V38 N1 / 2023 ©2023 American Medical Writers Association. All rights reserved. ISSN 2163-5315 AMWAJournal.org 40 Common Grantsmanship Hurdles of Early Career Clinician-Scientists and How a Medical Writer Can Help ABSTRACT Researchers with medical training and clinical experi- ence bring essential perspectives to academic medicine. Compared with their nonclinician, PhD-trained peers, cli- nician-scientists typically have less training in grant writ- ing, and their time for this work is even more constrained. Medical writers can help clinician-scientists understand and fulfill the expectations of funding organizations and review panels, and ultimately, help them compete more successfully for funding. Based on the literature and per- sonal experience in this role, I propose 4 grantsmanship hurdles that often confront clinician-scientists: (1) iden- tifying funding opportunities that fit, (2) mastering the unique language and integrated narrative style of a compel- ling grant proposal, (3) turning ancillary documents from drudgery into assets, and (4) shedding the “bunker mental- ity.” This article surveys practical strategies by which med- ical writers can foster time efficiency, mitigate experience gaps, and help clinician-scientists develop persuasive grant proposals effectively tailored to the relevant audience. Medically-trained faculty at academic medical centers play essential roles in the advancement of biomedical research. Clinician-scientists bring the perspective to recognize knowledge gaps that impede progress in patient care and translation of discoveries to the clinic. Although they are well-positioned to enroll patients and coordinate clinical trials, early career clinician-scientists often receive min- imal training in crucial research and grant writing skills and have heavy clinical duties that dominate their time. Although junior faculty can seek didactic research training, it is often more effective and efficient for them to consult a medical writer with expertise in writing and grantsmanship. Some academic institutions employ such consultants under job titles such as grant writer, scientific editor, or medical writer.1 An individual investigator might engage a freelance writer for similar support. This article discusses several grant writing hurdles facing clinician-scientists and details tools and strategies by which a medical writer can help them clear the hurdles and gain professional skills. CLINICIAN-SCIENTISTS Clinician-scientists are biomedical researchers who have formal training and credentials in a clinical discipline. Although many clinician-scientists are physicians, the cat- egory also includes pharmacists, nurses, advanced practice providers, dentists, dietitians, and other medical profes- sionals. Clinician-scientists are sometimes categorized by how much of their professional effort is spent in clinical prac- tice compared with research.2 The diverse backgrounds, job descriptions, and goals of clinician-scientists correspond with diverse funding objectives. Those with a primary focus on research usually pursue federal funding along a proto- typical path that aims for mentored career development grants (eg, National Institutes of Health [NIH] K awards), then research project grants large enough to support a research laboratory or larger clinical trials (eg, NIH R or U awards).3 Others see themselves as clinicians first and have a comple- mentary research portfolio that can be integrated with their clinical practice.2,4,5 Critical funding for these individuals may come from subcontracts on federal grants, industry sponsor- ship of multisite clinical studies, or small grants from founda- tions, professional societies, or intramural funds. Regardless of career trajectory, early career clinician-sci- entists face 2 particularly difficult headwinds. First, clini- cians who assume junior faculty positions often start with limited research mentorship and hands-on research expe- rience.5-7 In the sphere of grant writing, they may be unfa- miliar with the structures, norms, and vocabulary that more experienced researchers take for granted. A clinician devel- oping a grant might need guidance on how the review pro- cess works so that they can write with the true audience in mind. Second, clinical duties increasingly dominate their time,4 so clinicians with thriving research programs often rely on a cast of trusted collaborators and team members working around them. A medical writer with expertise in grant writing who fosters effective communication and Matthew R. Sandbulte, PhD / Child Health Research Institute at Children’s Hospital & Medical Center and the University of Nebraska Medical Center, Omaha, NE TOPICAL FEATURE http://www.amwajournal.org AMWAJournal.org 41Grantsmanship Hurdles of Early Career Clinician-Scientists and How a Medical Writer Can Help efficiency is an invaluable addition to these teams and can help clinician-scientists capitalize on scarce research time. GRANTSMANSHIP HURDLES FOR CLINICIAN- SCIENTISTS Most grant writing challenges common among early career clinician-scientists are also familiar obstacles for their PhD-trained peers, so the advice offered here might help a researcher in either category. However, training gaps and patient care duties for clinician-scientists often accentuate the following hurdles. By helping them clear these hurdles, medical writers can foster both professional achievement and progress in medicine. Hurdle 1: Identifying Funding Opportunities That Fit Funding agencies post funding opportunity announce- ments (FOAs) using a variety of channels, and the window of time between the FOA and submission deadline can be as short as several weeks. Investigators who passively wait for relevant opportunities to present are prone to discover- ing them too