• Research

    Clinician-investigator: Translating science into better care

During residency and post-residency fellowships, emerging doctors can be overwhelmed with the responsibilities of caring for patients. As a result, they often abandon their research work in the laboratory. The Clinician-Investigator Training Program at Mayo Clinic provides physician-scientists with the time and mentoring to continue their research while establishing a robust clinical practice.
Mayo Clinic physician-scientists Lewis R. Roberts, M.B., Ch.B., Ph.D., David Dingli, M.D., Ph.D., and Harmeet Malhi, M.B.B.S., share a common goal: finding balance.

David Dingli, M.D., Ph.D., says Mayo's Clincian-Investigator Training Program made him a scientist.
David Dingli, M.D., Ph.D., says Mayo's Clincian-Investigator Training Program made him a scientist.

They juggle the complicated medical needs of patients, the rigors of scientific precision in the labs, the demanding cycles of grant funding, the need to stay abreast of rapid changes in their specialties and the expectations of mentoring younger scientists, all while trying to find personal time for family and friends.

This is the life of the clinician-investigator at Mayo Clinic.

Each, however, has been trained to excel in the dual role of physician and scientist.

Drs. Roberts, Dingli and Malhi have completed Mayo Clinic's Clinician-Investigator Training Program, a two- or three-year comprehensive education program for doctors doing their residency or fellowship at Mayo Clinic. The program is specifically designed to protect time for research, provide leadership through an active mentoring program, and offer assistance in establishing a track record for publications and securing grant funding.

Protecting an endangered species

In 1979, James Wyngaarden, M.D., who later became director of the National Institutes of Health, rang the first alarm about physician-scientists becoming an endangered species.

Lewis R. Roberts, M.B., Ch.B., Ph.D., is a Mayo Clinic clinician-investigator and recently named Peter and Frances Georgeson Professor in Gastroenterology Cancer Research.
Lewis R. Roberts, M.B., Ch.B., Ph.D., is a Mayo Clinic clinician-investigator and recently named Peter and Frances Georgeson Professor in Gastroenterology Cancer Research.

Practicing physicians have traditionally played a central role in research, advancing breakthrough treatments for innumerable diseases, from smallpox and cholera to polio, heart disease and cancer. Much of their success has been possible because of the unique perspective of their own experiences with caring for patients.

But the immense challenges of being both a researcher and a practicing doctor who sees patients once threatened the very existence of these vital clinician-researchers.

To help address the problem, Mayo Clinic launched its Clinician-Investigator Training Program in 1980, and it continues to thrive today as the need for clinician-investigators remains strong.

Every two years, 18 doctors are selected to participate in the training program. Participants can combine the M.D. degree with another advanced degree, such as a Ph.D. Their research can fall anywhere along the spectrum of biomedical inquiry, from highly specialized basic science to population-based studies.

"It's very difficult for the clinician-investigator to stay current with the vast and rapidly developing body of biomedical science while keeping up with all the major changes that are occurring in their area of clinical practice," notes Steven H. Rose, M.D., dean of the Mayo School of Graduate Medical Education. "However, the Clinician-Investigator Program provides residents and fellows with the time and the mentoring to develop their skills in both areas. The disappearance of physicians from the basic medical research workforce would cripple the translational process of medical discovery."

From patient to laboratory, and back again

One area where the dual role of physician-researcher plays a crucial part is translational research.

Translational research is biomedical research whose goal is to turn scientific findings into practical applications that enhance health and well-being. For example, doctors at Mayo Clinic hope to translate laboratory discoveries into better patient care and improved treatment options.

Steven H. Rose, M.D., dean of the Mayo School of Graduate Medical Education
Steven H. Rose, M.D., dean of the Mayo School of Graduate Medical Education

Achieving that goal isn't easy, though.

Translational research, Dr. Rose says, is not a separate discipline but rather "at the very core of medical research at Mayo. The key is a dynamic, two-way partnership between clinical practice and biomedical researchers. That takes great discipline and commitment."

To understand that partnership, imagine a two-lane road with the research lab at one end and the patient in clinical practice at the other. Important research findings need to reach the patient with potentially better treatment. The patient's problems need to reach the laboratory to guide and direct research.

The key is the seamless flow of ideas and information between the two. Clinician-investigators drive the vehicles that travel back and forth along that road.

"It can be a challenge trying to balance both research and practice," says Dr. Roberts, a hepatologist at Mayo Clinic in Rochester, Minnesota, who has spent the past two decades studying how liver cancers develop, grow and spread. "But I have a perspective in the lab that people who are 100 percent devoted to research don't have. The patient interactions are critical to my future research. I can bring their problems back to the lab and it drives my research."

The gifts of time and mentoring
David Dingli, M.D., Ph.D., treats patients and conducts cancer research.
Time is both precious and limited for a young resident who is learning a profession and working long hours to gain experience. The Clinician-Investigator Training Program protects the doctor's time to continue to work in the laboratory, as well as with the patient.

"It's like taking on two full-time jobs," Dr. Roberts says. "You want to achieve mastery in both, and mastery takes time. This program gave me that gift of time. Not many doctors have that opportunity."

Dr. Dingli shares a similar experience.

"Research takes time and money," says Dr. Dingli, a hematologist at Mayo Clinic in Rochester, Minnesota, whose research into replicating viruses for cancer therapy lives at the interface between mathematical theory and experiment. "The program expanded my vision to see the importance of group or collaborative science — and taught me how to compete for money. None of that would have happened without the Clinician-Investigator Program. It made me a scientist."

Mentoring is also an important element of the training program. In fact, no one is accepted into the program without the support of an active researcher who helps train the emerging scientist. And the mentoring goes far beyond teaching experimental design.

For example, Dr. Malhi, a gastroenterologist at Mayo Clinic in Rochester, studied with Gregory J. Gores, M.D., now executive dean for research at Mayo Clinic.

"Greg certainly made me a better researcher," Dr. Malhi says. "But he also taught me how to prepare manuscripts for publication and the ins and outs of grant writing and fund raising. He showed me how to be a better clinician and how to find balance between my professional and personal life. I'm more successful because of his mentoring, but I'm also a better person."

Taking the lessons home

One day, Dr. Roberts hopes to return to his native Ghana with news that he has discovered a means for early detection and subsequent treatment for liver cancer, which kills hundreds of thousands of people each year, according to the American Cancer Society. The clinician-investigator understands how important this news would be to his sub-Saharan nation — and to the world.

If he succeeds, it will be, in part, because of his work as a clinician-investigator.

"My program training and the Mayo culture of mentoring and collaboration has allowed me to care for patients and do my liver cancer research," Dr. Roberts says. "That would not have been possible if I had stayed in Ghana, but all of the people at home may still benefit from my work. Professional and departmental boundaries don't exist here. If I succeed or if a colleague succeeds, we all succeed. And people's lives are improved."

In the end, that's what Mayo Clinic's Clinician-Investigator Training Program is all about: directed research combined with clinical expertise to improve people's lives. It's the perfect balance.

-- Jeffrey Briggs

March 2015