Journal of Clinical Psychology in Medical Settings

, Volume 15, Issue 1, pp 54–59

Recommendations for Research Success: One Investigator’s Perspective

Authors

    • Department of Medical Humanities and Social SciencesFlorida State University College of Medicine
Article

DOI: 10.1007/s10880-008-9104-0

Cite this article as:
Johnson, S.B. J Clin Psychol Med Settings (2008) 15: 54. doi:10.1007/s10880-008-9104-0

Abstract

This article is a personal reflection by an investigator with over 25 years of funding from the National Institutes of Health (NIH). The article: (1) highlights research opportunities for psychologists at the NIH outside of the traditional mental health arena; (2) provides specific recommendations to individual investigators to enhance their likelihood of obtaining NIH funding; (3) specifies needed changes in psychology’s research education and training programs to prepare the next generation of psychologists for research success; and (4) asks the Association of Psychologists in Academic Health Centers to play a lead role in both research training and advocacy.

Keywords

ResearchFundingEducation

Although most psychologists obtain their research funding from the National Institute of Mental Health (NIMH), the National Institute on Drug Abuse (NIDA), or the National Institute on Alcohol Abuse and Alcoholism (NIAAA), research success in the mental health domain is not the focus of this article. Rather, I will emphasize opportunities for psychologists to obtain funding from other National Institutes of Health (NIH) institutes. It is not my intention to minimize the very important work by psychologists supported by the traditional mental health institutes. However, there are many opportunities for psychologists for funding from the other NIH institutes. In my view, these opportunities are not well recognized by the larger psychology community and are particularly relevant to psychologists who work in medical settings. An increasing number of psychologists are employed in health care settings and their work has expanded the scope of practice for psychologists in both patient care and research. These psychologists treat patients suffering from cancer, diabetes, heart disease, stroke, Alzheimer’s disease, or any of a myriad of other disorders. Their knowledge of human behavior and behavior change are important to the care of these patients but also to the research enterprise. For this reason, I have elected to emphasize research opportunities for psychologists in NIH institutes whose focus is on diseases other than mental disorders.

In the interest of full disclosure, I should point out that I have never had funding from a traditional mental health institute and as a consequence, it would be inappropriate for me to discuss funding issues in that domain. This article is essentially a personal reflection, based on over 25 years of successful research funding in the area of childhood diabetes obtained from three different NIH institutes (National Institute of Child Health and Human Development [NICHD]; National Institute of Diabetes and Digestive and Kidney Diseases [NIDDK]; National Heart, Lung, and Blood Institute [NHLBI]), many years serving as a reviewer for an even broader range of NIH institutes, and my own observations of NIH funding patterns. My recommendations for research success span the gamut from recommendations to the individual psychologist working in a health care setting to educational recommendations for the field as a whole, including what the Association of Psychologists in Academic Health Centers (APAHC) as an organization might do to promote greater numbers of psychologists as successful NIH researchers.

NIH Funding Opportunities in Behavioral and Social Science

Although obtaining funding from NIH is exceedingly difficult in this time of flat or even declining NIH funding, examining NIH funding patterns in a larger context and over time provides considerable evidence for optimism. Table 1 provides the top 12 funding areas across the NIH for the last 5 years. Behavioral and social science does well as a category, ranked 12th in 2003 and 10th in the years thereafter. However, psychological science is clearly relevant to all of the NIH’s top funding areas, whether it is clinical research, prevention, cancer, and so on. I would argue that all of the top NIH funding areas present real opportunities for psychologists to become a larger part of the NIH research enterprise.
Table 1

