOPIC, VERY DIFFICULT TO PUT PARAMETERS AROUND. AND THAT THE COALITION OF ALL OF THE -- COALITION OF ALL THE LITERATURE AS WELL AS THE RESPONSES THAT WE RECEIVED TO A SURVEY WAS THAT IT. COMPASSES EVERYTHING PURCHASE LOGIC WOULD LEAD YOU TO BELIEVE. THAT THE DEGREE OF TRAINING AND EDUCATION IS A VERY STRONG PROCEED DEATHER OF SUCCESS. PREDICTOR OF SUCCESS. PERSONALITY TRAITS, SOMETHING THAT WE SPEND MORE TIME DOING SELF-REFLECTION UPON, IS HUGELY PREDICTIVE OF OUTCOME. I DON'T THINK THERE IS ANYBODY IN THIS ROOM WHO WOULD NOT IDENTIFY WITH EACH OF THESE PERSONALITY TRAITS, WHETHER YOU'RE AN MENTOR OR PLENTY, THERE THE MENTOR PERSPECTIVE, WE SPEND A LOT OF TEAM WORKING WITH OUR TRAINEES TO SAY STAY FOCUSED, BE DELIBERATE, BE DETERMINED, BE THOUGHTFUL MUCH BE ANGEL, BE AMBITIOUS, BE INNOVATE. ALL THOSE TERMS YOU SAY WHAT DOES THAT MEAN? SO CONCEPTS AROUND PERSONALITY TRAITS ARE HARD TO PUT MEAT TO, AND WE HAVE TO STRUGGLE TO WORK WITH THEM. AS A WOMAN IN ACADEMIC MEDICINE I WOULD SAY THAT PERSONAL CIRCUMSTANCES, SOMETHING THAT IS OFTEN NOT PAID ENOUGH ATTENTION TO. LIFE HAS AN UNCANNY HABIT OF GETTING IN THE WAY OF SCIENTIFIC DISCOVERY. AND HAVING OUR EYES WIDE OPEN TO THE POTENTIAL CREATIVE WAY IN WHICH WE CAN ADDRESS PERSONAL SEARCHINGS, TO OUR ADVANTAGE, AND STILL ALLOW US TO BE SUCCESSFUL, IS AN ACTIVITY THAT REQUIRES DELIBERATE ACTION ON THE PART OF MENTEAS, BUT SO, SO, SO MUCH MORE IMPORTANTLY, OPPART OF US AS MENTORS. ON THE PART OF US AS MENTORS. WE WOULD BE REMISS NOT TO MENTION THE INPUT OF ENVIRONMENTAL DETERMINANTS OF SUCCESS. THIS IS PROBABLY WHERE I SPEND MOST OF MY TIME. EXAMINING WAYS IN WHICH AN INSTITUTION CAN FOSTER THE DEVELOPMENT OF THE MEMBERS OF THE ACADEMY. AND FOCUSING OUR EFFORTS PRIMARILY ON THOSE WHO ARE IN THE EARLIER STAGES OF CAREER DEVELOPMENT. AND THERE ARE 3 PRIMARY AREAS THAT ARE WORTHWHILE SPENDING SOME TIME THINKING ABOUT. THE FIRST OF THESE IS THE QUALITY OF THE MENTORING THAT WE PROVIDE TO OUR TRAINEES. THOSE OF YOU OF THE SAME VINTAGE AS ME, OR OLDER, WILL REMEMBER THAT IT WAS HAPPEN STANCE, THAT EVERYTHING OCCURRED SERENDIPITOUSLY. THERE WAS A PRETTY HIERARCHICAL NATURE TO MOST OF THE MENTORING RELATIONSHIPS, NOT THAT THAT HAS DISAPPEARED COMPLETELY. BUT I THINK WE RECOGNIZE THAT TO BE AN EFFECTIVE MENTOR MAY NOT COME NATURALLY TO A LARGE NUMBER OF US. AND REALLY CULTIVATING MENTORING SKILLS DOES HAVE MEANING AND DOES HAVE VALUE. THE OTHER PART THAT'S IMPORTANT IS RECOGNIZING THAT IT'S IMPORTANT FOR US AS AN INSTITUTION TO RECOGNIZE PEOPLE WHO EFFECTIVELY MENTOR. AND THOSE WHO MAYBE COULD DO SOME IMPROVEMENT IN THEIR SKILLS A TRICKY SUBJECT MATTER TO ADDRESS IN ANY ENVIRONMENT. BUT RECOGNIZING IS THE FIRST STEP THERE. FUNDING, MARKET FORCES ARE EXEXTRACT IN THEIR ABILITY TO RERODE FOCUSED DETERMINATION AND COMMITMENT. INFRASTRUCTURE IS CRITICALLY IMPORTANT, ESPECIALLY WHEN WE THINK ABOUT TRANSLATIONAL SCIENCE, PARTICULARLY IN THE NONPROFIT AREA. SO I'D LIKE TO DISTILL FROM TWO PERSPECTIVES. WHETHER YOU'RE SITTING IN THIS AUDIENCE AS A TRAINEE, OR WHETHER YOU'RE SITTING IN THE AUDIENCE AS SOMEBODY WHO -- ENABLES THE SUCCESS OF YOUR TRAINEE, I'D LIKE TO BE SOMEWHAT SYMP INDIANAPOLISIC IN MY -- SIMPLETIC IN MY VIEW. THIS MAY COME FROM MY IRISH HERITAGE. WE NEED TO BE CRYSTAL CLEAR WHEN WE'RE TRANSMITTING TO OUR TRAINEES WHAT IT IS WE'RE UNTIL LAW TRAINING -- ACTUALLY TRAINING THEM FOR. AND HAVING A SENSE OF THE HETEROGENEITY OF THE EXPERIENCES THAT TRAINEES WILL HAVE IN THE FUTURE. IF WE'RE GOING TO CREATE A FORM OF STRUCT, WHICH IS BEAUTIFUL -- HAS BEEN BEAUTIFULLY ACHIEVED HERE WITHIN THE CLINICAL CENTER, AROUND THE MORE APPRENTICESHIP MODEL, WITHIN THE LAB ENVIRONMENT, THEN WE NEED TO DEFINE WHAT THE COMPETENCIES OF A WELL TRAINED INDIVIDUAL MIGHT BE. AND HAVING DONE THAT, THEN WE NEED TO CULTIVATE THE TRAINING PROGRAM AND SUPPORT THAT TRAINING PROGRAM SO IT ENGENDERS THE SUCCESS OF THE PARTANTS. WE NEED TO FUND THOSE EXPERIENCES SO EDUCATIONAL DEBT DOESN'T CONTINUE TO SKYROCKET. WE NEED TO PROVIDE AN INFRASTRUCTURE THAT ENABLES THE EXECUTION OF THE SCIENCE THAT WE ARE SO ARDENTLY INTERESTED IN. WE NEED TO MENTOR THOSE TRAINEES WITH HIGH QUALITY MENTORING, AND ADDRESS SITUATIONS THAT NEED TO BE ADDRESSED IN A TIMELY MANNER. THEN WE NEED TO DO A VERY GOOD JOB OF SELECTING THE TRAINEE, WHICH IS SOMETIMES MORE CHALLENGING THAN WE MIGHT ANTICIPATE. FROM THE TRAINEE'S PERSPECTIVE, I THINK EYES WIDE OPEN IS A VERY GOOD PHILOSOPHY. GOING INTO THE EXPERIENCE, SOMEHOW KNOWING SOMETHING OF WHAT YOU DO BUT RECOGNIZING THAT YOU CAN'T KNOW EVERYTHING. THAT'S WHY YOU'RE A TRAINEE. THINKING HOW YOU PLAN OUT YOUR CAREER AND SEEKING OUT THOSE RESOURCES, I CAN'T TELL YOU HOW MANY TIMES I SPEAK WITH TRAINEES AND THEY'RE SO RETICENT TO APPEAR PUSHY OR FOURTH COMING OR FORWARD. THEY'RE LYING TO BALANCE THAT -- TRYING TO BALANCE THAT DELICATE DANCE FOR A FAVORABLE OUTCOME FOR BOTH THE MENTOR AND MEANTTY. LEARNING YOUR ENVIRONMENT, TAKING RESPONSIBILITY, HAVING AN INWARD LOOKING CONCEPT OF I AM RESPONSIBLE. THAT IT'S