It Takes a Team to Make Team Science a Success: Career Development within Multicenter Networks.

Physician-scientists play an essential role in the translation of basic laboratory discoveries into novel therapies to improve outcomes of disease, yet the “vanishing physician-scientist” remains a problem.1Daye D. Patel C.B. Ahn J. Nguyen F.T. Challenges and opportunities for reinvigorating the physician scientist pipeline.J Clin Invest. 2015; 125: 883-887Crossref PubMed Scopus (49) Google Scholar Successes in advancing the outcomes of children with complex diseases are often limited by the lack of expertise in moving basic science to the bedside, especially in the setting of rare disorders, with small patient numbers at each center. Diverse teams in which physician-scientists collaborate with individuals with a variety of research methods expertise are necessary to translate discovery into new diagnostics and therapeutics. In recent years, there have been new challenges in attracting, recruiting, and retaining clinical investigators in pediatrics.2Alvira C.M. Steinhorn R.H. Balistreri W.F. Fineman J.R. Oishi P.E. Padbury J.F. et al.Enhancing the development and retention of physician-scientists in academic pediatrics: strategies for success.J Pediatr. 2018; 200: 277-284Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar,3Cornfield D.N. Lane R. Abman S.H. Creation and retention of the next generation of physician-scientists for child health research.JAMA. 2013; 309: 1781-1782Crossref PubMed Scopus (17) Google Scholar Medical research has steadily increased in both complexity and scale over time, posing formidable barriers to junior faculty attempting to establish an identity as a traditional “independent investigator.” At a time when fundamental basic science research is achieving dramatic breakthroughs, there is also a growing concern that the training and development of young investigators who can translate these findings into relevant animal models or appropriate clinical studies is not keeping pace. Shifting clinical commitments owing to economic pressures within academic centers (eg, more structured clinical effort and clinical productivity targets) have further challenged the traditional paradigms of academic success and individual pathways to career development and promotion. However, there are also new opportunities for trainees and junior faculty, with the growth of diverse multicenter networks for clinical research, in part reflecting greater recognition of the need to improve child health outcomes by better understanding rare disorders through more effective research and care strategies. This trend represents a shift toward collaborative research, with interactive networks providing robust opportunities for growing team science.4Libby A.M. Cornfield D.N. Abman S.H. There is no “I” in team: new challenges for career development in the era of team science.J Pediatr. 2016; 177: 4-5Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar, 5Von Roth P. Canny B.J. Volk H.-D. Noble J.A. Prober C.G. Perka C. et al.The challenges of modern interdisciplinary medical research.Nat Biotechnol. 2011; 29: 1145-1148Crossref PubMed Scopus (13) Google Scholar, 6National Research CouncilEnhancing the effectiveness of team science. National Academies Press, 2015Google Scholar Within these networks, collaborative research is conducted by teams of investigators and multiple centers, rather than individual investigators at single centers. These networks offer the benefits of bringing together more extensive expertise from multiple sites, having access to larger datasets, developing geographically and racially diverse cohorts, studying rare diseases more effectively, increasing collaborations outside the home institution, and making use of unique mentoring opportunities. The work undertaken by these collaborative networks frequently includes shared data registries, observational cohort studies, randomized clinical trials, development of consensus guidelines, joint grant submissions, sponsorship of conferences and meetings, the establishment of biobanks, and other functions, which can provide a wealth of opportunities for trainees and junior faculty. However, these potential benefits for trainees and junior faculty are tempered by the challenge of simultaneously being a team player and developing independence. Engagement in multicenter networks can also lead to time- and effort-demanding commitments to develop and sustain network infrastructure, such as contributions of data to registries and management of local regulatory issues, often with limited resources to support such activities and without opportunities for first author publication. The BPD (Bronchopulmonary Dysplasia) Collaborative is an international multicenter network that includes more than 25 tertiary care centers dedicated to optimizing outcomes in infants with severe BPD through collaborations in developing care strategies, research, education, and advocacy.7Abman S.H. Collaco J.M. Keszler M. et al.BPD CollaborativeInterdisciplinary care of children with severe bronchopulmonary dysplasia.J Pediatr. 2017; 181: 12-28Abstract Full Text Full Text PDF PubMed Scopus (235) Google Scholar As with most networks, diverse activities in the BPD Collaborative, such as the development of consensus statements, a common patient registry, diverse working and writing groups, regular case conferences, frequent research presentations, and others, provide an environment to enable career development of early stage faculty. To understand and optimize opportunities for career development and leadership roles through engagement in network activities, the BPD Collaborative held an interactive panel discussion during its annual conference to provide insights and guidance for recognizing and enhancing career-related opportunities and challenges facing junior faculty who are engaged in network science, including issues regarding academic productivity, meeting promotions criteria within academic institutions, and other challenges. Network science provides many benefits to trainees and junior faculty (Figure 1; available at www.jpeds.com).4Libby A.M. Cornfield D.N. Abman S.H. There is no “I” in team: new challenges for career development in the era of team science.J Pediatr. 2016; 177: 4-5Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar,5Von Roth P. Canny B.J. Volk H.-D. Noble J.A. Prober C.G. Perka C. et al.The challenges of modern interdisciplinary medical research.Nat Biotechnol. 2011; 29: 1145-1148Crossref PubMed Scopus (13) Google Scholar,8Beckerle M.C. Reed K.L. Scott R.P. Shafer M.