Dibs, PhysioProf.

September 30, 2011

Has anyone else heard this surgeon guy with the “professional coach” book he’s shilling?

“The coaching model [is] what you think of with athletes and singers, who have someone who coaches them all the way through their career, even if they’re one of the best in the world. But violinists and surgeons — at least in our theory of how we’re supposed to do it — we don’t. You go to medical school, you go to Juilliard, and you graduate. You get a degree, you get in your 10,000 hours of practice, and then some cream [is] supposed to rise to the top.

“But I was really struck by how different these models are and tried to understand it … I had a fascinating discussion with Itzhak Perlman, the great violinist, and I said, ‘Why don’t violinists have coaches, but singers do?’ And he said, ‘I don’t know, but I think it’s a mistake.’

“He said he had a coach his entire career. In his case, his wife …

Do we need coaches, Professoriat? At the lectern or at the bench, okay, Atul Gawande covered that. But what about the rest of it?

Reviewing manuscripts or grants. Writing them. Advising trainees. Collaborating.

Would we benefit from professional coaching?

First PhysioProf baited me with this ridiculous commentary in Nature from John P. A. Ioannidis. Then Genomic Repairman took a cast and then PiT threw a big box of chumsicle into the water.

What could I do, DearReader? What could I possible do but chime in?

Before I get into this, a minor caveat to my remarks. I do like the fact that Ioannidis proposed a number of different fixes and suggested a pilot-study type of approach. I’ve made similar proposals for trying new ideas on this very blog. However. Proposals for change should be based on a clear and honest recognition of the present reality.

Ioannidis:

Leading thinkers and experimenters worthy of unconditional support could be identified through peer assessment of their work and credentials. Appraisals of project-based proposals already take a scientist’s merit into account, but they typically give less weight to it than to the project plan. Peer assessment does not work well for early-career scientists, who have a short track record. But for those more established in their field, a career trajectory offers a wealth of information. By contrast, an isolated project is only a snapshot.

This is a not uncommon suggestion. Our old friend Noonan was proposing this just a little while back.

It is based in large part upon this false belief that the NIH system actually works as formally designed. It does not. Or at least, not so far as it is supposed to be a strictly project-based (i.e., proposal-based) system of grant funding. Ioannidis deploys “typically” in a context that makes it clear that he equates this with “nearly exclusively”. This is total nonsense.

Admittedly, I had an experience in the very first months of my independent career that emphasized the person-based nature of the NIH funding system. In spades, with emphasis and I will admit quite shockingly. I mean, I had grasped the substantial table-slanting toward the established investigator already as a late-postdoc. But this was a whole ‘nother bit of whammo.

So in my case I have been aware of this for some time. I didn’t understand how it really worked, insidiously and no doubt unconsciously for the most part, until my first study section meeting. That’s all it took.

I have related my anecdotes regarding this before. The first time, I think my jaw was literally hanging open in disbelief. It happened in my presence many times after and I have heard similar anecdotes from friends on other study sections. I have no reason to think that “our” end of the NIH world is so startlingly unique. It is encapsulated by the review of a grant, typically a competing continuation but sometimes a new proposal, from a very well respected and established scientist. The reviewer(s) get to the end of a rambling critique in which it is made emphatically clear that the proposal is jam-packed with stuff, confusing, devoid of logical design, consideration of alternatives, hypothesis testing and generally full of StockCritique Bait common to that particular section. In short, a crappy proposal that would be kicked unceremoniously to the curb, were it anyone less legendary. Then the reviewer finishes by saying “But I know Professor Grey Fox’s lab is going to knock our socks off with great stuff because she has such a fantastic track record of unbelievable contributions. Post-discussion score, 1”.

The perception that the NIH system is in part a Person- or Program-based funding system is reinforced by experiences with the Programmatic pickup behavior. When times started getting grim I had personal conversations with POs in which they stated nakedly that keeping “their established investigators” in grant funding was a high priority…they were deaf to my observations that new investigators who were not able to launch were also a high priority and a better long term investment.

When you are are considering a competing review, on study section, you get to see the Summary Statement and scores for the original proposal. Sometimes, that original Summary Statement makes it clear that the proposal sucked, was lucky to get a marginal score in review and Program picked up that dog turd anyway! Then, to add insult to injury, sometimes the current competing app is just as bad as the original one, the critiques you make are similar to many criticisms made by that earlier group of reviewers…and you later find out that Program picked up this dog turd too!!!

GAaaahhhh!

Unless it is ME, of course. Dude, I totally have NIH proposals under review these days and I am no longer a NoobProf. I mean, what am I saying here? Nevermind that stuff. If you are a reviewer out there looking over my proposals and notice any StockCritique Bait, feel free to ignore any deficiencies in my proposal writing. In favor of the fact that you know me and I’ve managed to publish a paper or two. And for the most part been “productive” on my prior awards. C’mon now. I need some of that People-based funding love! (Oh, and for any of my POs that are reading, I was KIDDING about that dog turd stuff- friends?)

Returning the NoobProfs who are now screaming in dismay back to earth, let me note that despite this fact, the Project-based part of the NIH system does work too. Good proposals from less known investigators get funded all the time. Just go to RePORTER and look up some Noobs in your subfield. Some of them get funded. From my study section experiences it became clear that in many of these cases the Noob got funded by proposing something excellent, not just because she happened to have postdoc’ed with ol’ Horace Grizzler or Grey Fox. Great proposals from young (and not so young) investigators who are not tied cosily into the system get funded.

So when you hear a guy like Ioannidis implying that the system needs novel introduction of “person-based” grant funding, realize that we already have a balanced system. It is not exclusively person-based, nor is it exclusively proposal-based. There is a mixture.

Naturally, people’s assessment of the current “balance” is greatly influenced by their perceptions (and misperceptions*) of their own status within the system and their predictions about how to make it easier for them to get the grant money that they deserve. I have a pretty short fuse for such nakedly self-serving myopia.

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*How do they know they would be the one judged to have a track record that merits some sort of BSD-based funding?