SELF-DETERMINATION. BEING AWARE OF THOSE CONCEPTS. THAT ALLOWS FOR A PRETTY GOOD FUNCTIONAL RELATIONSHIP BETWEEN YOUR INSTITUTION AND AS THE TRAINEE. I'M GOING TO SPEAK PRIMARILY NOW TO THE INSTITUTION. I WILL RETURN TO THE TRAINEE TOWARD THE END. MY RESPONSIBILITY FOR 15 YEARS HAS BEEN WORKFORCE DEPARTMENT WITHIN PEN NON LIFE THREATENING INJURIES. WE HAVE FOCUSED ON -- PENN. WE HAVE FOCUSED ON THIS THROUGH A VARIETY OF DIFFERENT APPROACHES. I'M ONLY GOING TO FOCUS ON THIS AREA HERE, BUT LEST THE OTHERS BE FORGOTTEN, THEY'RE EQUALLY IMPORTANT. INNOVATION NEEDS TO BE TRANSLATED INTO CLINICAL CARE. SO THE ENTREPRENEURIAL ASPECTS OF SCIENCE ARE SOMETIMES LEFT UNTIL IT'S TOO LATE TO DISCUSS. FOCUSING ON ENTREPRENEURIALIAL SCIENCE AS A TRAINING VEHICLE IS SOMETHING WE'RE SPENDING A LOT OF TIME DOING. RECOGNIZING THAT EVERY INTERVENTION INHUMANS IS REGULATED BY SOMEBODY AND SOME LAND MASS SOMEWHERE AROUND THE GLOBE. HAVING A KNOWLEDGE OF WHAT REGULATORY AGENCIES ARE LOOKING FOR, AND INCORPORATING THAT IN YOUR SCIENTIFIC PROPOSALS ARE GOING TO SAVE YOU A LOT OF WASTED TIME AND CERTAINLY A LOT OF SLEEPINESS NIGHTS. I AM GOING TO FOCUS PRIMARILY ON THE TRANSLATIONAL SCIENCE PIECE HERE. SO I'VE TOLD THIS STORY TO THE STUDENTS THAT I MET WITH THIS MORNING AND I'M GOING TO FOR FEAR OF BOREDOM REPEAT IT BRIEFLY. I CAME TO PENN IN 1994. I WAS THROUGH A WHOLE SERIES OF INTERVIEW PROCESSES IN 1993. THERE IS ONE INTERVIEW THAT STANDS OUT IN MY MIND, WITH MY DEPARTMENT CHAIR, VERY PLEASANT CONVERSATION. NONE OF WHICH I REMEMBER EXCEPT FOR THE LAST STATEMENT THAT HE MADE WHICH WAS YOU WILL BE SCUFFLE AT PENN IF YOU MAINTAIN A PORTFOLIO OF 2, RO16789s, A PPG, CLINICAL PRACTICE, AND EDUCATION PROGRAM AND YOU COVER YOUR SALARY 100%, YOU WILL DO VERY WELL AT PENN. AND I SAID THANK YOU VERY MUCH, THAT SOUNDS WONDERFUL. AND I LEFT THE ROOM, AND I -- MY MENTOR, I WAS MEETING HIM FOR DINNER THAT NIGHT. HE SAID HOW DID THAT GO? I HAVE ABSOLUTELY NO IDEA WHAT HE SAID. SO I CAME TO PENN AS A VERY HIGHLY TRAINED CLINICIAN. THERE IS ONE THING ABOUT THE EUROPEAN SYSTEM IS YOU LEARN TO BE A GOOD DOCTOR. AND I FELT VERY CONFIDENT ABOUT BEING A CARDIOLOGIST. I TRAINED IN INTERVENTIONAL CARDIOLOGY. BUT I KNEW I DIDN'T WANT TO BE 100% CLINICAL. I HAD DONE 2 YEARS AS A POSTDOCTORAL FELLOWSHIP IN CLINICAL PHARMACOLOGY AND I LOVED THE ALIGNMENT OF DRUG DEVELOPMENT FOR CARDIOVASCULAR DISEASES AND CLINICAL PHARMACOLOGY, A MARRIAGE OF THE MINDS FOR ME. I HAD THAT OPPORTUNITY. I HAD NO IDEA HOW I WAS GOING TO EXECUTE THAT. IT WAS THE FIRST TIME I PULLED MYSELF UP SHORT AND SAID MAYBE I CAN'T DO THIS. ONE OF THE THINGS THAT WAS CLEAR TO ME WAS I NEEDED TO LEARN QUICKLY AND NEEDED TO LOOK AS IF I KNEW WHAT I WAS DOING. THAT'S SOMETIMES A HARD THING TO PULL OFF, IGNORANCE CAN BE VERY DANGEROUS IN AN ACADEMIC ENVIRONMENT. SO WE SET ABOUT CREATING AN EDUCATION PROGRAM. THE FOCUS OF THAT PROGRAM HAS ALWAYS BEEN ON WHAT I WISHED I HAD KNOWN WHEN I STARTED IN MY FIRST ACADEMIC POSITION AT PENN. THE ONLY REASON I SHARE THAT, SOME SAY WHY WOULD YOU SHARE THAT? THAT MAKES YOU LOOK LIKE AN TOTAL IDIOT, YES, I WAS A TOTAL IDIOT. SOMETIMES IT'S OKAY TO OWN YOUR IGNORANCE AND THINK ABOUT HOW YOU CAN PREVENT PEOPLE WHO FOLLOW YOU FROM EXPERIENCING THAT FEELING OF BEING AT SEA. SO OUR MASTER'S PROGRAM IS NOW 12 YEARS IN ITS EXISTENCE. WE STRUCT MUCHED IT AS A FORMER DEGREE PROGRAM. HOWEVER, THE PRIMARY PRINCIPLE BEHIND THE PROGRAM IS LIMIT THE COURSE WORK, THE AMOUNT OF TIME IN THE CLASSROOM. EVERYTHING IS FOCUSED AROUND EXPERIENCAL EXPOSURES, PRIMARY THESIS PROJECT TYPICALLY TAKES 2 IF NOT 3 YEARS. AND WE INBED INTO THAT, AND THIS IS NOT DISSIMILAR FROM THE APPROACH HERE WITHIN THE CLINICAL CENTER, UPON A CAREER DEVELOPMENT PROGRAM WHICH HAS BECOME PROBABLY THE PART THAT THE STUDENTS VALUE THE MOIST. AND A VERY RIGOROUS MENTORING PROGRAM WHERE WE HAVE ACTUALLY CULTIVATED THE MENTORING SKILLS OF THE MENTORS, AND THE PLENTY SKILLS OF THE TRAINEES. THAT'S SOMETHING THAT WE'VE SHIFTED OUR FOCUS ON MORE RECENTLY. NOW, THAT WE'LL NEVER HAVE MORE THAN 7 LINES ON A SLIDE I AM BREAKING THAT RULE. THIS IS TO GIVE PROCEDURE A SENSE OF THE SPECTRUM OF THIS COURSE ROOM, THERE ARE MULTIPLE DIFFERENT FACTS. DEPENDING ON THE AREA OF EMPHASIS. YOU CAN FOCUS MORE ON REGULATORY, ON THE ENTREPRENEURIAL SCIENCE OR STRAIGHT FORWARD HARD SCIENCE. THE STUDENTS CHOOSE WHICH DIRECTION THEY GO IN. WE STRUGGLED FOR A WHILE IN TRYING TO DECIDE WHETHER THE LEARNING ENVIRONMENT FOR PREDOCTORAL STUDENTS IS MUSHABLY DIFFERENT THAN -- MEASURABLE DIFFERENCE FROM POST DOCTORAL STUDENTS. WE CAME TO THE STUDENTS WE WOULD PUT THEM ALL TOGETHER. THIS DEGREE PROGRAM ACCEPTS PREDOCTORAL STUDENTS, MOST COMMONLY MEDICAL STUDENTS WHO ARE TAKING TIME OFF FROM MEDICAL SCHOOL AND THEN POST-DOCS WHO WERE Ph.D.s OR MDs WHO HAVE FINISHED THEIR COLUMN TRAINING. WE ACCEPT ON AVERAGE 20 STUDENTS PER YEAR. AND WE HAVE CREATED A FUNDING ALGORITHM THAT ENSURES THAT THE STUDENTS ARE DEBT-FREE. THEY ARE NOT REQUIRED TO PAY OUT OF POCKET FOR THE PROGRAM. THIS GIVES