Pediatric Hospital Medicine (PHM) is a broad field that has recently been recognized as a specialty requiring its own fellowship aimed at developing the more academic aspects of this career.1 Academic medicine encompasses the triad of medical education, clinical responsibilities, and scientific research. This triad is touted by training programs who have resources in place to ensure adequate exposure to all three facets of academic medicine. Many academic institutions note that continuing to emphasize all three aspects, particularly research, has been difficult at the junior faculty level.2 Common barriers to research productivity for faculty in primarily clinical positions include insufficient time, experience, funding, and infrastructure to support the physician–scientist.2–9 As two junior faculty members in the Division of Pediatric Hospital Medicine at a 315-bed, freestanding tertiary care children’s hospital, we have certainly encountered a number of these hurdles during our foray into clinical research.
Other academic institutions have suggested solutions to promote scientific research among junior faculty who juggle the competing demands of career planning, clinical responsibilities, increasing administrative pressures, and personal life. These include formalized mentor–mentee programs at the faculty level, gaining support from division chiefs, encouraging interdivisional collaboration, and providing increased infrastructure for research support.2–9 Forster et al9 recently emphasized the necessity of these resources in helping promote research productivity in pediatric hospitalists pursuing a research career. We noted that, for primarily clinical faculty within a division with limited research infrastructure, the creation of informal mentor–mentee relationships and interdivisional collaboration were the most attainable methods to increase access to research resources. These relationships allowed us to seek out the resources we needed to achieve our academic goals and placed us in the center of the “individual–mentorship–institutional support” Venn diagram referenced by Burns et al.8 We urge other hospitalist divisions interested in increasing research productivity to use interdivisional collaboration to develop infrastructure to support the physician–scientist pipeline.
During our first year as faculty, we embarked on a project that would ideally result in a multicenter randomized control trial, starting with a pilot study at our institution. With vigor, energy, and excitement, we started a literature review, the only part of the process with which we were confident. These were not only first-time pursuits for us, but they also posed new ventures for our division. Our senior collaborators, one of whom was our division chief, were supportive of our endeavor. However, we all soon realized our division, whose members are primarily clinical, lacked not only experience but also important resources, including a clinical research team, a research coordinator, and funding to hire these services. Such resources are crucial for supporting academic productivity when there is limited protected nonclinical time.
Feeling defeated and not even knowing what questions we needed to ask, we reached out to faculty from other divisions. We approached Pediatric Emergency Medicine (PEM) colleagues who had experience with the Pediatric Emergency Care Applied Research Network. Our PEM colleague offered not only suggestions for specific grants to which we should apply but also further literature to supplement our current review. He opened up our access to already implemented research tools, like the Pediatric Emergency Care Applied Research Network database, that could help with background for study design. He enthusiastically supported our research question and recommended we broaden our collaborative network by referring us to our outpatient General Academic Pediatrics (GAP) division for mentoring on grant writing.
Our first attempts at grant writing were guesswork. Fortunately, GAP already had systems in place to aid in scientific productivity, including a monthly meeting to discuss, critique, and improve ongoing projects. We were invited to attend these structured meetings, and our project was molded by the experienced voices of our GAP colleagues and their research aides. Although we knew that grant writing was no simple task, we had not realized that grant writing was a completely unique language requiring specific phrases to describe the innovation of our research and its public health implication. GAP provided us with references to grant-writing templates and examples of their previously accepted grants with similar research design, providing structure to our grant-writing. This experience also created a segue for further involvement in clinical research by revealing an opportunity to sit on the Institutional Review Board, only adding to the internal expertise within our division. It also prompted our division to start our own monthly research meetings to encourage scientific thought and discovery.