-A. Towner D. Valantine H.A. et al.Medical faculty development: a modern day odyssey.Sci Transl Med. 2011; 3: 104cm31Crossref PubMed Scopus (5) Google Scholar,9Butler D. Translational research: crossing the valley of death.Nature. 2011; 453: 840-842Crossref Scopus (485) Google Scholar It provides the ability to engage in research that advances the field, the chance to form new peer relationships and collaborations, and opportunities to interact and share expertise with colleagues from other institutions. Equally important are the intangible benefits of engaging in research that the trainee or junior faculty member finds meaningful, imbued with a shared sense of discovery and accomplishment. Additional opportunities to aid career development include leading research projects, developing relationships with collaborators (including new mentors and mentees), and sharing the excitement of novel observations and discovery, coauthorship of manuscripts, and developing grants within the context of the network (Figure 2; available at www.jpeds.com). These benefits are also accompanied by specific responsibilities when working in a collaborative structure. It is important for trainees and junior faculty to understand the expectations for participation in multicenter networks. Specifically, networks may have recruitment goals, membership dues, meeting or conference call commitments, and guidelines for authorship. Engagement in clinical databases and biorepositories and management of local institutional regulatory issues can demand time and effort, taking effort away from more traditional approaches to academic activities. The shared understanding of expectations should be aligned at the start of involvement in a network. Junior faculty should also be aware of the timelines involved in network science. Even simple registry analyses may require local institutional review board approval, signed data use agreements, and approval from network review committees, which add lag times from conceptualization of a project to its completion. More complex studies, such as clinical trials, may have even lengthier timelines and more involvement with meeting regulatory demands, which may not be favorable to a junior faculty member's timeline for promotion. Additionally, the limited agility of networks may interfere with pivoting for rapidly changing science or meeting deadlines for time-sensitive requests for applications. There are several potential roles for a junior faculty member within the structure of a collaborative network. For a network that does not include the institution at which the junior faculty member is based, it may be possible for the individual to become the lead or point person for the network at that institution. Another key role is becoming a lead or collaborator on a specific research project by joining a working group of interest or submitting a research proposal to the appropriate committee. There also may be opportunities to join administrative committees within the network, such as data use committees or meeting planning committees, which can serve as evidence of leadership for promotion review. In addition to the direct benefits to the network and the junior faculty member, the most important indirect benefit may be exposure to senior faculty for guidance and mentoring. However, junior faculty should also be mindful of some caveats. These issues include overextending themselves within networks and related committees or working groups. It is vital for junior faculty to understand expectations for participation in multicenter networks, including funding for patient enrollment, patient evaluation, research staff effort, and individual investigator effort, resulting in financial implications for one's division, department, and hospital. It is also important to understand the guidelines for authorship on publications and to be prepared to describe one's individual contribution to the research and expertise in performing the research (study design, data analysis, data interpretation). Fellows can also benefit from engagement in networks. First, networks provide exposure to faculty and potential mentors from outside institutions through collaborative meetings and networking with national leaders in the field. Second, networks provide the opportunity to undertake modest projects with registry data from the network and to develop critical research skill sets, including project development, data analysis, and others. Last, networks may provide fellows with additional experience to facilitate their transition to junior faculty with specific niche expertise for launching a successful academic career. Support from senior faculty is needed for any junior faculty member or trainee, including those engaging in networks and collaboratives. Although the archetypical model has been a mentee-mentor relationship, there are a number of evolving roles for senior faculty to advance the careers of their junior colleagues, including mentor, sponsor, advisor, collaborator, and coach. For success in the current academic environment, it is expected that trainees and junior faculty will engage with a number of senior faculty with overlapping and complementary support in career development. The traditional mentor can be described as an experienced faculty member who is focused on the career development of the mentee, frequently in the same field and most often at the same institution. The mentor provides advice and guidance, makes introductions, and provides feedback. Additionally, mentors should be prepared to provide empathy and build confidence with minimal expectations for return. In contrast, even though the sponsor provides many of the same functions as the mentor, the sponsor is often a senior faculty member in the same or a complementary field who believes in the potential of the junior faculty member. The sponsor may advocate for promotion, may nominate junior faculty for new roles, and encourage them to take risks and apply for opportunities with an unstated expectation of ongoing achievement by the junior faculty. Advisors and collaborators are typically less involved in career development, but provide invaluable technical or clinical expertise with a closer focus on a specific work product or project. Coaches may be individuals who are sought out by the junior faculty member to gain informal guidance or feedback, usually on a more limited basis. In general, senior faculty should consider being open to engaging with trainees and junior faculty in any of these roles. Aiding someone does not necessarily