I DON'T YOU A FEEL OF THE STUDENT BODY. IT COMES PRIMARILY FROM ALL OF THE DEPARTMENTS ACROSS THE CAMPUS. WE HAVE A GEOGRAPHIC PROXIMITY TO THE CHILDREN'S HOSPITAL, SO WE HAVE A LOT OF PAEDIATRIC TRAINEES IN THE PROGRAM AS WELL. YOU WILL SEE THAT THE VAST MAJORITIES ARE MDs, EVEN TO WE HAVE A GROWING NUMBER OF STUDENTS THAT ARE Ph.D.s. THESE PEOPLE HAVE DONE VERY BASIC BENCH WORK AND WANT TO MOVE THE TRANSLATION OF THEIR DISCOVERY DURING THE CLINIC, OR MD Ph.D. WHO'S Ph.D. WAS IN THE DISTANT PASS OR NOT ALIGNED WITH THE TRANSLATION INTO THE HUMAN CONDITION. SO A BROAD ARRAY OF STUDENTS. IF WE THINK ABOUT THE OUTCOMES OF THESE STUDENTS, METRICS OF SUCCESS AND ACADEMIA ARE PRETTY HARSH. PUBLICATIONS, GRANTS, ACADEMIC APPOINTMENTS, NATIONAL RECOGNITION. THE TYPICAL METRICS FOR ACADEMIC SUCCESS. AND IN THIS PROGRAM, WE HAVE ACTUALLY BEEN VERY SUCCESSFUL SO WE HAVE, OF THE TOTAL NUMBER OF STUDENTS WHO APPLY FOR CAREER, NIH CAREER DEVELOPMENT AWARDS, SUCCESS RATE IS IN EXCESS OF 80%. AND THIS IS NOT BY CHANCE. THESE STUDENTS ARE VERY FOCUSED AND PREPARED FOR THEIR GRANT SUBMISSION. HOWEVER, OUR STUDENTS DON'T RELY ENTIRELY ON NIH FUNDING TO SUPPORT THEIR CAREERS AFTER THEY LEAVE THE PROGRAM, THERE IS A [INDISCERNIBLE] FUNDING MECHANISM THAT HELPS SUPPORT THES THE. THE VAST MAJORITY STAY IN ACHEDIA. ALTHOUGH I WILL TELL YOU THAT MORE RECENTLY WE'RE SEEING AN INCREASING NUMBER OF STUDENTS ARTICULATING AN INTEREST TO HEAD TOWARD BIOTECHNOLOGY OR TRADITIONAL PHARMACEUTICAL COMPANIES. OUR POST-DOCS, THE OUTCOMES -- SORRY, PREDOCTORAL STUDENTS THAT MAKE UP ABOUT 20% OF THE TOTAL STUDENT BODY, TOO EARLY TO SAY. THEY'RE STILL IN THEIR RESIDENCY PROGRAM OR THEIR FELLOWSHIP PROGRAM. IN TERMS OF FUNDING, WE HAVE A NIH CAREER DEVELOPMENT AWARD CALLED THE KO2 AWARD WITHIN THE CTSA NETWORK, AND THEN WE HAVE 3 OTHER K12 AWARDS WHICH ARE INSTITUTIONAL CAREER DEVELOPMENT AWARDS. THESE SUPPORT 75% OF TRAINEES SALARIES WITH AN AN SILLRY FUND OF $25,000 A YEAR FOR UP TO FIVE YEARS FOR EACH STUDENT. VERY WELL FUNDED TRAINING VEHICLE. THEN WE HAVE NUMEROUS T32 TRAINING GROUNDS WHICH -- GRANTS, GEARED TOWARD PREDOCTORAL STUDENTS OR POST DOCTORAL STUDENTS. WE HAVE MANAGED BIG NEGOTIATION WIN FOR US, TO RETAIN OUR TURIGS REVENUE. OUR STUDENTS PAY TUITION, BUT WE GIVE THEM A TUITION STIPEND TO COVER THAT TUITION. 80% OF THE CHARGED TUITION GETS RETURNED BACK TO THE PROGRAM AND GETS REINVESTED AS TUITION STIPENDS FOR THE FOLLOWING COREPORT. AND THROUGH THIS AGREEMENT WITH THE UNIVERSITY, WE HAVE BEEN ABLE TO MAINTAIN THE PROGRAM FOR THE STUDENTS. THAT IS ABSOLUTELY KEY. IF WE START LOADING ON ANYMORE FINANCIAL HARDSHIP ON OUR STUDENTS IT WILL PROVIDE THE BIGGEST DISINCENTIVE FOR NIGERIAING -- FOR ENGAGING IN SCIENCE. WHEN WE THINK ABOUT THE INFRASTRUCTURE -- SO I HAVE BEEN AT PENN FOR 23 YEARS. IT HAS MORPHED OVER THAT PERIOD OF TIME. WHEN I FIRST STARTED THERE WERE BASIC SCIENCE DEPARTMENTS AND CLINICAL DEPARTMENTS AND VERY LITTLE IN THE WAY OF BRIDGING BETWEEN THE TWO. AND THAT BRIDGE HAS BUILT OVER THE LAST DECADE, AT A PRETTY SIGNIFICANT PACE. PROMPTED IN PART BY THE FACT THAT WE HAVE HAD CTSA FROM -- THAT HAS RELEASED PREVIOUSLY NCRR, REALLY SUPPORTED THE BUILDING OF THE INFRASTRUCTURE AND THE EDUCATIONAL PROGRAM. BUT I THINK THE BIGGEST IMPETUS IS SHOWN IN THIS SLIDE. AND LET ME JUST WALK YOU THROUGH THIS. THIS IS A SLIDE THAT WAS CREATED BY MY COLLEAGUE ERIC FITZGERALD THAT TRADITIONALLY PHARMA DID EVERYTHING FROM THE PRECLINICAL MOLECULE DISCOVERY RIGHT THROUGH UP UNTIL BLA OR NDA. WHAT WE HAVE WEAPONED OVER TIME -- WITNESSED OVER TIME IS THAT THE PREVIOUS RELIANCE ON ACADEMIA TO BE CONFINED TO PROOF OF CONCEPT ARE TARGET IDENTIFICATION, HAS NOW BROADENED. AND THE PLAYING FIELD HAS SIGNIFICANTLY LEVELED. AND THE NUMBER OF COMPOUNDS THAT ARE BROUGHT THROUGH TO MARKET, VERY CLOSE TO THE LATER STAGES, IN ACADEMIA, IS INCREASING. NOW, ACADEMIA DOES NOT WANT TO BE A PHARMACEUTICAL COMPANY, NOR DOES IT HAVE THE MONEY TO BE A PHARMACEUTICAL COMPANY OR A CLINICAL RESEARCH ORGANIZATION BUT IT DEFINITELY HAS THE INTELLECTUAL [INDISCERNIBLE] TO DRIVE THE INVENTION, THE INNOVATION, AND THE DISCOVERY A SIGNIFICANT LENGTH ALONG THE JOURNEY. SO WHAT WE ANTICIPATE WILL HAPPEN IN THE FUTURE IS THAT WE WILL SEE DIFFERENT LEVELS OF THIS ACTIVITY OCCURRING TO CLOSE TO AN EDEPENDING ON MONEY, IN THE NOT FOR PROFIT SECTOR. THAT IT'S WHAT WE NEED TO BE READY FOR. HOW DO YOU BUILD AN INFRASTRUCTURE? WITHIN AN ACADEMIC SETTING, THAT ACTUALLY ALLOWS THAT TO HAPPEN? AND THIS IS WHAT I SPENT THE LAST 7 YEARS OF MY PROFESSIONAL LEAF WORKING ON IN ADDITION TO THE EDUCATION, IS CREATING AN INFRASTRUCTURE THAT ALLOWS US TO DO CUTTING EDGE RESEARCH IN A COMP PRIANT WAY. REGULATIONS DON'T INTUITIVELY. THERE IS THAT ELEMENT THAT WE HAVE TO PAY ATTENTION TO AND MAKE SURE OUR INVESTIGATORS ARE PAYING ATTENTION. SO WHAT WE DID WAS WE BUILT THIS INFRASTRUCTURE, PRETTY SIGNIFICANT COST. TO ENSURE THAT WE HAD AN APPROPRIATE MONITORING AND COMPLIANCE PROGRAM, BUILD I. AT THIS MOMENT INFRASTRUCTURES THAT