Survive and thrive: Personal stories of persistence and resilience in aging research

Abstract

An academic career in aging research is filled with the incredible highs of important discoveries that improve the lives of older adults and repeated lows when papers and grants are rejected or studies are negative. To normalize the experience of setbacks and failures in aging research, we invited three senior investigators to share their journeys of persistence and resilience as they have navigated their research careers. This career development symposium was presented at the 2021 Annual Scientific Meeting of the American Geriatrics Society, which was held virtually. We aimed to connect researchers in aging, especially trainees and junior investigators, through personal stories of persistence and shared strategies to build resilience and respond to setbacks with a growth mindset.

INTRODUCTION

As Albert Einstein is reported to have once said, “Failure is success in progress.” In academic medicine and especially research, we all fail or get rejected. Multiple times. Sometimes epically. Yet, our failures are rarely discussed in an open forum. Some investigators try to avoid failure by not taking opportunities unless they are sure they will be successful while other investigators have learned through hard-earned experience to welcome failure as an integral part of their pathway to ultimate success. Imposter syndrome and self-doubt can be strong and pervasive and lead us to feel as though we may not belong in our chosen career.

With publications and grants as the primary currency for advancement in academia, researchers often only see the visible, curated successes of their peers, mentors, and other senior investigators. While many successful senior researchers in aging may appear to have had straightforward careers marked by long series of impressive accomplishments, the reality of their paths is often more tortuous and marked by setbacks followed by resilience (Figure 1). Additionally, with the COVID-19 pandemic, many investigators have faced substantial, unexpected challenges in both our professional and personal lives that have made academic research careers even more difficult.^{1, 2}

Figure 1.

The path to success is often tortuous and marked by setbacks followed by resilience.

The idea of mindsets stems from the work of psychologist Dr. Carol Dweck.³ With a growth mindset, skills can be developed and failure is an opportunity to grow. We embrace challenge and find lessons and inspiration in the success of others. With a fixed mindset, skills are static and failure is a limit of our personal abilities. We avoid challenges and may feel threatened by the success of others. Of note, having a growth mindset is not an all or nothing goal and may be easier or harder depending on the specific situation.

To normalize the experience of setbacks and failures in aging research, we invited three senior investigators to share their journeys of persistence and resilience as they have navigated their research careers. This career development symposium was presented at the 2021 Annual Scientific Meeting of the American Geriatrics Society (AGS), which was held virtually. We aimed to connect researchers in aging, especially trainees and junior investigators, through personal stories of persistence and shared strategies to build resilience and respond to setbacks with a growth mindset.

PERSISTENCE AND RESILIENCE IN EMBARKING ON NEW RESEARCH QUESTIONS

Dr. Cynthia J. Brown (Charles V. Sanders, MD, Endowed Chair in Internal Medicine, Professor and Chair, Department of Medicine, Louisiana State University Health Sciences Center)

I was a physical therapist for ten years before I decided to go to medical school. Because of my unique background, I have always gravitated toward understanding function in older adults. I became very interested in fall prevention and mobility, which are two sides of the same coin.

My next step was to identify a problem that I could solve. Initially, I focused on fall prevention, specifically hospital fall prevention, because no one was working in this area at the time. However, I soon realized that in order for me to study fall prevention in the hospital, I needed to have a lot more experience than I did. For example, to study hospital falls, a relatively rare occurrence, I would need a large sample size and more experience with patient recruitment in the hospital environment. Because of the variability within the patient sample (e.g., comorbidities, illness severity), I also needed additional experience with methodology and data analysis techniques, which led me to obtain a Master of Science in Public Health. These challenges led me to new opportunities to grow as an investigator.

To overcome this challenge, I flipped my focus to the other side of the coin and started studying hospital mobility because I could actually address it. I could visualize a five-year trajectory of papers and research projects starting with understanding barriers to hospital mobility, thinking about prevalence and outcomes of low hospital mobility, and finally trying to measure hospital mobility. Identifying a research problem that I could solve took me a while. I had to let go of fall prevention, which really was near and dear to my heart. And yet, I knew that focusing my research on hospital mobility was a better choice for me as an early investigator.