equate with significant time commitments. Senior faculty need to appraise their trainee's or junior faculty member's strengths and weaknesses to provide the most meaningful support possible. Advice must always be concrete and timely; action items or goals may be helpful. Senior faculty should also feel comfortable in stating that something is not within their expertise and providing the trainee or junior faculty member with suggestions for locating someone else better suited to meet the desired needs. In addition to encouraging mentor-mentee relationships and other coaching activities, networks should develop more formal programmatic strategies to ensure regular meetings with comentorship teams, hold scheduled peer discussions on topics related to career development and academic skills, and obtain regular feedback from junior faculty on any issues to ensure that goals, milestones, and timelines are clearly articulated for involvement and completing projects. Larger networks should consider establishing a junior faculty committee and having scholarship oversight groups, and all networks should consider having junior faculty representation on standing committees. Senior faculty should further play proactive roles in sponsoring junior faculty to present at regional, national, and international conferences and should advocate for junior faculty to have opportunities for first authorship on publication. Finally, senior faculty working together in the context of multicenter networks can develop many research and leadership opportunities to address high priority goals of achieving greater diversity for the development and retention of under-represented minority faculty in academic pediatrics through comentorship, sponsorship and coaching as a collaborative and highly interactive group. Success in team science is incumbent on institutional support. Investments in faculty engaging in networks or collaboratives can reap a number of dividends, including improved faculty morale resulting in higher retention, increased divisional research reputation, expansion of regional programs, and center of excellence certification. Considerations for the division chief, department chair, or other institutional leadership may include 10%-20% protected time for the faculty member (at a cost of $15 000-$30 000 per year), access to statistical support (at a cost of $2000-$5000 per year), and at least part-time research coordinator support (at a cost of $5000-$20 000 per year). The research coordinator is critical for recruiting subjects from clinical sites, obtaining and processing biospecimens, assisting with regulatory paperwork, and data entry. These costs are often much lower than basic science laboratory startup costs, which can run into hundreds of thousands of dollars,10Ehrenberg R.G. Rizzo M.J. Condie S.S. Start-up costs in American research universities. Cornell University ILR School Working Papers, 2003: 1-10Google Scholar and this support is critical to junior faculty wishing to engage in networks or collaboratives, particularly those on academic tracks that require scholarship for promotion. Even though large academic divisions may have resources such as mentors, support staff, and funding readily available, small and medium-sized divisions may need to draw upon departmental or institutional resources or seek philanthropy. Another key challenge for division chiefs and department chairs is recruiting and maintaining a diverse faculty. Participation of faculty in networks generates more potential contacts for recruitment of minorities under-represented in medicine and allows junior faculty to meet a more diverse group of mentors than may be present within the institution. The 2019 coronavirus disease pandemic led to an exponential increase in videoconferencing for clinical care, education, and research. Videoconferencing allows for increased and easier interactions between trainees or junior faculty and senior faculty in networks, which can be further facilitated by accommodations for introverted personalities and junior faculty more anxious about speaking in large groups. Virtual meetings provide unique opportunities to develop ongoing mentor-mentee relationships, present research in progress, create scholarship oversight committees, and cultivate other intersite relationships. Virtual meeting leaders may wish to directly call on participants to seek input. Senior faculty should allow for pauses in conversation before speaking immediately. Division chiefs should strongly consider ensuring that all faculty and trainees in their division have access to their own institutional videoconferencing account to set up meetings. Collaborative network science can aid junior faculty in meeting institutional criteria for promotion, including authorship on publications, development of expertise and reputation, access to biobank specimens to pursue collaborative or independent research, and provision of data for grant applications. In terms of authorship, faculty should be prepared to describe their individual contributions to the research and the expertise that they added, which may include study design, data analysis, and/or data interpretation. Authorship order remains a key metric as evidence of productivity for many institutional promotional committees, specifically the number of publications with first author or senior author status for the faculty candidate. Cofirst authorship should be considered and noted on the curriculum vitae where appropriate. Although being listed in the acknowledgements section of a manuscript is a valid form of recognition for contributing to the work, it is unlikely to merit substantial consideration by a promotion committee. Last, institutions should consider how to recognize and value efforts in networks in their promotion committees. Annotation of publications on the curriculum vitae with the specific contributions of the faculty candidate may help promotions committees understand the candidate's merits. Although divisions and departments may provide some funding for engaging with networks, frequently participation in multicenter networks is unfunded or underfunded for the junior faculty, both in terms of protected time and ancillary support. Junior faculty should take advantage of free institutional core support when available and make use of part-time or shared personnel if possible. Although data entry, specimen processing, and other tasks can be undertaken by the junior faculty member, it is difficult to maintain substantial subject recruitment over a prolonged period of time with solo effort.