K Awards: The Journey of a Thousand Steps

Introduction

Grants are a metric of academic advancement, and National Institutes of Health (NIH) funding is highly-coveted. The K mechanism is a category of NIH grant for clinicians and research scientists who wish to become independent investigators¹. Specifically, the K08 and K23 awards are mentored awards for clinicians which provide support for supervised research and career development activities. Both require a minimum of 75% of full-time effort, and are intended for postdoctorate, residency, or early career level clinicians who hold a clinical doctoral degree¹. Importantly, these programs enable aspiring physician-scientists to achieve higher rates of subsequent NIH funding².

In this article, two women reflect on their experiences in applying for NIH K awards funded in early 2020 organized into four lessons. We began this piece to share our experience and encourage more clinicians to venture on the path to a K-mechanism award. Specifically, our target audience is residents, fellows, and junior faculty who may find themselves with less directed mentorship or guidance regarding this specific award mechanism, such as: without effective research mentors, or at institutions with less-established research enterprises. Historically, women received less grant funding than men, though this is currently equalizing³. For some, less specific mentorship may contribute⁴ to hesitancy to consider these awards. We hope that our first-hand experience can provide actionable, realistic advice to help others better plan and position themselves for success, including through seeking a more optimal faculty position with protected time, resources, at a place with the right mentors and infrastructure.

Distilling a Thousand Steps into Five

The K-application process is complex, and the major steps in the K-application process include: 1) defining yourself, 2) positioning yourself, 3) planning, 4) gathering information, then 5) writing (see Table). We cannot fully discuss in detail all the steps leading to a successful K application, but have referenced some resources we found particularly helpful in writing a good K grant^5,6 and negotiating your first research job^7,8. In particular, good mentorship is the perhaps the single predictor of success⁹, and identifying a good mentor is especially important¹⁰.

Table:

Five steps to submitting a National Institutes of Health (NIH) K proposal

Step 1: Define yourself: Identify your area of interest and pathway Identify early career/research mentors to help in this process: https://www.npr.org/2019/10/25/773158390/how-to-find-a-mentor-and-make-it-work Self-reflection about your goals and preferences

Step 2: Position yourself well for the future K submission while in training: Have a good idea, usually building on your experiences and clinical knowledge Submit abstracts to conferences, publish papers in your area of interest (ideally first-author research papers) Consider applications for pilot and foundation grants, young investigator awards Consider grant writing, research methods courses/workshops/electives Secure a faculty position - Develop “job talk” and discuss pathway to K as part of employment negotiations - Understand what to negotiate for e.g. protected research time, resources; ask detailed questions about each institution’s track record; and ask about the level of departmental support/research infrastructure - Search NIH eReporter to identify current K and R grant holders within your potential institutions: https://reporter.nih.gov/ - Think about the pros/cons of staying where you are (you may be on a track and have a mentor already, you know people) vs. switching institutions (chance to change your focus a bit)

Step 3: Develop a “game plan”: Identify your primary K-award research mentor (ideally with NIH funding experience), develop mentor-mentee agreement Create detailed grant writing timeframe, including multiple CDA/grant submissions Create a plan to publish at least two first-author original research papers relevant to your topic Familiarize yourself with NIH resources - Read Request for Application (RFA) closely - Use NIH eReporter (https://reporter.nih.gov/) to find others at your institution who hold a K; ask for suggestions Draft Specific Aims (SA) Page, your 1- page “elevator pitch” which is a critically-important, abbreviated version of a K - Plan a 2-year review and editing process - Ask people both inside and outside your department/field to review Discuss career plans and goals with department leadership, ensure alignment

Step 4: Gather expertise and information (well-before writing the grant): Clinical trial yes/no: read the description and criteria on NIH website, and decide early! Get examples of funded K proposals or SA (https://www.niaid.nih.gov/grants-contracts/draft-specific-aims) Take K- or NIH-specific grant writing courses, use workbooks and web resources for this mechanism - Navigating the R01 & K Grant Submission Process at https://catalyst.harvard.edu/courses/fyr/ - Writing an effective K application at 2020 NIH Virtual Seminar Presentation Materials | grants.nih.gov Review detailed grant timeline with primary mentor, discuss key deadlines, ensure alignment with his/her key goals and deadlines Meet with grants office to understand their deadlines and requirements Identify secondary mentors / mentorship committee, develop high-level mentor-mentee agreements Review SA with secondary mentors, peers, experts in/out of your field