Even after I decided to focus on hospital mobility, I encountered challenges that I did not anticipate. The first was that there were not many established datasets with hospital mobility data. Junior investigators commonly rely on existing data sources for publications as they establish their own research programs. I had to be creative in leveraging datasets focused on other topics such as Dr. Sharon Inouye’s delirium dataset. The other real challenge I encountered was that there were no good methods to measure mobility then. For my first paper with Dr. Inouye, I had to create a scale that was based on nursing report of what the patient was doing, and that was as good as it got at the time.⁴

This is also where opportunity can come into play. Serendipitously, I met someone who was using a device that measured body position for pressure ulcer research, and I knew I could make this work for mobility. So I met with the company, asked lots of questions, and ended up being able to use this device to measure mobility. It was the first time that we had a true measure of mobility, which is amusing because, of course, we are now all running around with watches that tell us more information than my very first computer could do back in the day.

Lastly, I want to discuss failure. We all make mistakes. For me early on, I failed to address the “so what” question in a grant, which ended up being a true lesson. One of my grant reviewers was an internist without geriatrics training. At the end of the review, she concluded that since people are only in the hospital for three to five days, who cares? I immediately realized that I made a basic mistake. I didn’t tell her why it mattered. So you want to take those opportunities, those failures, and learn from them. Just know that every single one of us that you see is making those mistakes. Join the crowd.

PERSISTENCE AND RESILIENCE IN OBTAINING RESEARCH FUNDING

Dr. Supriya G. Mohile (Philip and Marilyn Wehrheim Professor of Medicine and Surgery, James Wilmot Cancer Institute, University of Rochester)

As I reflected on conceptual models of resilience, I was struck by the model from the American Foreign Service Association.⁵ In this model, personal resilience is supported by having meaning and purpose, maintaining a positive outlook, active problem solving, social support, and self-care.⁵ Resilience is part of what helps us deal with high levels of challenge and disruption, deal with ambiguity, adapt quickly, thrive in adversity, bounce back, and use challenges to make us stronger.

I am a geriatric oncologist. It is my identity and so I’ll start there. I was struck by geriatric oncology as a field very early on and I wanted to translate that passion to improved patient- and caregiver-centered care. My patients give me meaning and purpose. They teach me so much about resilience themselves because every day, they deal with challenges such as requiring assistance with daily activities, managing their comorbidities, and trying to get to medical appointments despite transportation issues. But they make it to us and they want us to be able to help them answer their questions. Meaning and purpose is the point of research. It is not the grants. When I work with mentees and colleagues to really think through their line of research, what they are passionate about is important. Grants are only a mechanism to that end.

Once I had clarity about the meaning and purpose of my work, I started to write grants and I was successful. I liked the process of putting the question together and thinking through how to answer that question. However, like everyone else, there were quite a few detours and hardships during that time, especially between 2006 and 2013 (Figure 2), where I was really stuck in getting a National Institute on Aging Paul B. Beeson Emerging Leaders in Aging career development award. That is really what I wanted more than anything in the world. And I literally tried every year for four years in a row. Unfortunately, none of them got funded.

Figure 2.

Dr. Mohile’s timeline of grant successes and failures: Celebrate successes and learn from failures. Abbreviations: CTSI, Clinical & Translational Science Institute; MCBS, Medicare Current Beneficiary Survey; NIA, National Institute on Aging.

Here’s where the active problem solving and positive outlook were critical. I reviewed my summary statements as opportunities to learn something that I and my team did not see. My initial research focused on exercise interventions for older adults with prostate cancer but I could not translate my early work to a larger study. I realized that I needed to move in a new direction and developed a clinic to gather new data about geriatric assessment for older adults with cancer. When I got stuck about research funding, working with patient and caregiver stakeholders helped guide my next steps.⁶ In addition, a major source of my resilience has been social support. I worked with close colleagues and friends—the late Dr. Arti Hurria and Dr. William Dale—to develop the Cancer and Aging Research Group.⁷ What started as a small, informal peer network has grown into a large very close-knit group that continues to work collaboratively across the country.

Lastly, grant writing is also about resilience in terms of taking care of yourself. It is hard. You speed up a lot and you work nonstop before grants go in, but we have to replenish our energy. We have to replenish our physical, mental, emotional, and spiritual energy and understand what our own personal limitations are.