Top NIH funding areas by year in $billions

Area

2003

2004

2005

2006

Est 2007

Biotechnology

9.89

10.69

10.89

9.97

9.95

Clinical research

8.03

8.50

8.72

8.79

8.81

Prevention

6.55

7.19

7.10

6.82

6.78

Cancer

5.43

5.55

5.64

5.58

5.56

Brain disorders

4.74

4.82

4.78

4.73

4.71

Neuroscience

4.71

4.91

4.90

4.83

4.82

Genetics

4.24

4.54

4.84

4.88

4.87

Women’s health

3.49

3.48

3.55

3.49

3.49

Pediatrics

3.07

3.13

3.21

3.16

3.16

Clinical trials

2.72

2.88

2.86

2.77

2.77

HIV-AIDS

2.72

2.85

2.92

2.90

2.90

Behavioral and social science

2.68

2.93

3.04

3.00

2.99

Data obtained from http://www.nih.gov/news/fundingresearchareas.htm

Note: These are not mutually exclusive categories

Table 2 depicts the number of new grants in the behavioral science arena across 5-year windows from 1982 to 2006, using data from the Computer Retrieval of Information on Scientific Projects (CRISP) (http://www.crisp.cit.nih.gov/). The institutes traditionally funding psychological science (NIMH, NIDA, NIAAA) are contrasted with some of the other NIH institutes—NIDDK, NHLBI, NICHD, the National Cancer Institute (NCI), and the National Institute on Aging (NIA). Several trends are noteworthy. First, consistent with the doubling of the NIH budget, we see a large increase in new behavioral research grants across all institutes in the 1997–2001 period. Although NIMH has always had the largest number of new grants, it may surprise many that in any given 5-year period, NCI, NHLBI, NICHD, and NIA have funded more new behavioral science grants than NIDA or NIAAA. In the most recent window depicted, 2002–2006, NIMH funded the most new grants followed by NIDA, NICHD, NCI, and NIA. These data show that there are ample opportunities for behavioral science funding in institutes other than the traditional “mental health” institutes of NIMH, NIDA, and NIAAA.
Table 2

Number of new research grants with a behavior/behavioral code by institute and time

Institute

1982–1986

1987–1991

1992–1996

1997–2001

2002–2006

NIMH

805

809

698

1,792

2,281

NIDA

184

543

441

1,170

1,403

NIAAA

138

221

208

530

640

NCI

214

190

285

590

873

NIDDK

17

97

85

209

430

NHLBI

305

258

195

356

447

NICHD

401

379

267

713

1,063

NIA

212

186

171

600

693

Investigator Recommendations

Recommendations for the individual investigator that may enhance his or her opportunities for research success include issues around choosing a research focus, joining an interdisciplinary research team, demonstrating research team productivity, NIH institute funding considerations, and looking for “big science” opportunities. As the investigator becomes more successful, I hope he or she will also become an active, constructive member of the NIH research review process and an advocate for increased NIH funding for behavioral science.

Choosing a Research Focus

Successful research funding begins with the selection of a research focus. An investigator may be fascinated by a specific topic but unless that topic is a priority of one of the NIH institutes, research funding will be difficult to acquire. It is important to remember that the National Institutes of Health is really the “National Institute of Diseases.” Each institute has its own diseases that are its priority. An investigator is wise to choose a disease or disorder that is consistent with one of the institutes’ priorities. Obviously, problems that are common or problems that are serious are more likely to have funding priority. However, an interest in a high priority topic consistent with one of the NIH institutes is not enough. The investigator must have access to sufficient numbers of patients to conduct fundable science and this is not always possible in all settings. Finally, the investigator must have access to the necessary interdisciplinary research and clinical expertise to create a viable research team. A psychologist may have identified a topic consistent with one of the NIH institute’s priorities and may have access to sufficient numbers of patients but unless the psychologist has an appropriate interdisciplinary research team in place, funding will be very difficult to achieve. NIH funding is becoming more and more interdisciplinary and psychologists will need to become part of these teams if they want to become NIH funded investigators.

Joining an Interdisciplinary Research Team

The availability of an existing interdisciplinary team is so important that it will often dictate the focus of the psychologist’s research. Teams that engage in both clinical care and research are ideal. Such teams provide more than access to the necessary patient population. Because patient care is part of their everyday world, these teams are often excellent at identifying the most important issues to be addressed through research. At the same time, clinical care teams that have no research expertise or experience are usually unable to successfully compete for NIH funding.

Joining an interdisciplinary research team can present a number of challenges. The psychologist often needs to define his or her role in the clinical care and research enterprise. Other members of the team may not know what expertise the psychologist brings to the team or perhaps worse, have preconceived misconceptions. It is important that the psychologist establishes a role as an independent investigator on the team with the mutual respect that entails. In my view, psychologists should not acquiesce to roles in which they are viewed as research assistants, ghost grant writers or publication writers for the “PI” or Principal Investigator of the research team. Psychological science is as important as any other discipline’s science on the team and the psychologist investigator should behave and be treated accordingly. However, this position on the team is not always automatic and the psychologist often needs to negotiate an appropriate role.