late or not at all. Medical writers can assist by designing a robust search strategy, of the sources below and others, and perhaps even take responsibility for maintaining the search and alerting their clinician-scientist colleague(s) to possible matches. Federal Funding Agencies FOAs for federal grants are relatively easy to track because sponsors disseminate them through well-maintained Web resources. The comprehensive database at Grants.gov is pop- ulated with links to FOAs from NIH, the Centers for Disease Control and Prevention, other arms of the Department of Health and Human Services (HHS), the Department of Defense, and other agencies with missions extending widely across medicine and beyond. Search filters allow users to focus on chosen agencies, funding categories, dates, and other variables. NIH- and HHS-sponsored opportunities also appear in the dedicated NIH database at NIH.gov, which features more agency-specific search and filter func- tionality; for example, you can filter results by activity code (eg, K08, R01) or by institute. In either of these databases, the Save Search function allows the user to set up auto- mated email alerts about relevant FOAs in the future. Private Funding Agencies Societies and foundations represent the spectrum of clin- ical disciplines, medical conditions, and patient advocacy themes, and they issue a vast range of FOAs. Although many of these FOAs are relevant to clinician-scientists, their con- figuration and dissemination vary widely. Some private grant programs are offered on a regular annual or semian- nual cycle, but in many cases the timing is unpredictable or a specific FOA happens only once. Because these FOAs are invariably posted on the respective organization’s website, clinician-scientists or a medical writer could proactively monitor the websites of relevant organizations for new FOAs. A few such organizations simplify this task by offering an electronic mailing list. However, neither method is very efficient if an investigator needs to monitor multiple organi- zations, or if a medical writer is assisting multiple investiga- tors at once. One-Stop Solutions Clinician-scientists and their grant writing consultants who are interested in diverse funding sources should consider accessing a subscription-based, comprehensive grants data- base (Table 1). These continually capture new opportunities from thousands of private funding organizations, federal and state government agencies, and international entities. Search filters and periodic email alerts make it possible to track opportunities in any sector that match an investiga- tor’s research interests and project parameters (eg, submis- sion deadline, budget size, geographic focus). Investigators or consultants can begin by checking what access they may already have through institutional subscriptions. Individual subscriptions to some of these services are also available. Hurdle 2: Mastering the Unique Language and Integrated Narrative Style of a Compelling Grant Proposal Clinician-scientists tend to be goal driven and action ori- ented. In the process of developing a research proposal they are generally most comfortable explaining their plan to attain new knowledge and drive clinical innovation. Less intuitive for the grant writing novice are how to craft the multiple application sections in a way that inspires urgency about a stated knowledge gap, curiosity about the scien- tific hypothesis, and confidence in the applicant’s capac- ity to achieve the objectives. In most successful grants, these pieces all begin to crystallize in the specific aims page and are emphasized in each subsequent section. A medi- Table 1. Subscription-Based Grants Databases Database Name Web URL Individual Subscriptions Funding Institutional fundinginstitutional.com GrantForward grantforward.com GrantScape thegrantscape.com √ GrantSelect grantselect.com √ Pivot-RP pivot.proquest.com SPIN spin.infoedglobal.com http://www.amwajournal.org https://www.grants.gov/ https://www.fundinginstitutional.com/ https://www.grantforward.com https://www.thegrantscape.com/ https://www.grantselect.com/ https://pivot.proquest.com/ https://spin.infoedglobal.com AMWAJournal.org 42Grantsmanship Hurdles of Early Career Clinician-Scientists and How a Medical Writer Can Help cal writer can help the clinician-scientist ensure that these facets are consistently, concisely, and effectively conveyed throughout the full proposal. Medical journals have recently published several excel- lent articles that speak specifically to clinicians about writ- ing effective grant proposals.8-16 These are easy resources to share with investigators, and medical writers can mine the articles for new ideas and language that might resonate with investigators who are getting used to this genre. In one arti- cle that focuses on how to write an effective specific aims page, Monte et al10 argue that a grant proposal is equivalent to a business pitch: We define the goal of grant writing as gaining finan- cial sponsorship for planned work; like sales, a proposal requires marketing, tailoring, and a value proposition… The aims page is the point of sale for planned science and is written with the goal of research sponsorship. These authors describe their formula for writing a per- suasive specific aims proposition in 4 paragraphs from defining a critical need to demonstrating the potential return on investment. Two other articles also dissect the specific aims page, offering similar instruction and borrow- ing colorful idioms from humanities and mathematics.8,14 Certain articles contain rubrics for objective evaluation of a specific aims page that may be valuable tools for a consult- ing medical writer.8,10 This “make the sale” mindset is beneficial throughout the grant writing process. Reviewers