Growing Our Workforce
By: Katherine Dvorak
Health research can’t be confined to insights obtained from examining a petri dish or peering through a microscope. Often, biomedical research needs to be looked at from the perspective of someone trained in medicine who understands the patient experience. That’s where clinician-investigators come in.
These experts, who focus on both clinical work and research — and often hold dual degrees in medicine and science — bring important viewpoints to the biomedical workforce. They are a crucial part of health care, but also an underrepresented one.
According to the most recent National Institutes of Health (NIH) Physician-Scientist Workforce Working Group Report, published in 2014, there were only about 9,000 clinician-investigators among the 50,000 or so NIH-funded researchers during 2008–12.
Clinician-investigators face many obstacles, including winning funding, finding time for both lab work and clinic work, and drawing people from a career focused solely on medicine into one that involves research. To address those and other challenges, the George Washington University (GW) School of Medicine and Health Sciences (SMHS) hired Alison Hall, PhD, to serve as associate dean for research workforce development.
Hall oversees research development activities across the school, offering guidance on research education, promoting research opportunities, and stimulating sponsored research support.
Clinician-investigators need the ability to form effective research networks, find collaborators on campus and off, and work with mentors in their field of study, says Hall. Those are areas, she notes, where GW can make major strides.
One action item Hall has already completed is the development of a searchable GW researcher database. She also plans to tackle the creation of a peer-to-peer learning community connecting clinician-investigators with one another and the rest of the GW research community. It will give them ways to share proposals and approaches, and also talk about the challenges they face.
In addition to fostering career growth for clinician-investigators, students will be in Hall’s field of vision as she takes on the additional role of co-director for the medical student research track. “I’m thrilled so many students are interested in research. I’d like to help them be even more successful,” she explains.
Another area of importance is funding, which comes in part through grants from the NIH and other foundations. Efforts to bring more research dollars to GW will include gathering faculty to write T-32 training grants, which can be used to train graduate PhD students, postdoctoral fellows, and medical fellows, Hall adds.
GW wants to grow its cadre of clinician-scientists to join those already working at GW and making advances in the lab and the clinic. Two such experts are Aileen Chang, MD, MSPH, assistant professor of medicine at SMHS, and Homa Ahmadzia, MD ’08, MPH ’08, BA ’04, assistant professor of obstetrics and gynecology at SMHS and of global health at the Milken Institute School of Public Health at GW.
Both received NIH KL2 Career Development Awards through the Clinical and Translational Science Institute at Children’s National Health System. The KL2 awards support newly trained clinicians in the development of successful clinical and translational research careers.
Chang began studying the dengue virus nearly 10 years ago, which led to her researching similar viruses, such as chikungunya. Not long after her arrival at GW, the Zika outbreak hit. That timing allowed Chang to lend her knowledge to GW’s efforts in researching and understanding the virus, and led to her receiving a KL2 award for her study, “Zika-Induced Guillain-Barre Syndrome: Elucidating the Role of Antibodies.”
Guillain-Barre Syndrome (GBS) is a neurological disorder caused by an array of different infectious diseases, Chang explains. With the Zika outbreak, the incidence of GBS increased. “I wanted to see what caused GBS, and if it would be something we could potentially prevent,” Chang says. “Sometimes GBS is caused by vaccines, like the flu vaccine, and researchers are in the process of making a Zika vaccine. We want to make sure that the vaccine would be safe for the general public.”
Chang seeks to determine whether Zika-induced GBS is caused by antibodies to the virus or caused by the virus itself. She helps to enroll patients in studies, collects the samples, and analyzes the data.
Chang also works with a host of scientists in the Department of Microbiology, Immunology, and Tropical Medicine, including Jeffrey Bethony, PhD, professor of microbiology, immunology, and tropical medicine; Rebecca Lynch, PhD, assistant professor of microbiology, immunology, and tropical medicine; Robert Miller, PhD, senior associate dean for research, Vivian Gill Distinguished Research Professor, and professor of anatomy and regenerative biology at SMHS; and Gary Simon, MD, PhD, Walter G. Ross Professor of Medicine and of Microbiology and Tropical Medicine, director of the Division of Infectious Diseases, and vice chair of the Department of Medicine. Investigators analyze the samples, determine the antibody content, and research whether antibody levels cause differing levels of nerve damage in vitro.
Chang says the most valuable part of her KL2 award is that it allows her the time she needs in the lab, while also giving her the opportunity to see patients in the clinic. “Because lab-based science is so advanced, there’s no way I will ever be as good as people who are spending all of their time in the lab,” she admits, but adds that her clinical-based expertise offers something extra. “I can bring an idea of what direction we might want to go in order to best address patients’ most pressing questions or needs.”
For Ahmadzia, being a clinician-scientist means balancing two interests, weaving them together to help patients and further research.
Her research interests lie in the use of the drug Tranexamic acid in prevention of postpartum hemorrhage, for which she recently received a KL2 award.
“Pregnancy is understudied in research. It [involves] a vulnerable population, and researchers are always very skeptical about studying it. So I wanted to study a critical area that has potential impacts not only regionally, but also nationally and globally,” she says.
Tranexamic acid stabilizes fibrin, which helps the body naturally process blood clots. “It doesn’t form new blood clots, it just helps stabilize your ability to keep blood clots you’ve already formed,” she explains. “It optimizes the body’s ability not to bleed out, which can be a big risk during delivery.”
Currently, she is investigating the bioavailability of an IV formula for Tranexamic acid. Ultimately, she’d like to see the utilization of an oral option for the drug during childbirth. There are concerns, however, that the drug could increase the risk for blood clots (no study has yet shown that, though). Ahmadzia is addressing those concerns in her research by looking at how the body responds to the drug.
Ahmadzia adds that her clinical work is aiding in her research because it helps her identify women who may be eligible for the study or who may be at risk for hemorrhage.
She also has a personal motivating factor for the work she does: Ahmadzia’s family is from Afghanistan, and although she has lived in the United States since age 4, she knows how great an issue maternal health is in that country and others like it. “While I can’t be in those countries or directly be involved,” she says, “I always feel like this is my way of helping. If not helping directly there, then at least by conducting research here that may one day be used globally.”