To be an effective member of any interdisciplinary team, the psychologist must acquire substantial knowledge about the biology, pathology, and management of the disease or condition that is the focus of the team’s research. Successful acquisition of this knowledge makes the psychologist a more valued member of the team by enhancing team member communication and assuring better integration of psychological science into the research enterprise.

Demonstrate Research Team Productivity

NIH reviewers often look for evidence that the interdisciplinary team listed in the application is more than a paper creation put together just for the application. NIH funding is extremely competitive and an application is unlikely to be funded if there is a question about the ability of the team to carry out the work. For this reason it is very important that the research team demonstrate research productivity. There are a variety of ways to do this. Conducting small pilot studies engages the team in the research enterprise and provides important data that demonstrate not only the viability of the research idea but of the research team. Obtaining small amounts of grant funding from the team’s institution or from a foundation is another excellent way of establishing the team’s credibility. Perhaps most important are joint authored publications by team members. These publications should appear in journals that are respected by the science and clinical community most relevant to the patient population studied. Psychologists interested in NIH funding will often increase their chance of funding success if they publish in medical journals, not psychology journals. All of these activities—pilot studies, obtaining a small grant for the work, and publishing together—also help the team itself sort our roles and responsibilities, assuring greater efficiency and productivity as the team takes on larger tasks as part of the research enterprise.

External Funding Considerations

A psychologist can enhance the likelihood of obtaining NIH funding by becoming aware of the relevant NIH institute’s funding history and priorities. Every institute provides a description of its research priorities that is publically available on the internet. Any psychologist would be wise to know what those priorities are and to write research grants that are explicitly consistent with those priorities. Requests for Applications (RFAs) and Program Announcements (PAs) are regularly published on the NIH website and should be specifically referenced in any grant application. When faced with all applications that have achieved a positive scientific review, Institutes do not always fund grants solely by their scientific review score. Based on Institute priorities, a grant with a poorer score may be chosen by the Institute for funding over a grant with a better score. Grant applications that specifically address institute priorities are more likely to achieve a more favorable scientific review and are also more likely to achieve funding priority when the institute makes its funding decisions.

Investigators submitting NIH applications can request the application be assigned to a specific institute. RFAs and PAs commonly list more than one institute in their announcement. In such cases, it may be useful to evaluate the recent funding patterns of the participating institutes (e.g., see Table 2) and request an institute that has a stronger history of support for the behavioral sciences.

Any psychologist trying to obtain NIH funding should seek mentors both within the psychologist’s own institution and where possible from the relevant NIH institute. Institutional mentors should have NIH PI experience and be willing to read and critique the psychologist’s grant applications. Psychologists often have to seek mentors outside of their department or even their institution or rely on multiple mentors from different disciplines or content areas. It can sometimes be difficult to find such mentors unless there is some institutional support for both identifying appropriate mentors and assuring the mentor has the sufficient time, resources, or acknowledgement to make mentorship a viable use of the mentor’s time. The psychologist may want to negotiate this type of support with his or her department chair at the time of hire or when undertaking a new research area.

Most NIH institutes have individuals with whom you can discuss your research ideas and their viability as a funded research project. RFAs and PAs identify the contact information of institute personnel familiar with the institute’s priorities. Although these individuals are not part of the scientific review process, they can help steer a new investigator toward areas that are particularly important from an institute’s perspective and sometimes attend scientific review sessions as observers. When final institute funding decisions are made, they may have influence on which of several scientifically worthwhile projects get funded.

NIH funding is difficult to achieve and all investigators should expect to submit their application more than once. Even very good applications are unlikely to be funded upon first submission. The investigator is wise to resubmit as soon as possible, addressing all reviewer concerns. If the investigator waits too long to resubmit, the study section reviewers’ are likely to have changed and a whole set of different issues may arise. In my experience, successful NIH grantees are highly persistent and do not let an application’s failure to obtain funding dissuade them from their goals. It is often very difficult to see something you have spent so much time writing fail to receive funding. However, this is the nature of the NIH funding process. If you want to be an NIH funded investigator, you need to accept the fact that you will write (and rewrite) many grants and only some of them will be funded.