Although our senior PHM mentors and collaborators in PEM and GAP had helped us initiate the study design and grant-writing processes, we needed more guidance on the logistics of how our specific clinical question would function as a research study. We met with investigators in the Divisions of Infectious Diseases and Pulmonary Medicine. Having had years of experience in the realms of both basic science and clinical research, they were able to give us pointed feedback on our study design. Meeting investigators who primarily worked at the bench was greatly refreshing. We found that there was a symbiotic relationship for each of us to achieve all of our collective research goals, which lead to further collaboration in translational research. From here, we experienced a snowball effect, and we found our network of resources expanding. We met with staff from microbiology, pharmacy, and informatics (divisions that were already interconnected and with systems in place to streamline scientific research) to learn about and set up the logistics of our pilot study.
Without realizing it, we had implemented a number of the solutions proposed by other authors who have written about developing and maintaining a clinical research program encouraging involvement of junior faculty.2–10 We had a found our way to the intersection of the individual, mentor–mentee relationship, and institutional support.8
In our experience, creating working relationships was key. We had inadvertently set up a small-group mentoring relationship between ourselves and two senior PHM faculty members, in line with solutions suggested previously in the literature. Notably, one of our senior mentors was the division chief. Having his support was immensely useful, as noted by Alvira et al.2 Additionally, the help of faculty and staff from a number of different divisions allowed us to navigate the processes of designing a randomized control trial and submitting a grant. These interdivisional collaborations opened doors to research infrastructure already in place in other divisions within the Department of Pediatrics, not only giving our PHM division ideas on how to develop such systems within our own group but also allowing members of our division the opportunity to participate in departmental review committees, thus adding to the group’s expertise.
Moving forward, we hope to continue to formalize training and exposure to clinical research among junior faculty. This may even be backtracked to the residency level, in which structured workshops can be offered in grant writing and project design by experienced PHM faculty. The resources available at our institution should be advertised more readily to residents, fellows, and faculty to help encourage their use in clinical research. Additionally, now that there is some divisional experience, ongoing research mentorship can be fostered throughout our division. The “pay-it-forward” culture of mentorship as junior faculty mentees become more senior has been noted as commonplace at multiple other academic institutions, and this is readily seen in our division.4 Spearheading this project has already incentivized the creation of positions with protected research time. The addition of faculty with increasing research experience can also foster the emphasis on clinical research within our PHM division and the larger PHM community as well. Decreasing barriers to accessing research infrastructure may encourage more participation in clinical research from faculty in primarily clinical roles.
Most importantly, we realized that the mentor–mentee relationships and interdivisional collaborations made resources available to us that were already in place within the larger Department of Pediatrics. These were useful to us in the short-term but also may help our PHM division design and implement its own infrastructure to help clinically focused junior faculty find ways to fit into the physician–scientist pipeline and be academically productive through translational research. Because scientific productivity is often valued within large academic medical centers, we would urge PHM divisions to afford more infrastructure and protected nonclinical time to junior faculty with aspirations toward scientific discovery and innovation. Although we realize these infrastructure changes take time, we would again like to emphasize the importance of reaching outside one’s division to establish collaboration.
Overall, this entire process of developing a clinical trial was new to our PHM division. In the end, it was fruitful. One day in early December, we received an e-mail that said, “Congratulations, your grant application has been funded.” Before going our separate ways for the day, we reunited in our office for a quick celebration and moment of joy before thinking about the work ahead. Many thanks go out to everyone in our division and all of our collaborators for their help, encouragement, and continued support. Although we still have a long road ahead, we hope that our experience and pathway to success through interdivisional collaboration encourages other junior faculty without strong divisional research infrastructure to pursue more scientific research.
We thank Benjamin Miller, MD, Tony Tarchichi, MD, Judith M. Martin, MD, Alejandro Hoberman, MD, John V. Williams, MD, Robert Hickey, MD, Stephanie L. Mitchell, PhD, and John Alcorn, PhD for their support and contributions.
Drs Mistry and Williams conceptualized and designed the commentary, drafted the initial manuscript, and approved the final manuscript as submitted.
FUNDING: The institutional Research Advisory Committee grant described in this commentary was accepted and received funding for a separate study.
POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.
FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.