Dr. Christopher Whitlow Interviewed by Dr. Paul Bunch

Christopher T. Whitlow, MD, PhD, MHA is the I. Meschan Distinguished Professor of Radiology with Tenure, Chief of Neuroradiology, and Interim Chair of the Department of Radiology at Atrium Health/Wake Forest School of Medicine. He also serves as director of the combined MD/PhD program. Dr. Whitlow has authored over 350 peer-reviewed scientific papers, abstracts, and book chapters, and he serves as principal investigator on active extramural grants totaling more than 17 million dollars.

What are the benefits of writing grant proposals?

I think the primary benefit of writing a grant and receiving an award is that it provides the necessary financial resources to really drive discovery and innovation in our field of medicine. Of course, there is a lot of really important research that thoughtful and creative investigators conduct with zero grant dollars, but other categories are simply not possible without a substantial amount of financial support, such as large-scale, prospective, hypothesis-driven work. For example, using imaging to ask questions about pathophysiology at the population level in a prospective way, including patient recruitment and acquisition of imaging outside the context of standard clinical care in an attempt to generate new information and then translating this new knowledge into something that’s clinically meaningful, like a new predictive imaging biomarker. This kind of research endeavor really benefits from financial resources in the form of extramural funding, and this is where a research grant award can give an investigator the support needed to recruit research participants, acquire imaging data, and fund the team that is necessary (e.g., study coordinators, programmers, technical staff, postdocs, graduate students) to achieve success.

It’s worth emphasizing that pursuing research is different in some ways than it was in the past. Specifically, research today is often not conducted by the lone scientist sitting in their Ivory Tower with test tubes and toiling away in isolation. The trend that dominates today has been called “team science,” as no one individual can typically do everything themselves when pursuing important translational questions about complex disease pathophysiology. This endeavor frequently requires a multidisciplinary collective – i.e., a group of talented investigators each applying their individual expertise to a unique problem and mixing their skills together to achieve momentum necessary to push forward in the field. I would say that grant writing has helped me realize the importance of the team and the innovation that can be brought to bear for pursuing really interesting questions in a prospective way using tools and methods that maybe aren’t part of routine clinical care. The exciting part of successful team science in the context of funded research is the new knowledge that is generated, which can improve our ability to take care of the patients we serve. This is the flavor of research that would be really hard to pursue for a sole investigator in a retrospective way, without any grant funding, and so if you’re interested in pursuing this type of work, successful grant writing can really allow you jump in and become fully immersed in the discovery process.

Do you remember the circumstances of your first grant proposal? What were the challenges? How did you navigate them?

Yes, I remember that very well. At the time, I was working in a lab and applying to combined MD/PhD programs across the country. I really wanted to stay at Wake Forest because I had already found an academic home in the lab in which I was working. Our MD/PhD Program at Wake Forest was new, and I had been accepted to the medical school and to the PhD program, but I was still waiting to hear whether I received the tuition scholarship and stipend support that typically accompanies matriculation into a combined MD/PhD program. One of my research mentors said “Well, you could always apply for an F30,” and I said “I have no idea what you’re talking about. What is an F30?” My mentor went on to explain that this was a specific funding mechanism for MD-PhD pre-doctoral students that basically funds tuition/stipend support, a research project, and other aspects of the MD/PhD training experience and told me, “Well, if you want to be at Wake Forest but the funding is a question, then you could just write one of these grants and get your own funding.” It was probably November, and I believe the application deadline was in January, so I agreed to give it a try. Not having previously written a full grant proposal presented a challenge, but I was fortunate in that my mentor/advisor had been really generous in letting me participate in parts of the grant writing process, for example, generating small portions of background/significance and reviewing specific aims. Participating in grant writing with a skilled mentor allows you to see how a grant proposal is constructed and to learn from someone else’s example, similar to writing a journal manuscript for the first time. Also, I had my research advisor/mentor and colleagues who were guiding me through the process, critically evaluating what I was writing and providing helpful edits. I have benefited from outstanding research mentorship throughout my training, which continues to this day. I remember feeling a bit overwhelmed at the time but pushed through and was able to get the proposal submitted and then just thought, “Well, I’ll never hear about that again.” To my great fortune, the proposal was reviewed favorably by study section and was funded. I also ended up receiving the institutional MD/PhD scholarship from Wake Forest, but I didn’t need it because I had secured my own funding, which was very reinforcing and enlightening for me, realizing that I could secure a level of academic independence via extramural funding. Indeed, there is a liberation that comes from extramural funding when you realize that you can create this pathway forward, providing an avenue to pursue the work you’re passionate about, and that you yourself can drive the process.