Look for “Big Science” Opportunities

NIH is the largest funding agency of health-related research in the world. Because of its size and resources, it can undertake projects that would be impossible for a single investigator. These “big science” projects typically ask an important question and require multi-site data collection. They are typically funded by cooperative agreements and have major NIH oversight. I have had experience with a number of these cooperative agreements in the diabetes arena—the Diabetes Prevention Trial-Type 1 (DPT-1) (http://www.niddk.nih.gov/patient/dpt_1/dpt_1.htm), the Environmental Determinants of Diabetes in the Young (TEDDY) (http://www.teddy.epi.usf.edu/) and Type 1 Diabetes TrialNet (http://www.diabetestrialnet.org/)—but there are many others. However, since I am familiar with these efforts in diabetes, I will use them for illustrative purposes. These are very large projects answering very difficult questions. For example, the DPT-1 screened more than 100,000 relatives of patients with type 1 diabetes to find 711 subjects to be randomly assigned to intervention and control arms in a prevention trial conducted by nine coordinating centers in the U.S. TEDDY will screen over 340,000 newborns in four countries to recruit 8,000 families with infants genetically at-risk for type 1 diabetes in an attempt to find the environmental trigger of type 1 diabetes in genetically at-risk children. TrialNet consists of 18 clinical centers in eight countries conducting multiple clinical trials with patients in the early phase of type 1 diabetes, seeking new approaches for diabetes prevention. TEDDY and TrialNet are funded by a special congressional mandate of $1.14 billion over a 10-year period (1998–2008), with current spending at $150 million per year (http://www.t1diabetes.nih.gov/about.shtml). NIDDK is the lead institute. Most “big science” projects are not funded by congressional mandates. In fact, most NIH institutes set aside funds for this type of “big science” effort. Often, multiple institutes are involved and sometimes other funding agencies.

Table 3 provides data on the number of new cooperative agreements over 5-year windows from 1987 through 2006 for all of Health and Human Services, for the three “mental health” NIH institutes and for selected other NIH institutes. The table also provides the percent of these cooperative agreements with a behavior code, indicating they have some sort of behavioral component in the study. The data were obtained from the NIH CRISP website (http://www.crisp.cit.nih.gov/). Over all, the number of cooperative agreements has been increasing; there is a particularly striking increase in the last 5 years. This type of funding activity is generally less common in the traditional mental health institutes although NIMH has seen a very large increase in this type of activity in the past 5 years. Overall, behavioral studies do not appear to play a large role in these projects, although the number of agreements with behavior codes has increased in the last 10 years. It is not surprising that the majority of traditional mental health institute cooperative agreements have behavioral studies components. However, for the other NIH institutes, with the exception of NIA, the inclusion of behavioral studies is relatively rare. I believe this is a very large potential growth area for psychology. Many of these cooperative agreements are for clinical trials or studies that involve recruitment of large numbers of patients into difficult study procedures. There are huge issues surrounding informed consent, recruitment, and retention, impact of the study protocol on participants and their families, participant adherence with the study protocol, and the use of behavioral “life style” interventions, to name a few. Psychologists are well positioned by training to address these issues but historically have not been part of this effort. I have found my own work in this area to be challenging but immensely rewarding (e.g., Johnson, Baughcum, et al., 2007; Johnson, Lernmark, et al., 2007) and encourage others to seek opportunities to join and contribute to “big science” research teams.
Table 3

Number of new cooperative agreements by institute, time and (percent) with a behavior/behavioral code

Institute

1987–1991 (%)

1992–1996 (%)

1997–2001 (%)

2002–2006 (%)

ALL HHS

1,117 (10.8)

1,489 (10.1)

1,925 (20.2)

4,421 (15.6)

NIMH

62 (19.4)

47 (27.7)

31 (90.3)

164 (76.8)

NIDA

34 (61.8)

22 (45.5)

55 (52.7)

41 (63.4)

NIAAA

30 (16.7)

5 (20.0)

58 (41.4)

80 (76.3)

NCI

268 (06.3)

325 (05.8)

423 (11.6)

417 (19.4)

NIDDK

16 (06.3)

85 (09.4)

183 (10.4)

206 (08.3)

NHLBI

78 (24.4)

126 (13.5)

252 (13.5)

305 (14.1)

NICHD

64 (14.1)

69 (40.6)

145 (29.0)

163 (18.4)

NIA

26 (46.2)

24 (54.2)

17 (17.6)

37 (40.5)

