NeuroVoices: Craig Blackstone, MD, PhD, FANA, on Helping Path Research Careers for Young Medical Professionals

Craig D. Blackstone, MD, PhD, FANA

In nearly every US state, a large mismatch exists between the need for neurologists and neurologic services and the availability of neurologists to provide these services. Patients with neurologic disorders are rising in prevalence and require access to high-level care to reduce disability. While the neurology community is certainly vying for additional members, a lot of those in the field understand the complexities and indecision that comes with choosing a career path.

At the recently concluded 2023 American Neurological Association (ANA) Annual Meeting, held September 9-12, in Philadelphia, Pennsylvania, a Research Careers Reimagined course covered the broader career options young medical professionals have at their disposal, and where they may turn to once school is done. One of the sessions, "Flexibility and Monitoring in Early Career Research: Navigating Promotion Pathways and Doing What You Enjoy Most," led by Craig D. Blackstone, MD, PhD, FANA, aimed to guide the upcoming generation based on their interests.

in an interview with NeurologyLive®, Blackstone, chief of the Movement Disorders Division at Mass General Hospital, noted that medical students may not fully be exposed to options that are of interest for them, and that the clinical community needs to continue to shed light on potential career paths. As part of a new iteration of NeuroVoices, Blackstone shared insight on the session covered at the meeting, the challenges and indecision medical students face, and the critical importance of an indispensable mentor.

NeurologyLive: Why did you choose to get involved in this? Can you tell us more about the revamped course?

Criag Blackstone, MD, PhD, FANA: This course has been in existence, in various forms, for about 15 years, and I've been its director for several years in the past. Historically, our focus was on teaching people the ins and outs of translational and clinical research. It was named the Translational and Clinical Research Course (TCRC). However, over time, both the AMA and many participants in the course realized that there's a greater need. We shouldn't just train individuals to be clinician-researchers; we should provide a broader perspective on the various career options available in research. We need to think beyond the limited options we considered 15 years ago.

We wanted participants to explore careers in the industry, different ways of shaping their careers. It's not just about being a clinician or a basic researcher; there are numerous paths one can take. Securing funding from various sources, such as foundations, the NIH, or philanthropic support, is also crucial. If you look at our course, you'll notice that it covers these themes extensively.

One of my primary goals was to understand our participants better and their career aspirations. So, every year, we gathered feedback and adjusted the course accordingly. Ultimately, our aim was to guide the upcoming generation based on their interests.

As young medical professionals enter the field, they may find it challenging to discern the best paths for themselves.

Certainly, there are a couple of challenges. First, medical school doesn't provide a comprehensive exposure to various medical specialties or subspecialties of neurology, as we do. While medical education is evolving, it still largely revolves around hospital settings. However, areas like mine, movement disorders, primarily involve outpatient practices. This can limit students' exposure to the diverse career options available. We need to ensure that students are exposed to the full spectrum of potential career paths.

Moreover, the nature of medical education has changed. In the past, many physicians, like me, spent a few weeks each year in hospitals, allowing people to get to know them. Nowadays, the role of hospitalists, experts in inpatient care, has become more prominent. While they play a crucial role, they might not have the same knowledge or ability to guide students toward non-hospital career options. We need to be flexible in how we expose medical students to the wide range of career paths in medicine.

There's also the element of uncertainty. With advancements in healthcare technology, some medical students fear that they'll be working round the clock. This uncertainty can create anxiety. Additionally, medical students often face constant evaluation, adding stress to their lives. In academic medical centers, there's significant consolidation occurring, further contributing to this uncertainty. While most healthcare professionals love practicing medicine, they worry about external factors affecting their career plans. They might feel a lack of control and uncertainty about the future.

In terms of values, what should mentors embody when teaching students?

Mentorship involves being part coach, part teacher, and part advisor. However, the most critical aspect of being a mentor is listening. When you meet someone, it's easy to provide immediate advice and move on. But taking the time to truly listen and understand a mentee's career goals, aspirations, and how medicine fits into their life is essential. With this understanding, you can better guide them, not by dictating what to do, but by presenting options and helping them make informed decisions.

I've mentored numerous individuals, and I've learned as much from them as they have from me. My mentees are my teachers. I strive to understand the unique era they're training in, which differs significantly from my own. This understanding allows us to be more effective mentors.

Notably, professional societies like the AMA have recognized the importance of engaging with the next generation. Instead of merely teaching or dictating, the focus is on creating interactive experiences, networking opportunities, mentorship, and career guidance. This shift is evident in many professional societies, not just the AMA.

How can we increase the number of specialists in movement disorders?

One of the primary challenges is the limited number of positions available in every medical field. To address this, we aim to attract more individuals to our specialty, even though it might mean diverting them from other fields. We must showcase movement disorders as a rewarding career choice.

What sets movement disorders apart is our potential to treat common conditions like Parkinson's disease, Huntington's disease, neuropsychiatric disorders, functional neurological disorders, and Tourette Syndrome. We're on the verge of more effective therapies. The excitement lies in the multitude of areas one can investigate within movement disorders. We're approaching an era where we can slow down disease progression, not just provide symptomatic relief. This requires research, innovation in clinical trials, and diverse roles in industry and regulatory agencies.

Movement disorders specialists possess clinical acumen and focus on history-taking, observation, and examination in diagnosis. We follow our patients over extended periods, getting to know them deeply. These aspects make it an exciting field for physicians. However, the challenge lies in introducing medical students and residents to our field, given the hospital-centric nature of medical education. There's limited exposure, and we must make the most of the short time we have to captivate their interest.

Foundations like the Michael J. Fox Foundation support initiatives to introduce neurology residents to our field. Patient foundations also play a role in encouraging aspiring physicians to explore movement disorders. Innovative approaches are essential to showcasing the excitement of this field.

In the years ahead, where should research efforts in movement disorders be focused?

Research in movement disorders should align with the trend toward personalized medicine. We're moving away from the one-size-fits-all approach and delving into individualized care. For conditions like Parkinson's disease, we're starting to identify specific drivers of the disease, which may vary among patients. This understanding will help us tailor treatments to individual needs, allowing us to intervene before symptoms manifest.

Clinical trial innovation is another critical area. We must design trials that consider disease subtypes and focus on patient selection. If we don't choose the right patients, we won't obtain positive results. Therefore, selecting trial participants is a vital aspect of future research in Parkinson's and other movement disorders.

Additionally, the growing understanding of genetics and its role in movement disorders is essential. We're making strides in this area, which will guide us in identifying therapeutic targets. Furthermore, the use of devices like deep brain stimulation is on the rise and holds promise for the future.

Overall, research in movement disorders encompasses genetics, clinical trial design, and the development of innovative therapies. To facilitate progress, it's essential to have experts in the field working not only in clinical practice but also in industry and regulatory agencies. This will ensure a comprehensive approach to advancing our understanding and treatment of movement disorders.

At the moment, I serve as the president of the Council on Science and the Council on Research at the AMA. The Council on Science advises the AMA on scientific matters, including issues related to stem cells and artificial intelligence (AI) in medicine. The Council on Research focuses on advocating for research funding and supporting research careers.

These roles are distinct but essential in today's medical landscape. The AMA has expanded its focus beyond traditional areas like physician payment and now engages in cutting-edge topics like AI. It's an exciting time to be part of the AMA, and I believe many other professional organizations are taking similar steps to address the evolving needs and challenges in the medical field.

Transcript was edited by artificial intelligence.