Research is a long game, and it is about small steps over time. Those small successes matter, and we should embrace them. What I learned was it is not just hard work that makes someone productive. It is all the other things that make one resilient that matters in grant writing, and what’s making me resilient now are my mentees and early career faculty, whom I love to see succeed in their own way.

PERSISTENCE AND RESILIENCE IN ADAPTING AFTER UNEXPECTED RESEARCH RESULTS

Dr. Dalane W. Kitzman (Kermit Glenn Phillips II Chair in Cardiology Sections on Cardiovascular Medicine and Geriatrics/Gerontology, Atrium Health Wake Forest Baptist)

The focus of my career has been heart failure with preserved ejection fraction, which is the most common form of heart failure in older adults. My team and I reported the first two treatments currently proven to improve symptoms, quality of life, and physical function.⁸ With more than 475 publications and six R01s, you would think that I charted a course at the beginning of my career and went straight to these high levels of success. But it was not a straight path. It was a journey. And I would like to share that with you.

The first grant I applied for as a faculty member was not funded, even though I was the only applicant who showed up at the interview. The foundation apparently decided they would rather fund no grants that year than fund me! This was tremendously disappointing and led me to rethink everything. And ultimately, I decided to start over. However, to my surprise, within weeks, my R01 on the same topic was funded.

Unfortunately, the hypothesis of my first R01 was disproven by my study. It was supposed to be positive and lead me on to a logical sequence of additional proposals. So again, I started over and had to learn new, sophisticated techniques. But thankfully I had colleagues to help me learn them. The primary hypothesis of my second R01 was also disproven. Yet again, I had to start over by developing new hypotheses based on these unexpected findings and learn a new technique to test them. The primary and mechanistic hypotheses of my third R01 were disproven. Start over. The first seven medication trials I led or helped lead were neutral, negative, including an international trial with 4,000 patients that took over seven years of hard work.⁹ I’ve had to start over and over and over and ultimately reinvent myself and my research.

But these challenging experiences provided the path that led to the many pivotal discoveries that my team has made and you see today, so I would like to share what I learned along the way:

1. Never give up on your dream.

2. Select an important question and the answer will be important, no matter the results, even if the study is negative.

3. Relentlessly pursue the truth, regardless of where it leads you. Do not value a predetermined outcome or a positive proven hypothesis but rather value the truth.

4. Trust your data.

5. Reach out to others when you reach a dead end and need to learn new techniques. You may be surprised that at your own institution, there are international experts in what you need. And of course, that includes having to adapt and be flexible.

6. Learn from your mistakes. They may be your best clue and your negative data may be the most important you have ever produced.

7. Have fun and enjoy the journey of discovery. Ultimately, when you unveil your data and look at your results for the first time, you are the first person ever to see this truth about human biology. That is a thrill—appreciate it, relish it.

CONCLUSION

In conclusion, we offer some strategies to develop more of a growth mindset in response to setbacks that we encounter in research. Seek advice from trusted mentors and colleagues when you need encouragement after a rejection or setback. When you hear your inner fixed mindset voice, identify what triggered it so you can try to respond differently next time. If you have a choice between something safe and a challenge, try to take the challenge. This may take a nudge from a mentor or friend. If you hit an obstacle, ask yourself, “What can I learn from this?” And lastly, embrace the power of yet. My grant hasn’t been funded yet. My paper hasn’t been accepted yet. By seeing how we have struggled and nevertheless persisted, we hope that trainees and junior investigators will be less likely to internalize their own failures and more likely to see rejection as a normal, common, and expected part of research.

KEY POINTS.

Key points

• Three senior investigators in aging research share personal stories of persistence and resilience in embarking on new research questions, obtaining research funding, and adapting after unexpected research results.

• A growth mindset can help us reframe research setbacks and embrace the power of yet, which emphasizes that while we may not have achieved a goal yet, we have the power and ability to improve and keep striving toward it.

Why does this matter?

By seeing how we have struggled and nevertheless persisted, we hope that trainees and junior investigators will be less likely to internalize their own failures and more likely to see rejection as a normal, common, and expected part of research.