Johns Hopkins All Children’s Associate Dean for Research Neil Goldenberg, M.D., Ph.D., recently received a five-year K24 mentoring grant from the National Institutes of Health.

The grant supports Goldenberg’s mentoring work in the field of pediatric venous thromboembolism (blot clots in the veins of the body or arteries of the lungs) with several faculty mentees at The Johns Hopkins University (JHU) and other pre-eminent academic institutions. Faculty mentees include JHU faculty members John Morrison, M.D., Ph.D. (pediatric hospital medicine), Marisol Betensky, M.D., M.P.H. (pediatric hematology), Tony Sochet, M.D., M.H.S. (pediatric critical care medicine), and Amy Kiskaddon, Pharm.D., M.B.A. (pediatric hematology and cardiology), all of whom are based on the Johns Hopkins All Children’s Hospital campus in St. Petersburg, Florida. Additional faculty members under the award include pediatric hematologists Hope Wilson, M.D., of the University of Alabama at Birmingham/Children’s Hospital of Alabama and Riten Kumar, M.D., M.Sc., of Harvard University/Boston Children’s Hospital.

In honor of this grant, we present an interview of Goldenberg (also professor of Pediatrics in the Johns Hopkins University School of Medicine and the Perry Family Endowed Professor in Clinical and Translational Research) by Johns Hopkins All Children’s pediatric resident and Goldenberg mentee, Austin Sellers, D.O., about mentorship in medical research.

Sellers: Tell us about your areas of clinical and research focus.

Goldenberg: I'm a pediatric hematologist, which means that I focus on blood disorders in children. I subspecialize in a specific area of blood disorders called thrombosis, which is the disorder of blood clotting in veins and arteries. I also subspecialize in pediatric arterial ischemic stroke (insufficient arterial blood flow to the brain, causing permanent injury to brain tissue), as one of the early “stroke hematologists” in that field. Although thrombosis has been on the rise in children for the past two decades, pediatric thrombosis and stroke are both considered rare diseases, and therefore challenging to study — often requiring collaboration with colleagues from around the country or around the world, which is one of the wonderful aspects of a research career in pediatric rare disease.

Sellers: How did you arrive on this career path?

Goldenberg: My path is somewhat unorthodox. I went to a liberal arts undergraduate school (Williams College) where I pursued interests in both English (creative writing and American literature) and Science (biology/pre-medical concentration). I ultimately decided to go into a medical and scientific career and keep the creative writing as a hobby that I could pursue later in life. In med school at McGill University, I was able to successfully compete for an opportunity to engage in research during my third and fourth years that got me really excited to have research as a part of my future career. The study was designed to investigate the blood-based factors that are associated with development of venous thromboembolism in adult cancer patients — and my roles included being the mentored principal investigator, the study coordinator, the phlebotomist and the lab tech. Thankfully, I had two great research mentors in hematology and one great career mentor at McGill.

I then went on to residency training in internal medicine and pediatrics at the University of South Florida, where I focused on gaining as much clinical skill and experience as possible, while analyzing and writing up the research study that had recently finished enrolling patients and collecting data (with the help of a few research staff members from my mentors’ research programs, after my return to the United States). I was able to present my research at a few international meetings (American Society of Hematology, American Society of Clinical Oncology) during residency, and after a lot of stumbling and rejections along the way, the study was finally published during my first year of pediatric Hem/Onc/BMT fellowship in Colorado, in the Journal of Clinical Oncology (one of the top journals in the oncology field). At that point, I had truly “caught the bug”, and there was no turning back.

Sellers: Can you talk about creativity and innovation? How do you try to “teach” creativity and innovation, as a mentor?

Goldenberg: When we're really young, we think about laboratory-based science as creating experiments and inventing things. That’s very innovative, very creative. However, over time, we can lose sight of this because of the necessary disciplined approach to research and the procedures that must be followed as part of the research process. The shift in perspective can especially occur in clinical and translational science, because of the important steps that must be taken to protect patients and their rights in the research that we conduct with the goal of improving care or outcomes for those patients or, in many cases, for future patients

As we get further along in clinical and translational research careers, for example, we often perceive that generating evidence isn’t creative, even though there's value to innovation and creativity in the way we conduct research. This can be a deflating moment to many mentees. Yet, as we develop newer methods and adapt technological innovations, their application allows us to be more effective and informative in our research. I try to remind (and role-model for) my mentees that clinical and translational research does push you to be creative, particularly when challenges are faced in using conventional approaches to answering medical and scientific questions.