ALLOWED DATA SHARING ACROSS THE FIVE DIFFERENT HOSPITALS WITHIN THE PENN MEDICINE HEALTHCARE SYSTEM, SHEARING DATA FROM BIOBANKING INITIATIVES WITH OUR ELECTRONIC HEALTH RECORDS, ENSURING THAT WE'RE CAPTURING ADVERSE EVENT DATA FOR PATIENTS ENROLLED IN CLINICAL TRIALS, MAKING SURE THAT WHEN PATIENTS ARE RECEIVING CLINICAL CARE, THAT THERE IS AN APPROPRIATE LEVEL OF AWARENESS OF THE PATIENTS ENGAGEMENT. THE I.T.NIST HAS BEEN A HUGE PROCESS. -- INFRASTRUCTURE HAS BEEN A HUGE PROJECT. NEGOTIATING CONTRACTS WITH SPONSORS IS AN AREA THAT IS VERY TIME CONSUMING. MANY OF OUR FACULTY WANT TO INVESTIGATE COMPOUNDS FOR THE FIRST TIME, SO SECURING AN IND OR IDE FROM THE FDA OR SIMILAR SUBMISSIONS TO HEALTH CANADA, CHINA, FDA, ET CETERA, ET CETERA, THAT REQUIRES A LOT OF EXPERTISE. SO WE HIRED A CORE OF REGULATORY SPECIALISTS TO SUPPORT THE STAFF, THE INSTITUTION HOLDS THE INDs AND TAKES CARE OF ALL THE REGULATORY REQUIREMENTS, IS PENN IS FUNCTIONING AS A REGULATORY SPONSOR. THAT CHANGED THE LIFE OF OUR INVESTIGATORS BECAUSE THEY REALLY DON'T WANT TO HAVE TO DEAL WITH MUCH OF THE REGULATORY REQUIREMENTS. THEY WANT TO FOCUS ON THEIR SCIENCE. ENSURING THAT THE ABILITY TO PATENT, LICENSE COMMERCIALIZE, WAS IN PLACE. WE CREATED AN OFFICE FOR TECH TRANSFER. WHERE WE ACTIVELY SEEK OUT LEVEL ONE FUNDING FROM VENTURE CAPITAL FIRMS, LOOK FOR COMMERCIALIZATION OPPORTUNITIES, SEEK OUT BUSINESS PROPOSAL TO THE VIABILITY OF INDIVIDUAL PRODUCTS. THIS IS SOMETHING THAT ACADEMIA TEN YEARS AGO DIDN'T SPEND A FOCUSED AMOUNT OF EFFORT ON. I THINK MANY INSTITUTIONS ARE SIMILAR TO PENN IN TRYING TO ENABLE THE TRANSLATIONAL OF BASIC DISCOVERIES ACROSS THE DEVELOPMENT PIPELINE. AT PENN WE'RE VERY FORTUNATE. I REALLY FEEL THAT ALL THE STARS ALIGNED WHEN I HAD THAT INTERESTING CONVERSATION WITH MY DEPARTMENT CHAIR WHO IS NO LONGER AT PENN. BECAUSE THAT FOCUS IN INNOVATION HAS EVOLVED INTO THE CREATION OF MULTIPLE CENTERS THAT ARE INTENT ON DELIVERING NEW MOLECULES FOR TREATING PATIENTS WITH VARIETY OF DIFFERENT AILMENTS, AND TO GIVE YOU AN EXAMPLE, I'M SURE NONE OF THESE ARE NOT KNOWN TO YOU. THE CONSIDER FOR CELLULAR IMMUNOTHERAPY, THE CENTER FOR JEAN GENE THERAPY, WITH [LIST OF NAMES]. THE CENTER FOR ORPHAN DRUGS IS DON RADAR AND JIM WILSON. CENTER FOR PERSONALIZED DIAGNOSTICS AND PRECISION MEDICINE IS DAVID ROTH AND [INDISCERNIBLE] SO THESE ARE ALL CENTERS WITH SCIENTIFIC EXPERTISE, OPERATIONAL EXPERTISE THAT ALLOWS THE COALESCENCE OF INTERESTS AND MOTIVATION ACROSS THIS DOMAIN. WE'RE BUSY IN DEVELOPMENT PLANS FOR AN INSTITUTE FOR BIOMEDICAL DEVICES, AND AREA THAT PENN HAS NOT DEMONSTRATED ANY GREAT STRENGTH IN PREVIOUSLY, PARTICULARLY IN THE ARENA OF NANOTECHNOLOGY AND DIAGNOSTICS. THIS IS SOMETHING WE'LL BE WORKING ON FOR SEVERAL YEARS TO COME. I WANT TO SHARE WITH YOU AN EXAMPLE OF HOW THIS INFRASTRUCTURE CAN ENABLE AN ACTIVITY. THIS IS A PROJECT THAT I WORKED ON FOR CLOSE TO 20 YEARS. SO IN MY COLLABORATORS, THE LEAD SCIENTIST ON THIS PROJECT WAS DAN RADAR AND MARINA IS A CLOSE COLLABORATOR OF MINE. MY CLINICAL PRACTICE HAS BEEN IN THE MANAGEMENT OF DYSLIPIDEMIA. WE HAVE HAD A PARTICULAR INTEREST IN GENETIC FORMS, MOST NOTABLY A RARE ORPHAN DISEASE, AND WE ARE PRESENTED WITH CASES LIKE THIS OF A 28-YEAR OLD FEMALE WHO HAD CUTANEOUS XAN THIS. OMAS THAT GAME EVIDENCE AT THE AGE OF 3. OBSTRUCTIVE COACHRY ARTERY DISEASE, A BYPASS PROCEDURE AT THE AGE OF 12. AT THE TIME OF HER PRESENTATION SHE HAD LDL CHOLESTEROL OF 780-MILLIGRAMS. IDEAL IS 100. ON THE LEFT IS A PICTURE OF HER XANTHOMAS AND ON THE RIGHT IS A PICTURE REPRESENTING HER OBSTRUCTIVE CORONARY ARTERY DISEASE. WE WORKED WITH A PHARMACEUTICAL COMPANY, BRISTOL MYERS SQUIB, AND THEY HAD AN MTP INHIBITOR, AN ENZYME CRITICAL ON THE ASSEMBLY LINE FOR CHOLESTEROL SYNTHESIS WITHIN THE LIVER. THEY HAD A MOLECULE THAT INHIBITED THAT ENZYME WITH THE IDEA THAT IF YOU REDUCED THE LEVEL OF ACTIVITY OF THE INSOMETIME, THE DEGREE OF EDGE DODGEINOUS BIO SIP THEYSIS OF COLLABORATERAL WOULD DECREASE AND THE LDL CHOLESTEROL WOULD FALL. THIS IS WHEN STATIN THERAPY WAS IN FULL FLIGHT. RESIN BASED THERAPY WAS STILL BEING USED, DESPITE ALL THE ADVERSE EFFECT PROFILES WAS STILL USED IN COMBINATION THERAPY. BMS CAME UP WITH THIS MOLECULE. THE PRECLINICAL DISCOVERY WAS DOWN IN HOUSE. THEY REACHED OUT TO PENN TO PARTNER THROUGH ITS LIPID PROGRAM IN DOING A PHASE ONE STUDY TO EVALUATE THIS MOLECULE IN HEALTHY VOLUNTEERS, WENT INTO PHASE 2, DEMONSTRATED EXTREME HEPATOTOXICITY, OR I SHOULD SAY EXTREME NUMERIC TOXICITY. AND THE COMPANY MADE THE DECISION NOT TO PURSUE ANY FURTHER CLINICAL DEVELOPMENT OF THE DRUG. AT THAT TIME, WE HAD A VERY ACTIVE PROGRAM IN HOMOZYGOUS FH. OUR PROGRAM WAS WELL ESTABLISHED. WE WERE TRYING TO THINK OF WAYS THAT WE COULD GET ACCESS TO THIS COMPOUND FOR AN ORPHAN DRUG INDICATION, WHICH THE IDEA THAT -- WITH IDEA THAT IF THE PROSPECT IS A CABBAGE AT THE AGE OF 13, THEN THE RISK TOLERANCE FOR THE DRUG WAS GOING TOO MUCH HIGHER, AND WE COULD CONFINE THE USE TO THE DRUG. THAT IS ESSENTIALRY WHAT WE DID -- ESSENTIALLY WHAT