Influence the Process

Once an investigator has some success in the research arena there will be many opportunities to influence the research process itself. Investigators are often asked to serve on study sections and I firmly believe this activity is important for several reasons. First, participating in the review process helps all investigators become more successful applicants themselves. Investigators often get a better picture of the review process itself and how other members on the study section—especially those from other scientific disciplines—perceive the work of psychologists. Observations of this type can only help the investigator write his or her own applications in a more readable and convincing manner. However, study sections also permit the participant to argue for the importance of behavioral science and to promote high quality applications from psychologists. In my experience on study sections, I am often disturbed to see psychologists tear down a fellow psychologist’s application as if the purpose of the critique was to impress the other non-psychology members of the study section with the reviewer’s remarkable intelligence. In the larger scheme of things, this is not helpful. It undermines psychology as a science and only makes it more difficult for all psychologists to get NIH funding. I am not suggesting that poor psychological science be promoted. However, I am suggesting that critiques be fair and balanced and when a high quality application is submitted by a psychologist, I believe in advocating for it.

Many psychologists are part of other organizations relevant to their particular patient care and research interest. For example, I am a member of the American Diabetes Association (ADA) as well as a number of other more psychology-oriented associations. I strongly believe that psychologists should advocate within these associations for the importance of behavioral science as well as encouraging the association itself to advocate for behavioral science within NIH. For example, within the ADA, psychologists set up their own section (Behavioral Medicine and Psychology) and have used that as a mechanism to increase attention and resources devoted to behavioral science within ADA activities and publications as well as a forum to increase NIDDK funding for psychological research. Although similar efforts are important within psychological associations, I think they can have equal or perhaps larger impact when they are part of an interdisciplinary organization or an association that focuses on a particular patient population. Although psychologists often feel they do not have time for association service, I strongly believe that this type of activity can have a significant impact on improving research-funding opportunities for all psychologists.

Educational Issues: Preparing the Next Generation for Research Success

In this article, I have highlighted the numerous research opportunities for psychologists in the broad NIH family beyond the traditional mental health institutes. Behavioral science will continue to be an important component of health research. The question remains: who will conduct this behavioral science? Will it be psychologists or will it be other investigators trained in public health, epidemiology, sociology, anthropology, health education, nutrition, exercise science, or nursing? Of course, the answer is “both” but I am very concerned that unless our educational programs change, psychologists will have a small share of this behavioral science research pie. This is a poor outcome not only for psychologists but also for the scientific enterprise as a whole since psychology’s methodology and conceptual critical thinking are second to none.

However, in my view, most psychologists are not being adequately prepared to take advantage of the research opportunities I have articulated here. Many educational programs remain insular in departments of psychology, training students to conduct studies using traditional methods and populations (e.g., undergraduate subject pools) and publishing in psychology journals. This is not the type of training that will prepare the next generation to be successful NIH investigators. Today’s students need training in interdisciplinary research. They need knowledge and experience in issues relevant to conducting large-scale clinical trials (e.g., recruitment, retention, protocol adherence, study design). They need expanded quantitative methods (e.g., epidemiology, survival analysis) and exposure to the practical issues of conducting research with medical patients (e.g., informed consent, HIPPA, electronic medical records). They need to learn to write for and publish in medical journals. These are rare components of our current educational programs and unless this changes, psychology will be the loser.

What Can APAHC Do?

APAHC is in an excellent position to address these important research education and training issues. Academic health centers offer the ideal setting for graduate psychology research training, with access to multiple patient populations, interdisciplinary research teams, expanded expertise in quantitative methods and study design, exposure to clinical trial and “big science” research, and research mentorship. In my view, APAHC should work with the American Psychological Association’s Science and Education Directorates, as well as other organizations, to find ways to increase the number of psychology research training opportunities within health science centers. These training programs could take many forms from full scale training programs at the pre-doctoral and post-doctoral level to joint programs with existing psychology graduate programs to individual mentored research experiences. In my view, psychologists working in health science centers hold the key to psychology’s future success in the NIH research enterprise. Unless this important resource is effectively tapped as part of psychology’s research training programs, the next generation of psychologists will be poorly positioned to become successful investigators at the NIH level. For me, this is a disheartening view of the future since I see psychology’s potential as so great. Unfortunately, current training programs are often comfortable with the status quo and fail to recognize many of the issues I have articulated here. Positioning psychology to play a major role in NIH supported research will take advocacy and I hope APAHC can be a leading advocate for change.

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© Springer Science+Business Media, LLC 2008