Typically, one of the first steps we do to address a question is to look at what has been shown by prior research on the issue. If, despite many efforts in the past to address this question, there has been an indeterminant result or there are conflicting results, that's when we're pushed to think about new approaches (for example, an innovative study design, or an innovative analytic design) to get a more definitive answer.

Sometimes the creativity and innovation are not about the design, but about the execution. I think my past and current mentees would agree that, as is the case in many other professions and callings, what distinguishes the most successful researchers is the ability to execute on great ideas.

Often, in clinical and translational research, limitations of prior work stem from investigators being too insular in their thinking; maybe there's an opportunity to engage a broader network of collaborators to be able to answer that question more definitively, not just by sheer numbers, but also by a broader representation of patients. I think that can also apply to basic scientific experiments where you may bring in a number of different techniques and laboratories to address a fundamental biological mechanism or interrogate a pathophysiological process. Creativity and innovation in process or execution—especially by leveraging the strength of collaboration — can be at least as important to success in research as creativity and innovation in design.

Sometimes a traditional or conventional way of addressing a problem doesn’t serve to meet the challenge at hand, and then you make a variation on a theme. And sometimes we don't think that's very creative because it’s just a modification of pre-existing work — but I think we do that all the time, not just in medicine and science, but in so many other fields. Making meaningful adaptations to existing approaches can be really important to solve a problem you’re facing, and then others can benefit from that, because then they can refer to and employ that modified approach when they face similar challenges. To me, that’s adaptive creativity, or iterative innovation.

Sellers: Being a researcher requires a lot of writing — writing grants, writing abstracts for presentation of original research at large scientific meetings, writing book chapters in your field, writing original research manuscripts for peer-review publication … What do you instill in your mentees about the writing process in research?

Goldenberg: For sure, a scientist (whether clinical/translational scientist or other) does a lot of writing. In addition to what you mentioned, the list includes writing study protocols, study manuals of procedures, analytic plans, data management and security plans, data and safety monitoring plans, and more. The writing definitely benefits from a team approach, but the principal investigator is leading the team and typically does most of that writing. It’s not simply writing up the findings for a peer-reviewed publication in a medical or scientific journal, when we complete a study; there's writing all the way throughout. For that reason, you have to enjoy writing in order to be be successful as a researcher, and to be able to design, execute, and communicate the findings of study upon study throughout your career, in order to advance the field. In order to achieve that goal as a researcher, you have to have a passion for writing, and a healthy relationship with your writing, rather than an adversarial one.

Sellers: In our previous conversations, when I asked you about creativity in research, one of the things you said was, “On the surface, I don't feel very creative. A lot of times, I practice expansive thinking rather than creative thinking.” That's a beautiful way to put it, and really resonates with me. Can you talk a bit about what you meant at that moment, and how you practice and mentor others toward expansive thinking?

Goldenberg: First off, I want to make the disclaimer that I'm not sure I always engage in expansive thinking … but I certainly try. What I really appreciate about our mentor-mentee relationship, Austin, is — as it always should be in a mentor-mentee relationship — that we learn from each other in different ways. It's symbiotic. Initially, that was my response, but you helped me to expand my thinking — to realize that there is actually so much more creative work in what we do as researchers and even in clinical research. That's why in my earlier response in this interview, I did talk about creativity — so I appreciate you for that.

In regard to what I mean by expansive thinking, I think it's important to try to step as far away as we can from the various solutions that are our first instinct, and to really question what we know and how we know it. In the face of challenges, to really pause, reflect, digest, step back and consider other options. Come up with other potential tactics or approaches to addressing the problem. Even if you end up arriving back at your initial solution, your initial instinct, it's a really healthy process because it will help to validate that solution. However, very often through that process you will come up with an even better idea, or perhaps a portfolio of solutions and tactics, by having taken that time to reflect and to think more expansively. And that includes engaging other minds. It doesn't have to be a lot of folks, but engaging other minds to assess the problem from their different perspectives, will generate more and often better solutions, and will enhance your ideas. Expansive thinking in this way can (and perhaps should) be applied to both study design and execution. There are nearly always pitfalls in both, when engaging in research.