WE DID. BMS SHELFED THE DEVELOPMENT IN 2000, IT TOOK US JUST SHY OF 2 YEARS TO CONVINCE THEM TO HAND OVER THE RIGHTS TO THE COMPOUND, AND THAT WE WOULD INDEMNIFY THEM AGAINST FUTURE LITIGATION RELATED TO ADVERSE OUTCOMES WITH THE DRUG. AND THEN WE SPENT, PROBABLY THE MOST EXCITING PERIOD IN MY SCIENTIFIC PURSUITS, TRYING TO FIGURE OUT HOW WE WERE GOING TO PURSUE CLINICAL DEVELOPMENT AND FOR KEEPING AN EYE ON THE CLOCK, WHAT WE ESSENTIALLY DECIDED TO DO WAS JUST PURSUE A HOMOZYGOUS FH PATIENT POPULATION, RECOGNIZING THAT IT WAS A VERY, VERY SMALL POPULATION. IN FACT THE PREVALENCE WASN'T VERY WELL DELINEATED AT THE TIME BECAUSE PEOPLE DIDN'T GO AROUND GETTING GENETIC TESTING FOR IT BECAUSE THERE WAS NO DEFINED TREATMENT MODALITY THAT WOULD RESULT. SO WE DID A SERIES OF PRETTY PIVOTAL CLINICAL STUDIES TO TRY TO CHARACTERIZE THE DEGREE OF TOXICITY ASSOCIATED WITH THAT MOLECULE. I LED THAT SERIES OF EXPERIMENTS TO LOOK TO SEE WHAT IS THE THERAPEUTIC INDEX ASSOCIATED WITH THIS MOLECULE? AND TO WHAT DEGREE CAN IT BE MODIFIED BY TWEAKING AROUND THE ADMINISTRATION, ET CETERA, ET CETERA, ALSO ALSO COMBINATION OF OTHER DRUG THERAPY. IT WAS A KEY CONCERN. WE GOT INTO PHASE 2 STUDIES IN 2003, AND -- SORRY, YES, 2003, AND DEMONSTRATED AN ACCEPTABLE SAFETY PROFILE. AND A PRETTY INCREDIBLE EFFICACY PROFILE. WE WERE TAKING PATIENTS WHO HAD LDL CHOLESTEROLS AND 300, 400, 500, 600. WE WERE DROPPING THEIR LTL CHOLESTEROLS BY 50%, NUMBERS THEY HAD NEVER PREVIOUSLY BEEN EXPERIENCING. WE WERE SEEING TOXICITY. AND WE WERE HAVING TREATMENT ALGORITHMS FOR REDUCTION IN DOSE, INCREASE IN DURATION OF DRUG HOLIDAYS, CREATIVE WAYS IN WHICH WE COULD TRY TO ENSURE ONGOING EXPOSURE TO THE DRUG. AT THAT POINT WE SUBMITTED A GRANT TO THEer PHONE DRUG PROGRAM FROM THE FDA TO GET FINANCIAL SUPPORT FOR CONDUCTING WHAT WAS GOING TO BE REQUIRED BY THE FDA TO DO A PITCHAL PHASE 3 CLINICAL TRIAL, AND THANKFULLY THE FDA DID NOT REQUIRE A CLINICAL OUTCOME STUDY IN ORDER TO DEMONSTRATE BOTH SAFETY AND EFFICACY. ONCE WE GOT INTO THE PHASE 3 CLINICAL TRIAL PERIOD, WE HAD NOW EXTENTED BEYOND THE U.S. WE HAD PATIENTS FROM SOUTH AFRICA, IN ITALY, AND WE WERE TRYING TO AMASS ENOUGH PATIENTS TO DO A YEAR LONG EXPOSURE TO THE DRUG TO BOLSTER THE AMOUNT OF SAFETY DATA. IN 2007 WE STARTED THAT CLINICAL TRIAL. WE WERE REQUIRED BY THE FDA TO DO A MINIMUM OF 26 WEEKS. WE WENT BACK TO THEM WITH OUR DATA AT THAT POINT. AND AGAIN, REPLICATING WHAT HAD BEEN SEEN PREVIOUSLY, REDUCTION IN LDL CHOLESTEROL OF ABOUT 50%. THEY REQUESTED A FURTHER SAFETY PERIOD OF A SECOND 26 WEEKS WHICH WE DID. WE DOSED PEOPLE OUT TO 56 WEEKS AND DEMONSTRATED A SUSTAINED REDUCTION. WE LOST SOME OF THE EFFECT BUT IT WAS STILL PRETTY IMPRESSIVE. AT 44% LDL REDUCTION. TO CUT A LONG STORY SHORT WE SUBMITTED A NDA TO THE AGENCY, WE GOT APPROVAL IN DECEMBER OF 2012, THEN AT THIS POINT WE HAD COMMERCIALIZED BACK THE RIGHTS TO BOY BIO TECHNICAL COMPANY, TOOK THE DRUG OVER THE FINISH LINE AND THE DRUG WAS APPROVED IN EUROPE IN 2013. FROM AN ACADEMIC PERSPECTIVE, I WOULD NEVER IN A MONTH OF SUNDAYS ANTICIPATE THAT I WOULD HAVE HAD THE OPPORTUNITY TO ENGAGE IN THAT TYPE OF ACTIVITY WITHIN AN ACADEMIC SETTING. AND I CAN TELL YOU THAT IT WOULD NEVER HAVE WORKED IF THE INFRASTRUCTURE WASN'T IN PLACE ALONG THE WAY, OR IDENTIFYING WHAT THE ELEMENTS WERE, TO ENABLE THAT TYPE OF TRANSLATION TO OCCUR IN THE ACADEMIC ENVIRONMENT THAT EXISTED AT PENN. SO I'D LIKE TO SWITCH FROM THAT AND TALK ABOUT MENTORING. THIS IS A TOPIC THAT'S DEAR TO MY HEART. I HAVE BEEN UNBELIEVABLY FORTUNATE IN THE MENTORING I HAVE RECEIVED ALONG THE WAY, AND WOULD HONESTLY SAY THAT I WOULDN'T HAVE HAD THE OUTCOME THAT I'VE EXPERIENCED IF INTO HAVE THE MENTORING THAT I HAD. AND I RECOGNIZE IT WAS COMPLETELY SERENDIPITOUS, HOW IT ALL CAME TOGETHER. SO I REALLY VALUE THE SENSE OF OPPORTUNITY. BUT THERE ARE CERTAIN PARAMETERS THAT YOU CAN PUT AROUND THAT. SO, FOR EXAMPLE, MENTORING TEAMS, THAT NO ONE INDIVIDUAL IS RELYING ON ONE INDIVIDUAL FOR THAT TYPE OF CAREER GUIDANCE, AND THE REALITY IS THAT IF YOU'RE WORKING IN THE TRANSLATION SPACE, EXPERTISE IS GOING TO BE GARNERED FROM MULTIPLE DIFFERENT CORNERS OF YOUR ENVIRONMENT. SO SEEKING OUT PEOPLE WHO CAN EFFECTIVELY PARTNER IN GUIDING YOU THROUGH YOUR CAREER BUT ALSO RECOGNIZING THAT YOU, AS AMENTA, IS TAKING OWNERSHIP. SO -- YOU, AS AMENTA, IS TAKING OWNERSHIP. WE CREATED A PROGRAM WHICH HAS BEEN VERY WELL RECEIVED. A LOT OF FACULTY HAVE COMPLETED THE MENTOR TRAINING PROGRAM. WE ARE BACK TO LAUNCH A MENTOR ACADEMY AT PENN, WHICH FINALLY WILL BE RECOGNIZED AS AN ACTIVITY ON THE PROMOTION PATHWAY AND CONSIDERATION BY OUR COMMITTEE ON APPOINTMENTS AND PROMOTIONS. THAT HAS BEEN A REALLY CHALLENGE TO ACHIEVE THAT. CREATING CLARITY AROUND EXPECTATIONS DELIVERABLES, WE'VE ACHIEVED THROUGH BOTH USE OF INDIVIDUAL DEVELOPMENT PLANS, WHICH WE'VE MADE PRETTY SHORT SO IT'S NOT JUST BUSY WORK AND PAPERWORK AND THE CREATION OF A MENTOR COMPOUND. BUT I THINK HERE IS WHERE IT'S REALLY IMPORTANT FOR PLENTIES TO APPRECIATES THEIR -- MENTEES