Being an academic surgeon is incredibly rewarding. While many may aspire to become a surgeon-scientist, the process to succeed early in one’s career may not be straightforward. Each year the Center for Healthcare Outcomes & Policy (CHOP) at the University of Michigan welcomes fellows for a dedicated two years of research. These two years serve as a pivotal launching point for their careers as surgeon-scientists, and over that time they experience three distinct phases in their development.
Herein we describe our process for mentoring early career scientists through these phases. For each fellow, we align intentional strategies as they move through each phase.
Phase 1: Moving Forward When You Don’t Know Where You’re Going
At the beginning of their fellowship most do not know what they want to study, but still want to move forward. During this phase we focus on transferable skills. These are skills that we believe will be valuable to them regardless of their ultimate direction. Examples of transferable skills include basic quantitative analytics, clear scientific writing and compelling public presentations. To develop these transferable skills, we implement three specific strategies:
Graduated Autonomy – Our approach to teaching research mirrors how we teach residents how to operate. We focus on graduated autonomy with early projects being highly mentored, followed by progressive transition toward the fellow ultimately being able to execute a project start to finish on their own. These first projects are excellent launching points during our Summer bootcamp to help teach the mechanics of clear writing.
Summer Bootcamp – Every summer our fellows enroll in an 8-week summer bootcamp. Over that time, they learn to analyze a basic administrative claims data set using STATA. They also arrive with an abstract, tables and figures from their mentor and over the 8 weeks we teach them to write each section of the manuscript. Because our sessions are in-person and everyone has a steep learning curve, we generate an import cohort effect that creates community among them. The strategy here is similar to the intensive training workshop that we design for incoming clinical surgical residents.
Focused Mentorship – While fellows may ultimately work on projects with several mentors over time, we encourage them early on to stick to one or two. Having a limited number of mentors early on help fellows stay focused on learning core concepts and gain early confidence in their emerging skills. Similar to teaching residents how to do operate by having residents perform similar procedures with the same attending, we try to keep their early research projects focused.
Phase 2: Going Faster Once You’ve Found Your Direction
As the fellows acquire their transferable skills, they also begin to hone the direction of their ultimate work. For some it may be a specific content area (e.g. rural surgery), while for others it may be a specific method (e.g. interrupted time series analysis). As they develop their own areas of expertise, we encourage them to explicitly identify it and compound the advantages of that hard earned new skill. In this phase, we focus on three development strategies:
Identifying Red Threads of Expertise – With some prompting, fellows are often able to identify their own “red threads.” These are areas of expertise that when performed give the fellow energy, excitement and joy. Common prompts to identify them include: “When was the last time you did something and totally lost track of time?” or “What was something you did and were surprised how well it went the first time?” Such prompts help fellows identify the domains where they focus and build an arc of work on the same theme.
Multiplier of Analytic Expertise – One common form of expertise for fellows is analytic expertise around a specific data set or analytic approach. It is not uncommon for fellows to need six months to understand all the mechanics of administrative claims data or registries or how to appropriately risk- and reliability-adjust an outcome measure. But rather than learn it and move on to a new method or dataset that may take another six months, we encourage fellows to compound their advantages and execute multiple projects using that same analytic expertise.
Multiplier of Content Expertise – Similar to analytic expertise, fellows often develop a specific form of content expertise. This can be around a specific clinical area (e.g. emergency general surgery) or a specific policy (e.g. Medicaid Expansion). As they build this important expertise, we encourage them to “stay on topic” and take advantage of all the references and nuances they have learned to really go deep and sharpen expertise in that domain.
Developing deeper domains of expertise that extend from their red threads and discretionary energy serves as an important bridge to Phase 3 where they begin to collaborate with others.
Phase 3: Scaling Impact with Others
As fellows develop their expertise and can consistently execute projects, we transition our focus toward impact alongside others. Without question, several fellows will be able to go far on their own, but we believe they can go much, much further and have more impact if they do so alongside others. To scale impact alongside others, we take on three strategies:
Co-located Office Space – Our fellows offices are intentionally located alongside each other and other experts. We create an office environment that encouragement movement and interaction with visible “works in progress” and areas of interest to increase the probability of a chance interaction that leads to a collaboration.
Ritual Seminars – Our center revolves around seminar rituals that give fellows a chance to showcase their evolving work and also identify emerging collaborators. Our Tuesday morning seminars (led with coffee and donuts) are focused on quantitative methods (affectionately called “Data and Donuts”). On Fridays, we have a longitudinal curriculum at Noon and 3pm seminars that represent the many components of center including several different analytic approaches (e.g. policy evaluation, qualitative research, implementation science) and content areas (e.g. access to care, adoption of new technology, cancer in younger adults.) In addition to being didactic, these seminars become fertile ground for cross-pollinating new methods and approaches.
Intentional Sponsorship – As fellows grow specific domain or content expertise, we expect our faculty to sponsor them for rolls in relevant societies and national organizations. In doing so, the fellows are able to engage national experts and learn how their expertise can be applied.
Putting it All Together
Over two years of dedicated research early career surgeon scientist move through three stages that each require different development strategies.
- To move forward when don’t know where you’re going, we focus on developing transferable skills.
- To go faster once you’ve found your direction, we focus on compounding advantages
- To scale impact, we look for opportunities to collaborate and scale alongside others.
While this framework and set of strategies is specifically geared toward fellows in their two years of research, we also find it helpful for early career faculty.
Andrew M. Ibrahim MD, MSc