Sellers: What are some of the greatest mistakes that you’ve made, which your mentees should avoid?

Goldenberg: I think some of the greatest mistakes I've made over the years are when I tried to be a one-man machine to solve problems or take on the weight of a task. It's so important to take a collaborative approach, and develop (or tap into) a collaborative group. Working with co-investigators on a project is so valuable not only for the reasons I’ve mentioned previously (in order to optimize study design and execution), but also from a “give-back” perspective, because it provides more researchers with an opportunity to get involved. The goal in clinical research is to advance the field, to improve health and outcomes for patients, and it takes a village to achieve that goal reproducibly and sustainably.

On the other hand, as a counterpoint to some of the greatest mistakes, are some of the best decisions. I was encouraged by mentors early on to be ambitious in my thinking. If a solution to a problem involves a very complex approach, for example, and that meant that we needed to do a large, collaborative study. Often that becomes daunting and the quick answer becomes, well, we can't do that. Let's do something else. But if that's the right next step in the research design, if all the good hard work has been done prior to launching a multicenter study, then I've been fortunate to have been mentored toward the “say-yes” approach. To be ambitious in what can be achieved in collaborative research, and not easily daunted by the heavy lifts (as long as you’re willing to put in the hard work, persist, and not over-delegate), has been among the best decisions I’ve made (or perhaps perspective I’ve taken). What I do now (and for the past 15 years) is a lot of multicenter research studies, and I use a process that I hope is much more efficient than the first time I got to do it when I was much younger.

Sellers: One of my last questions (until next time): You’ve mentioned in our past discussions that, in a research career, it’s important to take inspiration from adversity. Can you give us an example, and how you use that experience to inform your mentor-mentee relationships?

Goldenberg: That’s a great question, and one you should ask of a lot of the other research faculty as well. In my own experience as a researcher, my greatest inspiration drawn from adversity has been when people say, “You can't do that.” As in, that’s not possible, or it’s too difficult. There's one instance of “you can’t do that” that I'll always remember, which I experienced during a research training program that I participated in early in my career. A key goal of that program was to cultivate and mentor the next generation of clinical researchers. After I gave a presentation on my aims, hypotheses and planned approach, one of the senior faculty pulled me aside as I left the podium and said, “You know, Neil, a project not worth doing is not worth doing well.” I was caught a bit by surprise, and just replied “Thanks, I’ll reflect on that.” (That, by the way, can be a useful reply to have in your back pocket, for a variety of situations you encounter.) After I did reflect a bit, I turned that critique into something constructive, concluding that I had designed a really nice approach, but that I hadn't convinced everyone that the problem being addressed was an important one (in this case, that thrombosis in children was important). I learned from that experience to make a better case statement.

At the same time, it inspired me even more to say, “You're wrong. This is really important, and I'm going to prove to you that it's important because I'm going to execute it well, and ultimately (perhaps) change clinical practice.” We usually need to measure that (the disciplined incremental stages of clinical research that ultimately inform clinical practice) in decades, rather than in years … although things are moving a lot faster now, in the post-pandemic environment.

Sellers: So, is that your motivator, your “why”?

Goldenberg: Yes, for me and many other clinical/translational researchers, my “why” is to improve health, improve outcomes, improve care. For me, a big motivator is also to help other researchers in their careers and in their work; so, a lot of my inspiration nowadays comes not from adversity, but from helping to advance a junior person’s research career trajectory and contributing (even in small ways) to the success of their research studies. To me, mentoring is the most rewarding part of an academic medical career. I’m so glad — and incredibly thankful — that the NIH K23 award program for mentees and the K24 award program for mentors continue to support and strengthen this critical aspect of academic medicine. 

Portions of this article were transcribed from The Medical Creative, a podcast produced by Austin Sellers, D.O.