TO APPRECIATE THEIR POSSIBILITIES IN THEIR OWN CAREER DEVELOPMENT. BEING AN EFFECTIVE MENTEE REQUIRES THAT YOU DO DIFFERENT THINGS AT DIFFERENT TIMES. I THINK THIS ARE CORE PRINCIPLES DO BEING AN EFFECTIVE MENTEE THAT ARE LISTED HERE. THE OBVIOUS ONES AND THEY CAME UP DURING BREAKFAST THIS MORNING, HOW DO YOU EFFECTIVELY COMMUNICATE WITH YOUR MENTOR? AND SOMETIMES THAT MAY BE CHALLENGING BECAUSE OF A GENERATIONAL DIVIDE, PAUSE OF CULTURAL DIFFERENCES, BECAUSE OF GENDER DIFFERENCES, WHATEVER THE REASONS ARE, IT'S ALWAYS SOLVABLE. SO RECOGNIZING THE IMPORTANCE FOR EFFECTIVE COMMUNICATION AND THEN ACTING ON BEING EFFECTIVE IN THAT REGARD. WHERE WE SEE MOST CHALLENGES ARISE IN MENTORING IS WHERE THIS IS A MISALIGNMENT IN EXPECTATIONS. SO MAKING SURE THAT THERE IS THAT ALIGNMENT AND THAT YOU AS AMENTA IS FEELING GOOD ABOUT THAT. -- YOU, AS A MENTEE IS FEELING GOOD ABOUT THAT. IF MENTORS ARE -- USUALLY A MARRIAGE OF THE MIND OCCURS. WORK LIFE INTEGRATION IS AN EXPECTATION OF THIS GENERATION. IN MY OPINION, A VERY HEALTHY EXPECTATION. THE IDEA THAT YOU CAN HAVE A SUCCESSFUL PROFESSIONAL CAREER AND COMPLETELY FULFILLING LIFE IS IMPORTANT. NOW, YOU'LL NOTICE THAT I DIDN'T SAY BALANCE. BECAUSE FOR EVERYBODY THIS IS GOING TO BE DIFFERENT. IT'S NEVER GOING TO BE AN EQUILIBRIUM. IT SHOULD BE AT A LEVEL THAT YOU'RE FEELING COMFORTABLE. WHATEVER YOUR CONTRIBUTION TO YOUR WORK IS GOING TO BE SUFFICIENT TO ALLOW YOU TO BE SUCCESSFUL WITHIN YOUR PROFESSIONAL DEVELOPMENT BUT NOT AT THE EXPENSE OF EVERYTHING ELSE THAT'S HAPPENING IN YOURUS. WE SEE BURNOUT ALL THE TIME. WE SEE PEOPLE MAKING DECISIONS TO ALTER THEIR CAREER PATHS DESPIED AN INCREDIBLE LOVE FOR SCIENCE THAT SOMETIMES CAN BE AVOIDED. SO THIS INTEGRATION OF TWO UNIVERSES FOR MANY PEOPLE IS SOMETHING THAT IS WORTHWHILE SPENDING ATTENTION TO. SOUTH AFRICA, SO THIS IS -- I'M PULLING THIS FROM THE PSYCHOLOGY LITERATURE, IT'S NOT SOMETHING THAT I WOULD SAY THAT WE HAVE USED TRADITIONALLY. IN BIOMEDICAL SCIENCES. SELF-EFFICACY IS THE IDEA OF BEING YOUR BEST ADVOCATE. PUSHING YOURSELF IN A MANNER THAT ISN'T OBNOXIOUSLY OBTRUSIVE. BUT ALLOWS YOU TO GET THE BEST OUT OF THE ENVIRONMENT THAT YOU'RE WORKING IN. AND EVERY INSTITUTION YOU WILL EVER WORK IN WILL HAVE SOME ELEMENT OF PROFESSIONAL DEVELOPMENT. IT JUST MAY NOT BE OBVIOUS TO YOU. I AM BEING PROACTIVE AND SEEKING THAT OUT. IF I LOOK BACK OVER THE LAST 30 YEARS, ACTUALLY NOT 30 YEARS, 28 YEARS. 28 YEARS, I THINK ONE OF THE THINGS THAT I DIDN'T APPRECIATE WHEN I WAS STARTING IS THAT YOU CAN CONTRIBUTE TO MULTIPLE DIFFERENT AREAS IN A PROFESSIONAL SENSE. WHEN WE THINK ABOUT MEDICAL STUDENTS PURSUING THEIR CAREER OR POST-DOCS AFTER THEIR CLINICAL TRAINING OR THE ATTAINMENT OF THEIR Ph.D., SOMETIMES YOU SHOULD STOP AND JUST SAY TO YOURSELF, HOW WOULD I REALLY LIKE TO CONTRIBUTE? AND THERE IS NO SHORTAGE OF OPPORTUNITIES. THE CHALLENGE IS THAT SOMETIMES WE HAVE A HARD TIME SAYING NO. AND WE WANT TO DO EVERYTHING. AND I'M CERTAINLY VERY GUILTY OF THAT CONDITION. TRYING TO FIND THE TIME AND BALANCE IT SO THAT YOU CAN BE EFFECTIVE IN THE DOMAINS THAT ACTUALLY MEAN THE MOST TO YOU, BUT RECOGNIZE THE AREAS WHERE YOUR CONTRIBUTIONS CAN REALLY MATTER. AND WHAT I'M SEEING INTERACTING WITH TRAINEES NOW IS TRAINEES ARE ASKING THESE DEEPS OF QUESTIONS. IN ADDITION TO BEING AN ACTIVE SCIENTIST, WHAT ARE THE OTHER ALTERNATIVE CAREER PATHS THAT COULD GIVE ME AN EQUAL DEGREE OF FULFILLMENT, THAT THIS WILL STILL HAVE EXTRAORDINARY VALUE. THIS IS NOT MEANT TO BE ALL INCLUSIVE BUT THESE ARE THE SORTS THAT I'VE DEALT WITH ALONG THE WAY. LET ME JUST FINISH WITH A RETROSPECTIVE. SO I'M ONE OF OF TEN CHILDREN. I'M THE YOUNGEST OF TEN CHILDREN. THERE ARE SEVEN FISSIONS IN MY FAMILY. MY FATHER IS 95. AND MY MOM JUST TURNED 90. I WAS HOME FOR MY -- MIFULLY LIVES IN -- FAMILY LIVES IN DUBLIN. I WENT HOME FOR MY MOM'S 90th BIRTHDAY. MY FATHER IS A TOUGH COOKIE. AND HE SAID TO ME I'M THE ONLY ONE IN THE U.S. HE SAID SO WHAT ARE YOU DOING? AND I SAID I DID A LOT OF THINGS. HE SAID THOUGH, NO, NO, WHAT ARE YOU DOING? AND HE'S ALL ABOUT ACADEMIC INTEGRITY, ACADEMIC PRODUCTIVITY. SO I TOLD HIM, I SAID -- HE ASKED DID I HAVE ANY NIH GRANTS. HI FATHER NEVER KNEE WHAT THE NIH WAS UNTIL HE CAME TO THE U.S. HE NOW HOLDS ME TO THAT STANDARD. EVERY TIME I GO BACK, HOW IS YOUR NIH PORTFOLIO? SO THIS TIME I DECIDE I WOULD ONE UP HIM. AND I SAID WELL, ACTUALLY, A GOOD FRIEND OF MINE HAS INVITED ME TO SPEAK TO TRAINEES AT THE NIH CLINICAL CENTER. WHICH OF COURSE HE HAD DONE HIS HOMEWORK. HE SAID WHAT ARE YOU GOING TO TALK ABOUT. I GAVE HIM A VIEW OF WHAT I WAS GOING TO TALK ABOUT. HE GAVE ME GREAT FEEDBACK. HE SAID -- I TOLD HIM I WAS GOING TO FINISH IT BY GIVING A RETROSPECTIVE. HE SAID GOOD GOD, CHILD. YOU'RE NOT EVEN AN OCT NO [INDISCERNIBLE]. WHICH PULLED ME UP SHORT. I'M SURROUNDED BY SO MANY YOUNG PEOPLE I CONVINCED MYSELF I'M ON THE WRONG SIDE OF THE HILL. THAT BEING SIDE, LET ME SHARE WITH YOU WHAT I THINK OF WHEN I LOOK BACK WHAT I CAN ONLY DESCRIBE AS BEING AN UNBELIEVABLY FULFILLING AND