Step 5: Writing the grant (approx. 12 month process): Leverage workbooks and courses: - Robertson JD, Hassell SW, Morrison DC. The Grant Application Writer’s Workbook, National Institutes of Health Version. May 2020 edition. (http://www.grantcentral.com/workbooks/national-institutes-of-health/) - LaRocque P. The Book on Writing: The Ultimate Guide to Writing Well. Grey and Guvnor Press; 2013. Specifically address mentorship role, schedule of meetings, and milestones in mentorship plan Create “My Bibliography” site (my NCBI), NIH Biosketch, NIH-formatted Other Support, sign up for eRA Commons Start online submission and click through all sections; ensure you have the latest versions of all forms Identify any special requirements (Human Subjects, subcontracts, biostatistical review, etc.) Get your SA done 3 months before you need to submit, then STOP. Plan at least 2 days for final edits: Figures matter. Fonts matter. Make sure you are within all the page limits. Review due dates for cycles of your K award – be prepared to turnaround your proposal and resubmit

Lessons learned

In reflecting on our experiences, we highlight four lessons that we felt were the most important to our success, that seemed less well-known, and that we experienced first-hand: the “hidden curriculum” of grant writing.

Lesson 1. Resources beyond the workshop including mentors

We took courses in grant-writing, read workbooks⁵ and websites (see Table); we rapidly learned that people are the best resources. Past K/CDA awardees are insightful resources, and discussing our Specific Aims page -- the 1- page summary of the objectives of your proposed study and the associated hypotheses -- with as many people as possible was critical to our proposals. When seeking a faculty position, consider institutional experts. Get a copy of a funded K-application. Funded proposals outside of your institution can be obtained through the freedom of information act; although this requires advance planning, it may be useful when sample applications are not readily available.

Lesson 2. Help your mentor help you

Finding a good mentor is invaluable, but it is equally important to be a good mentee. Understand how your proposal fits into your mentor’s plans, and how your research aligns with her career goals. Building an explicit mentor-mentee agreement can help clarify these items proactively. Create a shared schedule of abstracts for conferences, papers, pilot grant applications, CDA applications, as well as clinical or personal obligations. At scheduled meetings with your mentor, share an agenda in advance, bring work to review, and allocate time for feedback. If you put time into preparation, your mentor can contribute more effectively.

Lesson 3. Have a realistic timeline that incorporates unexpected delays

Sample timelines give broad guidance, but we found many of these too high-level. We each opted to explicitly allow time to gather materials, refine formatting, and perform the logistics of grant filing; these sometimes-ignored steps threatened to throw off our plans. Many understandably focus time and effort on the Specific Aims, the Research Plan, and the Budget. There are, however, over a hundred pages of content in a K award submission, all requiring advance planning; our timeline is shared (Table). Equally important is matching your research schedule with your life. Do you have significant life changes planned in next 5 years, such as: moving cities, having children, changing your work-life balance? Your career plan should support all aspects of your life.

From our discussions, the grants office can be a common source of surprises. Remember that the institution, not the individual researcher, files a NIH proposal; the grants office may have a vetting and signature process. Learn their expectations and timeline, and understand that they will not create materials for you, and aren’t familiar with every funding mechanism. Similarly, subcontracts to other institutions can take time and multiple handoffs to complete. Be sure to build these requirements into your plans. Additionally, one author discovered that additional online forms appeared only after entering information on the NIH website. The other author learned at the last minute that her department had a separate set of approvals required for any CDA proposal, previously unknown to her mentor. Fortunately, we submitted on-time despite these unexpected delays.

Finally, hope for the best but plan for the worst. Anticipate that you may need to resubmit your proposal and incorporate this into your timeline.

Lesson 4. Put your best foot forward

The best laid plans often go awry; allow flexibility in your schedule during the last month prior to your submission deadline. Before you click that last ‘submit’ button, remember that you shouldn’t submit simply because you planned to. If your proposal isn’t ready, take a breath, and realize that four months is not a long delay. Sometimes the initial submission is funded, but many will need to plan for revision and resubmission, so include these steps in your timeline. While awaiting your score, continue progress on your project, submit first authorship work, and identify other potential funding sources.

Conclusion

Every journey is unique. However, we hope this road map can bring awareness of the K-mechanism to trainees, give direction to other clinicians who are considering a career-mentored award, and encourage more clinicians to chart the path toward clinician-scientist. We learned the importance of people, a timeline, and persistence. The K-application journey of a thousand steps includes self-discovery, planning, and hard work, but is rewarding.