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Structure, grants key to research future This excerpt was edited and reprinted with permission from the Children’s Hospital and Darby Children’s Research Institute’s (DCRI) newsletter, Kid Connection.   Young physician-scientists must have the necessary training to proceed forward in a health care environment increasingly dominated by the need for translational research. Academic medicine at large and MUSC must encourage and develop scholars capable of becoming clinicians with the ability to do it all—research and patient care.     Dr. Bernie Maria, left, and students from the DCRI summer research program discuss a student's slide.  The task is enormous, but by placing support systems designed to cultivate those bound for clinical and research excellence, MUSC serves as an example of a new way of thinking in the academic medicine field.   “The MUSC campus is undergoing a transition period that takes clinicians out of an environment of conducting research in isolation, and integrates them with departments campuswide, making research more relevant,” said Carol Wagner, M.D., MUSC General Clinical Research Center (GCRC) associate director and professor in pediatrics. “That means that if someone has an interest in science—basic, clinical, or translational—there will be a universitywide infrastructure to support that from the very beginning.”   The Children’s Hospital and Darby Children’s Research Institute  (DCRI) provide relevant examples of how to grow such a support structure with mechanisms to train future clinician-scientists through the Clinical and Translational Sciences Award (CTSA) model. “These mechanisms include National Institutes of Health grants such as K12s, K23s, and T32s; pre-doctoral training programs; and National Scientific Research Awards,” Wagner said.   A highly competitive grant, the K12 is awarded to universities to support mentored clinical research scholars, typically one to two per year.   The K23 is an individually awarded, five-year mentored training grant.   The National Institutes of Health (NIH) developed these grants when fewer residents, including pediatrics, were exploring fellowships or academic medicine because of the need to deal with debt incurred while in medical school. To combat the decrease, NIH programs provide grants to train physicians who also desire a career in clinical or patient-oriented research.   “MUSC has a long track record of having K23 recipients, and is in the process of creating more K12s,” Wagner said. “The goal is to create a K12 in pediatrics so we can support young faculty right out of fellowship, enabling them to develop the skills necessary to be an independent academic clinician in pediatric research. These grants encourage us to nurture young clinicians in their formative years to provide actual experience with those of us who conduct research.”   A K12 in pediatrics would solidify the university’s research program and make MUSC more competitive in developing a network of independent researchers.   “In addition to developing multiple mechanisms to enhance the application of novel discoveries to improve people’s lives, we have to ensure continuity in research through various stages of career development and training,” said Bernard Maria, M.D., DCRI executive director.   Many students entering medical school have positive experiences with research but then have only the summer after the first year of medical school to rekindle the joy of discovery.   “The challenge is to connect pre-medical, medical, residency, fellowship, and junior faculty stages of career development into a continuum for gifted pediatricians-to-be,” Maria said.   “We’re developing a cohesive front here at MUSC,” Wagner said. “We must be proactive in developing a K12 program so we can have physician scientists for future generations. The physician scientist of tomorrow is being taught today. We really must preserve all the opportunities we have to support that.”   Closely related to these grant opportunities for future clinician researchers is the evidence-based medicine program (EBM) in the Department of Pediatrics that places interns in position to actively learn evidence-based practice techniques.   “This integrated EBM program is the offspring of Dr. Lyndon Key’s vision to make EBM a part the culture of the department of pediatrics,” said Gautham Suresh, M.D., leader of the EBM team for pediatrics. “Very few pediatric departments in the country have such a program. It’s intensive, and it’s on the forefront.”   It’s a hands-on teaching program in which interns generate clinical questions based on their experience. Suresh, Ron Teufel, M.D., and Joel Cochran, M.D., provide initial training and practical experience in the approaches and methods of EBM.   “We’re teaching these interns to look for the best evidence available to answer a given question,” said reference librarian Laura Cousineau. “There are two objectives in this program. The first is to provide evidence-based patient care. Secondly, to teach new doctors to make EBM a routine part of patient care, a lifelong process.”   Interns address real-world questions that usually garner about 14 opinions from 20 different physicians.   “It’s well known that there is a big gap between research literature and actual practice. We are teaching these future doctors that the only way to answer these types of questions is to look at the research published. They search for literature, and we help them analyze it and come up with answers to their questions.”   Challenges for EBM education include formulating a proper question and then the most effective way to search for the answer.   With the inaugural year of the EBM program completed, the interns will next participate in a hands-on project. “They will address the quality and safety of patient care using the principles of EBM learned in the past year,” Suresh said.   The program is structured so that second-year interns serve as teachers for first-years. “Dr. Key’s vision is that, after three years, the entire batch of residents will be fully trained in EBM, so that residents will teach the program. It will become a program run by residents for residents,” Suresh added.   “For all of us involved, this program has brought home, in a concrete way, how EBM really works. We have all been able to experience it in action,” Cousineau said. “If doctors know how to search for and find the best research literature, then they are able to take care of their patient in the best way possible. When a doctor is practicing EBM, he or she is finding the best evidence for that particular patient—his situation, his values. EBM means more than just doing what the evidence says. It’s a very patient-centered approach. EBM results in the best patient care possible based on the best research available.” What is CTSA? The Clinical and Translational Science Awards (CTSA) program, a roadmap initiative established by the National Institutes of Health (NIH), has been described as the most significant strategic opportunity facing academic health centers in the last 50 years.   By engaging in this initiative, MUSC joins the ranks of a handful of top research hospitals ready to benefit from increased federal funding opportunities for collaborative and applied research between clinicians and scientists.   At the core of the initiative is the realization that basic, translational and clinical investigators along with clinical practices, networks and industry must be brought together to improve the understanding and treatment of human disease.     Friday, July 21, 2006 Catalyst Online is published weekly, updated as needed and improved from time to time by the MUSC Office of Public Relations for the faculty, employees and students of the Medical University of South Carolina. Catalyst Online editor, Kim Draughn, can be reached at 792-4107 or by email, catalyst@musc.edu. Editorial copy can be submitted to Catalyst Online and to The Catalyst in print by fax, 792-6723, or by email to catalyst@musc.edu. To place an ad in The Catalyst hardcopy, call Island Publications at 849-1778, ext. 201.