Fostering an Effective Team for MCCs Research

Join Dr. Heather Whitson, from Duke University School of Medicine, and Dr. Albert Siu, from Icahn School of Medicine at Mt. Sinai, to discuss ways to foster an effective team for multimorbidity research. The pair also define an ideal team, with real-world relevance to your MCC research agenda and strategies that support effective interdisciplinary teams. 

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Transcript

Albert Siu, MD: Hello, I'm Dr. Al Siu from the Mount Sinai Icahn School of Medicine, where I am a professor and past Chair of Geriatrics. And I am here today with Dr. Heather Whitson, Professor of Medicine and Director of the Duke Aging Center. Today we're gonna be discussing key points from the Being an MCC Researcher module of the AGS/ AGING LEARNING Curriculum.

So, Heather, welcome. 

Heather Whitson, MD: Thanks. Thanks for having me. I'm excited to talk to you about this. 

Albert Siu, MD: Heather, let me start this off, you know, by asking you a little bit about MCC teams. You and I have both been in- involved in cobbling together MCC teams, and they almost required that we bring together investigators with different types of content expertise or methodological training.

By its nature, we're dealing with multiple chronic conditions, so we may need specialists involved in treating some of the more common chronic [00:01:00] conditions. We may need people involved, you know, in clinical trials with clinical trials expertise. We may need individuals, you know, with expertise and outcomes research, et cetera.

So that is often a challenge, certainly for young investigators starting out in the field. Can you talk a little bit more about that and offer perhaps an example where you've seen that, that diversity as a real asset to cobbling together a team to investigate issues in multiple chronic conditions? 

Heather Whitson, MD: Sure, sure.

I, I think I can give two examples of that and you know, when I think about the diversity on a team in, in a sense there's, there's sort of two types. There's the diversity that we all bring through our content expertise, you know, our, our training and our background and, and what part of the multiple chronic conditions puzzle we've been trained to understand.

And then there's also the diversity that we just bring as people, who have perspectives in the world, and [00:02:00] we've all grown up with our own lived experiences. And I really think both of those kinds of diversity enrich a team. 

So I guess an example of the, of the first a very concrete example is, as you know, some of my work in multiple chronic conditions has been considering chronic vision impairment as one of those chronic conditions, but in the setting of other conditions that a person has. 

And very early on, really on my my K award project, I remember being so thankful when I was planning the budget for that project that my team included, number one, an occupational therapist who had a lot of experience with the day-to-day lives of the population that I was gonna be studying. And then in addition, we had a person on the team who was herself visually impaired.

So those two people were the people who told me when I was planning the budget that I needed to include a budget for car service. That some of the participants would only be able [00:03:00] to come into the study if we provided car service because they're visually impaired and they, they wouldn't be able to drive and some might not have a driver that that could provide that transportation. And that ends up being a fairly hefty charge for somebody on a, on a K ward that I don't know where I would've come up with that funding if I hadn't had that built into the plan at the beginning of the study. So it's kind of not something that can be tagged on or that you can figure out as you go because you have to budget for it. So those, those two things were incredibly helpful, having, having people on the team who knew something that I didn't about that particular problem. 

Another time that I think just having the other kind of diversity on the team was super helpful was in 2020 in, in the wake of, you know, the summer of 2020, having on the team people who were African American, could experience that time in history through the lens of that community was incredibly helpful again, in understanding the impact that that time was having on our [00:04:00] participants, our- other members of our team. And so again, I think that was a time when I was super grateful that this team of people that are coming together, because they all have different expertise, that we also had people who could sort of bring their different experiences to bear because that also affects the quality of your research you when a community is really dramatically affected like that.

Albert Siu, MD: Heather, that is so interesting. And certainly over the last decade or more we've also tried to bring patients onto the team for the perspectives that they bring. And I think you know that your two examples really drive that home. Those perspectives can come from team members as well as from patients.

Heather Whitson, MD: Yes, so important. I think that that is a huge part of the team as well. It's something that, that is important for all researchers, but for people who study multiple chronic conditions, it's really important to have the voice of patients living with multiple chronic conditions from all stages of the [00:05:00] development of the idea through the implementation.

Albert Siu, MD: You know, and not only do we frequently, you know, bring together individuals with diverse experiences, but sometimes we need to bring together individuals with different academic expertises. Even within medicine, I have found sometimes that working with surgeons, for example, can be very different from working with internists. And certainly when we bring in social scientists, their methods of working and how they publish can be very different so that we create some sort of academic culture clash where people are used to different communication styles or expectations around publication. 