Which piece(s) of a proposal do you write first?

I always focus on the “Specific Aims” first. For any readers who may not be familiar with the different sections of a grant proposal, the Specific Aims section is the very first piece in which you state what exactly it is that you’re going to accomplish with your proposed research and the associated hypotheses you plan to pursue. This section also encapsulates the significance of the work, and should answer the question “So what?” or “Why is this so important?” In this section, you’re really pitching an idea as well as justifying the importance of the work from the proverbial 20,000-foot level, setting the stage for everything else to come in the proposal.
The other piece that I suggest starting on early is the budget and budget justification.

The reason for starting the budget early in the process is that the budget really determines how much science you’re going to be able to propose. Your aspirations may have no limits, but the budget does – a dollar limit – which varies based upon the specific funding mechanisms you engage. So, I typically start with the Specific Aims and then dive into the budget and research plan (back-and-forth), really drilling down on “What am I measuring? Why am I measuring it? How much does it cost to measure? How many research participants do I need to recruit? What is my statistical analysis plan?” These are the kinds of bare bones questions you want to ask yourself and answer early to then build out the rest of the proposal, including the team that you need. Alas, for me, I tend to significantly overshoot the budget on my first pass and then have to cut it back sidling to-and-fro between the research plan and dollar allocation until I achieve a balance between the science proposed and the budget needed. A lot of times the process of scaling back the research plan to fit the budget also really helps to refine the question and ultimately improve the science.

Advice or words of encouragement for young professionals considering writing a grant but also feeling intimidated or not wanting to fail?

Well, I would say that anyone considering writing a grant proposal is going to have to just throw that “not wanting to fail” part out the window. I have written far more grants that have not been funded than grants that have been funded. So, it’s worth understanding that failure is almost expected – if you want to call it failure. I’m not sure I would. Writing a grant proposal that isn’t funded does not mean that you’re a failure. It just means that it wasn’t funded this time around, that you learned something through the process, and that you’ve gotten feedback on the proposal that will help you revise and resubmit in the future. Perseverance and persistence are important. I think to be really successful at writing grants, you just have to keep writing and submitting, and you will become good at anything you do a lot. There’s a bit of a craft to it, but even beyond the craft, really great ideas don’t necessarily always get funded on the first round, and I think that you just have to keep trying and keep writing/submitting. I get really concerned when I learn that an early career investigator’s proposal isn’t funded and she/he says, “Well, I tried to write a grant, and it didn’t get funded. I guess this just isn’t for me,” and my response is “No, no, no. Come to me after you’ve written 20 grants and those 20 haven’t gotten funded and then let’s talk about how maybe this isn’t the thing for you.” Many physicians and scientists who pursue this process may be the product of academic success and high achievement, so NOT receiving a fundable score on the first round may be a foreign experience and where expectations need to be realigned with the reality of funding success, which can take multiple tries for many investigators. My guess is that if you write and submit numerous proposals with the help of an experienced mentor, at least one of them is going to eventually get funded, and that can be all you need to get some momentum going. A single K- level or R01 grant will last you five years and then you can go from there. Perhaps aspire to submit one proposal per funding cycle every year and just keep doing that combined with strong mentorship via advisors who are accessible and with whom you can talk as well as a team that can help critically review your work.

The other thing I’d say in terms of maximizing your potential for success is “Don’t think that science is an activity that you have to pursue by yourself.” Again, use the “team science” approach I discussed previously. As radiologists, we can bring the imaging piece to an investigative team. For example, you might form a dyad with a non-radiology colleague who is perhaps more senior and experienced with grant writing and who is investigating a population that you find interesting but maybe hasn’t yet added imaging to the work. Talk to her/him and discuss how imaging might be inserted into a team science project that can be pursued together as co-principal investigators. This way, you’re not 100% responsible for writing everything in the proposal but rather can focus on your expertise with a partner who adds additional direction, expertise, and dimensionality. Currently, the majority of my funded grants employ this multi-principal investigator (MPI) approach, and I think it substantially enriches the work because of the wealth of talent that team science can leverage, which can help you leap- frog beyond incremental advances to real and substantial innovation.