JOYFUL CAREER SO FAR. IS THAT WHEN I WENT INTO MEDICAL SCHOOL I WAS 17 YEARS OLD. IT WAS THE IRISH SYSTEM, YOU DON'T DO AN UNDER-GRADUATE DEGREE. THERE IS ANOTHER SURGEON GRADUATE HERE IN THE AUDIENCE. YOU GO IN YOUNG, PRETTYICALLY CLUELESS, YOUNGEST IN A FAMILY OFS FROM. WHAT ARE YOU GOING TO? OF COURSE YOU'RE GOING TO DO MEDICINE. THERE JUST WASN'T ANY DISCUSSION. SO I WENT INTO MEDICAL SCHOOL AND LOVED EVERYTHING, LOVED LEARNING, LOVED THE WHOLE LIFE. HAPPIEST 7 YEARS. AND THEN I LEFT AND REALIZED I BETTER GET SOME CLINICAL TRAINING. YOU GO ALONG THIS PATH. EVERYBODY DOES THE SAME THING. THERE IT'S CALLED INTERN. JUNIOR, SENIOR HEIGHT OFFICER, REGISTRY, SENIOR REGISTRAR, LECTURER, SENIOR LECTURE. LIKE HEARING CATTLE. YOU'RE DOING THAT AND YOU'RE ASKING YOURSELF WHAT'S NEXT? IS THIS REALLY WHAT I WANT TO DO? IS THIS WHAT I WANT TO TAKE ON? AND AT THAT TIME, I WAS GIVEN THIS OPPORTUNITY TO COME TO PENN. MY HUSBAND WAS A TRAINED SURGEON, ABOUT TO TAKE UP HIS FIRST JOB. AND WE CAME TO PENN FOR HIM, HE WAS GOING TO HAVE TO RETURN TO BEING A SURGICAL RESIDENT. I DON'T ACTUALLY REMEMBER, I THINK IT WAS ABOUT 37 AT THE TIME. SO WAS PREDAUNTING TASK. WE SAW THIS OPPORTUNITY OF DOING SOMETHING DIFFERENT HERE. AND WHEN I CAME, I FIRST STARTED IN THIS CONTINUING THE CLINICAL RESEARCH VAIN THAT I HAD BEEN DOING IN DUBLIN. BUT THEN I GOT A FLAVOR OF WHAT IT WAS LIKE TO BE AN EDUCATOR. AND I HAD DONE SOME TEACHING IN MY ALMA MATTER AND LIKED IT, BUT THIS WAS A WHOLE NEW LEVEL. THIS WAS LOOKING AT SOMETHING THAT WAS NOT OPTIMUM, SAYING I COULD FIX IT BY CREATING AN EDUCATIONAL PROGRAM THAT COULD HELP PEOPLE WHO WERE SIMILAR TO ME. THAT WAS SO MUCH FUN. THAT WAS THE PLATFORM WHERE I HAD THIS, YOU KNOW -- PEOPLE KEPT SAYING YEAH, TRY IT. THE ONLY PERSON WHO IS GOING TO SUFFER IF IT DOESN'T WORK IS YOU. GREAT LEVEL OF ENCOURAGEMENT. BUT IT WAS FUN. AND THEN THROUGH THAT, YOU GOT GOOD AT DOING SOMETHING. THEN IT LED YOU INTO EVERYTHING ELSE. I GOT TO A POINT WHERE I WOULD SAY MID CAREER, WHERE I WAS STRETCHED VERY THIN BECAUSE I WAS TRYING TO DO EVERYTHING, AND THEN YOU HAD TO COMPROMISE. YOU HAD TO -- SOME, HAD TO GIVE WEIGH. AND NOW MOST OF MY WORK IS PRIMARILY A LEADERSHIP ROLE. I CLOSED MY CLINICAL PRACTICE LAST OCTOBER, A VERY SAD DAY. BUT I FEEL LIKE I'VE GOT ENOUGH UNDER MY BELT THAT I'M ABLE TO HAVE SOME SORT OF IMPACT ON THE DIRECTION WE'RE GOING THERE THE WORKFORCE DEVELOPMENT PERSPECTIVE. BUT IF I COULD LEAVE YOU WITH ONE THOUGHT, AND THAT IS, REMEMBER THAT YOUR PROFESSIONAL LIFE ISN'T EVERYTHING. 24 IS A PICTURED OF MIFULLY. I HAVE TO TELL YOU THE STORY BEHIND THIS. IT'S CHRISTMAS MORNING, ABOUT 8:00 A.M. MY CHILDREN ARE 26, 25, 23 AND 22. THIS IS MY BELOVED. I HAULED THEM ALL OUT OF BED AT 8:00 IN THE MORNING. THEY'RE NOT ONE BIT HAPPY. AND TELL THEM WE'RE GOING FOR A WALK. SO THEY'RE ALL IN THEIR PJs. THIS ONE, KIA, CAMERON, THIS IS KIA, PUTS A BOW IN HER HAIR. SHE WANTS TO REMEMBER WHAT SHE WAS AWE ALLOWED TO SLEEP IN 9:30 IN THE MO RNING. AND I THINK WHAT THIS PHOTOGRAPH -- I HAVE THIS IN MY OFFICE, THESE ARE MY PUPPIES. IS THIS IS WHAT'S IMPORTANT. NO MATTER WHAT YOU DO IN LIFE, IT NEEDS TO FULFILL A PURPOSE SOMEWHERE. AND FOR ME, THIS IS MY PURPOSE. I LIVE IN THE U.S. WITH MY FAMILY. NO OTHER FAMILY HERE. AND IT'S INCREDIBLE HOW GRANDING THAT EXPERIENCE ACTUALLY IS. AND SO IN MAY OF THIS YEAR, LOOKING A LITTLE BIT MORE HEALTHY, WE WENT TO CELEBRATE THE YOUNGER TWO, THIS IS SIMON, NICOLE, THEY GRADUATED FROM PENN LAST MAY. WENT TO PARIS. FRANCE, WENT TO SEE THEIR GRANDPARENTS IN DUBLIN AND THEIR GRANDMOTHER, WHO MY HUSBAND IS FROM JAMAICA, AND GRANDMOTHER IN JAMAICA. I WAS ON A PLANE WITH MY HUSBAND AND I SAID NOW I KNOW WHAT THE MEANING OF LIFE IS. IT'S THAT I GET TO DO SOMETHING THAT I REALLY LOVE TO DO. HE'S A SURGEON. HE LOVES WHAT HE DOES. I THINK IT HAS MEANING, I THINK IT HAS VALUE. BUT IF I COULD LOOK TO THE NEXT GENERATION AND KNOW WHAT THAT THE TRAINING OPPORTUNITIES PROVIDES TO THOSE THAT ARE GOING TO REPLACE US MUCH SOONER THAN WE IMAGINE, THAT'S TRULY REMARKABLE. SO I THANK YOU FOR YOUR ATTENTION. AND I'M HAPPY TO TAKE ANY QUESTIONS. [APPLAUSE] >> THAT WAS A WONDERFUL LECTURE. I HAVE A QUESTION. THE SCARTY OF SCIENTISTS WORKFORCE HAS BEEN RECOGNIZED FOR A LONG TIME. AT LEAST 30, 35 YEARS. THE PROBLEMS WITH THAT PARTICULAR THING IS YOU HAVE ATTRITION, YOU HAVE LONG COURTING ZONE. LIKE WHAT IS SHORT. IT TAKES 45 YEAR OLD TO GET IT, FIRST NIH GRANT. MORE THAN 40 TO GET THE FIRST FABLING ULT APPOINTMENT. I'M NOT TALKING ABOUT PENN. I'M TALKING ABOUT THE REAL WORLD. [LAUGHTER] >> POINT TAKEN. >> SO IF A YOUNG MEDICAL STUDENT, FELLOW COLLEGE KID WHO WANTS TO PURSUE -- BE A TRANSLATIONAL SCIENTIST, HOW DO YOU BALANCE THE JOY OF DISCOVERY WITH JOY OF PAYING TAXES, JOY OF RAISING YOUR FAMILY, JOY OF REPAYING YOUR LOAN. SO WHAT WOULD BE YOUR ADVISE? >> GREAT QUESTION. AND YOU'RE RIGHT. THE PIPELINE OF PHYSICIANS, SCIENTISTS IS NOT SOMETHING THAT WE'RE TERRIBLY PROUD OF. SO I SAY A COUPLE THINGS. FIRST OF ALL, IS WE ARE AT THAT POINT IN