Can you provide some tips, you know, for managing those issues?

Heather Whitson, MD: Yes. And some of these have been learned through painful experience. But yes, I think that that's honestly one of my favorite parts of doing multiple chronic conditions [00:06:00] research. My longtime mentor used to tell me that I never met a collaboration I didn't like, and that's probably true. But it's also very true that you sometimes do experience that -there are just- fields are- are different in how they approach even something as simple as communication.

So what I've learned is that at the beginning of kind of assembling or bringing together these teams of people that come from different disciplines, it's important to just kind of almost have a, number one, have a full team meeting on a regular basis, which it's very easy for that not to happen for the PI to just kind of speak with the different experts one-on-one or differently and it's, it's hard to schedule everybody to come together. But I think having a touchpoint where people come together, even if it's just a 30 minute Zoom on a quarterly basis for the whole team to be in one place. 

And then at the very first one of those, I try to have a launch meeting where we sort of talk about some of the things that I've learned can be sticking points such as [00:07:00] different team members' expectations around communication. As simple as "Do you email? Do you check your, you know, do you use your email?" 

Because there are some people who will say, that's not my preferred communication. And what I've found is, you know, just a- the stereotypical is that, social scientists on the team may write really, really long emails that are full of rich information, and those will not be read by, by other members on the team. So just establishing that kind of upfront. 

Another big one is around data sharing. And in some disciplines or, or on cer- certain teams, there's really a lot of sensitivity around how freely we share even ideas outside the team because of concerns about IP or being scooped by other, other researchers. And then for other teams, we sort of just we're, we're not, we're not used to thinking that way. 

So I've, I've found, the final one I would say is publication. So setting those expectations and talking about that very directly upfront. If we can say, these are the main [00:08:00] publications we know will result from this project together and sort of a sign in the beginning, who's expected to be the first author and senior author of each of those. And then also kind of set some ground rules for if other publications bubble up and present themselves, how does this team want to govern itself with regard to who should be first author, who should be last author, and also who qualifies for authorship on any other publications. I think setting those ground rules from the beginning is so important. And again, I've, I've learned the consequences of not doing that.

Albert Siu, MD: Heather, that is so true, you know. And the other piece of this is that sometimes academic disciplines approach publications very differently.

In social science. It would be highly, highly unusual to have a publication with 10 authors. Departments and promotions committees would not know what to do with them and, you know, and what to do with these authorship orders. [00:09:00] And sometimes, you know, I've wished you know, that we could do authorship orders the way they did movie credits, you know, where they roll out, you know, individuals' contributions.

Have you encountered this issue? 

Heather Whitson, MD: Yes, absolutely. And you know, I always refer the team to- there, there are the ICMJE guidelines that we all of course follow. But there is a lot of gray area and room for interpretation even within those guidelines. And so, yes, I think for example, the contributions of recruiting the patient population are not always recognized or seen as contributing to a certain analysis that might be done later if, if the, if the team that comes in later and does the analysis thinks, well the data's here and my team accessed the data and did an analysis and we didn't have to talk to any of the people who were originally involved in making that data exist through, through patient recruitment.

But then the people who [00:10:00] did the recruiting feel well, that was an intellectual contribution to even make the data available. So I, you know, we want to be involved and engaged and, and have rightful authorship on that publication. And I think just again, establishing that sort of understanding upfront is really helpful.

Albert Siu, MD: Gosh, you almost have to have a, a therapist or counselor on the team, you know, to navigate some of these issues.

Heather Whitson, MD: True. It's true.

Albert Siu, MD: What are some of the resources that are out there, you know, to help new investigators establish and foster their teams? 

Heather Whitson, MD: Yeah. I think in terms of the resources, one of the best resources is just other people who have done this before. So, so really leaning on mentors and maybe not just mentors who have done research in a single discipline or, but really talking to people who have participated in transdisciplinary research and have had these experiences.

Then in addition to that, there are some resources out there. The AGING [00:11:00] Initiative itself offers some, some tips and tools on its website. There's even a website called MultipleChronicConditions.org that, that offer some tips on this and some potential connections. People that can help you build your team or just help sort of think about some of these issues upfront.

Albert Siu, MD: Great. I think that'll be a, a useful resource to investigators. Thank you Heather. This is Al Siu. I've been here today with Heather Whitson from Duke recording a session on Fostering an Effective Team for MCC Research for the AGS/ AGING LEARNING Collaborative.

Heather Whitson, MD: It was great to talk with you Al. Thanks so much.

Albert Siu, MD: Thank you.