CURRICULUM DEVELOPMENT WHERE WE HAVE A REAL OPPORTUNITY TO EXAMINE THE STRUCTURE OF OUR EDUCATIONAL PROGRAMS. AS YOU ALL KNOW, THE TRADITIONAL MD Ph.D. ROUTE HAS BEEN SYNONYMOUS WITH AN ENTRY PATH TO BEING CALLED A PHYSICIAN SCIENTIST. THAT'S MORPHING A LITTLE BIT. SO WE'RE SEEING MORE MDs WHO AREN'T Ph.D. TRAINED, WHO ARE BEING SUCCESSFUL PHYSICIAN SCIENTISTS. WHETHER THEY HAVE -- OR WON FUNDING OR NOT. THE SECOND IS I THINK THERE ARE GREAT OPPORTUNITIES TO INTEGRATE THE WAY IN WHICH WE EDUCATE OUR TRAINEES. SO THE INTRODUCTION TO SCIENCE, FIRST YEAR OF MEDICAL SCHOOL, SHORTENING -- WE'RE CONSIDERING SHORTENING MEDICAL SCHOOL FOR 3 YEARS AS OPPOSED TO 4, INTEGRATING THE 4th YEAR INTO INTERNSHIP. THE SECOND POINT I WOULD MAKE IS THE HOLY GRAIL WAS ALWAYS THE RO1. AND I THINK WE'RE LOOKING AT A HOLY GRAIL AS THE GRAIL IS GETTING SMALLER AND SMALLER AND SMALLER. AND WE'RE BEMOANING THAT FACT. I DON'T GIVE A TALK WHERE SOMEBODY DOESN'T SAY THE MEAN AGE OF FIRST RO1 IS 47. COMMONLY SAID. MAYBE WE'RE LOOKING AT IT THE ROPING WAY. MAYBE IT'S NOT ABOUT RO1 FUNDING. RIGHT? SO ONE OF THE THINGS WE HAVE SEEN AT -- NOT RO1 FUNDING EXCLUSIVELY. ONE OF THE THINGS THAT WE HAVE SEEN AT PENN, WE HAVE BEEN EXAMINING FUNDING PORTFOLIOS FOR A WHILE. SOME OF OUR MOST SUCCESSFUL TRANSLATIONAL SCIENTISTS HAVE AN EXTRAORDINARY ARRAY OF FUNDING WHERE THEY WILL HAVE AN NIH CORE OR FOUNDATION CORE, AND THEN THEY HAVE A FILL LAN THROWPY MIX, AND THEY HAVE FOUNDATION -- THEY HAVE FOR PROFIT FUNDING. SO I THINK LOOKING TO BE CREATIVE IN HOW WE DIVERSIFY THE FUNDING PORTFOLIO PROVIDES A MORE ATTRACTIVE VISION, AND LESS OF A DISINCENTIVE, FOR OUR MOST JUNIOR TRAINEES TO REMAIN ENGAGED. CAN SPITE ALL OF, THAT I THINK THAT -- DESPITE THAT I THINK EVERY YEAR WE SEE THE FUNNEL GETTING SMALLER AND SMALLER. I'M NOT SURE THAT ANYONE HAS THE ABSOLUTE ANSWER TO THAT. BUT MY PERSONAL BIAS IS THAT IF YOU CAN MAINTAIN THE EXTRAORDINARY EXCITEMENT ASSOCIATED WITH DISCOVERY, IT HELPS. THAT POINT I WOULD MAKE. EVERY ONE OF MY CHILDREN, WHEN THEY GOT THEIR FIRST PAYCHECK HAVE CALLED ME TO SAY I'M VOTING REPUBLICAN NEXT TIME. SO THE PAIN OF TAXATION, PROBABLY NOT A GOOD STATEMENT TO MAKE IN THIS PARTICULAR -- [LAUGHTER] -- TIME, BUT I HOPE THEY WON'T VOTE REPUBLICAN. BUT THAT'S BESIDE THE POINT. I THINK THE CONCEPT OF FINANCIAL DEBT IS AN AREA THAT WE WILL SEE A SOLUTION FOR WITHIN THE NEXT DECADE. I THINK THE IDEA THAT MEDICAL STUDENTS ARE GRADUATING WITH A MEAN DEBT OF $198,000 IS LUNACY. YOU ADD ON TO THAT RESEARCH TRAINING ON TOP OF ALL OF, THAT AND THE TIME LIMITS ON THEIR STAFFORD LOANS RUNS OUT. THAT'S JUST A LAW OF DIMINISHING RETURNS. THAT FROM THE ECONOMIC ARGUMENT PERSPECTIVE, I THINK WE WILL IMPROVE THAT. NO EASY FIX, FOR SURE. AND SOMETHING THAT YOU HAVE TO CONTINUE TO SHRUG ALONG WITH, TRYING TO IMPROVE. >> THANK YOU. >> THANKS FOR THE QUESTION. >> THANK YOU. >> NICE TO SEE YOU. >> GOOD TO SEE YOU. ONE THING YOU DIDN'T COVER, WHICH INTERESTS ME, IS THE CHALLENGE WE HAVE IN SUSTAINING A CAREER FOR WOMEN. WE, LIKE MOST MACES, HAVE A HUGE DROP OFF IN THE EVOLUTION OF A CAREER FOR WOMEN IN TRANSLATIONAL RESEARCH. SO AS A SUCCESSFUL WOMAN WHAT ARE YOUR THOUGHTS ABOUT THIS? I WON'T GO FURTHER. >> HOW LONG DO YOU HAVE? [LAUGHTER] >> THAT'S A TALK. >> SO THIS WAS A QUESTION ASKED BY SOME OF THE STUDENTS THIS MORNING. AND THEY MADE AN INTERESTING COMMENT WHICH I WILL PITCH BACK TO THE AUDIENCE HERE. SEVERAL OF THEM REMARKED ON THE FACT THAT I WAS THE FIRST WOMAN PRESENTER TO THEIR GROUP. RIGHT? SO I THINK THE FIRST THING IS I'M NOT UNIQUE. THERE ARE MANY OF ME OUT THERE. AND I THINK ONE OF THE THINGS IS PUTTING THE MODELS OUT THERE. SHOWING HOW IT CAN BE SUCCESSFUL. THE SECOND, I WOULD SAY, IS GOING BACK TO MY COMMENTS ON -- THAT LIFE HAS AN UNCANNY ABILITY TO GET IN THE WAY OF LOTS OF THINGS. I THINK THAT UNLESS WE ARE EFFECTIVE AT REALLY MENTORING FEMALE TRAINEES, TRY PERIODS IN THEIR LIFE -- THROUGH PERIODS IN THEIR LIFE WHERE FOR SO MANY REASONS THEIR CONFIDENCE IS ROCKED EXPONENTIALLY TO THE POINT WHERE THEY JUST DON'T BELIEVE THEY CAN KEEP PACE WITH THE DEMANDS OF THE PHYSICIAN SCIENTIST PATHWAY. OUR SOLUTION TO THE PROBLEM IS IN THE INDIVIDUAL'S WHO ARE EITHER POST-DOCS BEFORE GOING TO MEDICAL SCHOOL, OR JUST AFTER RESIDENCY. AND THERE IS NO BETTER WAY TO EFFECT CHANGE THAN TO DEMONSTRATE WITH EXAMPLES, PEOPLE WHO HAVE MANAGED TO ACTUALLY DO IT. THERE IS NO MAGIC RECIPE IN THERE. IT IS HARDER. NO MISTAKE. I CAN TESTIMONY TO THAT ANY DAY. IT IS HARDER. BUT IT IS -- THE FEELING OF SUCCESS WHEN YOU GET THERE -- APOLOGIES TO ALL THE MEN. I BELIEVE IS SWEETER AS A RESULT OF HAVING ACTUALLY GOT THERE. SO I THINK IT'S THE EARLY CAREER DEVELOPMENT PIECE, SHOW THEM EXAMPLES OF WHO IS SUCCESSFUL, TRAIN EFFECTIVE MENTORS TO BE ABLE TO GET THOSE INDIVIDUALS -- IT'S NOT MENTORING ABOUT THEIR SCIENCE. NOT MENTORING ABOUT THEIR FOCUS AND DETERMINATION. IT'S ABOUT SHORING THEM UP WHEN THEY FEEL THAT THE HURDLE IS JUST TOO BIG FOR THEM TO SURE MOUNT. -- SURMOUNT. >> THANK YOU, EMA. [APPLAUSE]