are drawn to a grant proposal if it convinces them that (1) the investigator has delineated an urgent problem, (2) they have an innova- tive and scientifically credible idea to address the problem, (3) the proposed plans are well designed to test the great idea, and (4) the investigative team and research environ- ment display the capacity to execute the plan. Each of these parts is fulfilled through multiple sections of the applica- tion (Figure). A clinician-scientist may feel most engaged and confident in describing the core idea or innovative ele- ments of their plan, whereas certain sections (eg, budget, biographical sketches) may seem like mere boxes to check. However, a medical writer who helps them integrate all 4 major elements improves the probability of an outstanding impact score from the review panel. For an inexperienced applicant who lacks fluency in the jargon and expectations of grants, the instructions and review criteria found in an FOA are often opaque. A medi- cal writer can help not only by decoding the requirements but by checking the application against the FOA for com- pleteness and fulfillment of the specified review criteria (“responsiveness”). A simple way to help the clinician-sci- entist stay on track is to create a checklist early in the writing process and keep it updated as a dashboard while complet- ing the application. The AMWA Member Resource Library features a template for a detailed grant checklist and sched- ule of milestones.17 Hurdle 3: Turning Ancillary Documents From Drudgery Into Assets For some clinician-scientists, the list of required support- ing documents is a daunting barrier. Often, an investigator either spends many precious hours producing these from scratch or hurriedly produces subpar documents that likely dampen reviewers’ confidence. A medical writer can help elevate the application by introducing resources that lighten the investigator’s learning curve and boost document qual- ity. Sometimes useful tools are readily available, and we may just need to point the investigator in the right direc- tion. For example, the National Center for Biotechnology Information provides a free online app called SciENcv, which helps investigators build a complete and compliant NIH-style biosketch.18 Another way to help address this barrier is by encour- aging smart use of institutional boilerplate text. Many universities seek to help their investigators with grant appli- cations by maintaining boilerplate that describes facili- ties, resources, expertise, and administrative structures. Although these resources can be a good building block, beware of 2 possible flaws. First, watch for text that has grown stale after a couple of years on the shelf, both to eliminate outdated informa- tion and to ensure inclusion of newer resources. If the cli- nician-scientist is unsure about key details, reach out to the relevant core facility or office to ask for a fresh review of the information. A medical writer employed at an academic institution can benefit all affiliated investigators by maintaining a current boilerplate library. Figure. Four main elements of a grant proposal that the investigator must illustrate for reviewers. Multiple sections of the proposal combine to build confidence in each element. PROBLEM Scientific literature Standard of care Knowledge gap CAPACITY Personnel / Biosketches Facilities Equipment Letters of Support GREAT IDEA Aims / Hypotheses Preliminary data PLAN Approach Innovation Budget Human / Animal http://www.amwajournal.org AMWAJournal.org 43Grantsmanship Hurdles of Early Career Clinician-Scientists and How a Medical Writer Can Help Second, no matter how complete and current the infor- mation is, applicants should not simply copy unmodified generic boilerplate text into an application. Coherence among the many pieces of an application signals to review- ers that the investigator has given careful thought to every- thing that needs to work together to achieve the research aims. Therefore, resources that have no relevance should be deleted, and the generic text should be enriched with tai- lored sentences or phrases that emphasize relevance to the project (Table 2). mentality by encouraging them to seek the following kinds of feedback. Program officers working in the NIH institutes are known for the constructive advice they offer investiga- tors. They are often helpful in identifying programs and study panels in which a research idea would find its best fit, sharing the upcoming release of new FOAs, explaining the grant review processes, and decoding reviewers’ cri- tiques.21 In most cases, an NIH FOA lists contact informa- tion for the appropriate program officer(s). Alternatively, a great resource for identifying program officers (as well as institutes and review panels) rele- vant to the clinician-scientist’s project idea is the Matchmaker search tool at the Research Portfolio Online Reporting Tools website.22 Although pro- gram staff in other agencies or organizations may be less visible, it is worth trying to identify them for similar assistance. An investigator should ini- tiate the conversation about their proposal con- cept by email, share a draft of the specific aims, and propose setting up a call or virtual meeting for feedback. Many clinician-scientists seem ret- icent to reach out for this help; a writing consul- tant can provide critical assistance in facilitating this process and eliciting valuable feedback. Peers and colleagues are an invaluable source of grant feedback for investigators at any career stage. Fellow researchers can provide insight from various angles, such as: Has the investiga- tor made a persuasive argument for an important knowl- edge gap that must be filled? Does the proposed approach stand up to technical scrutiny? How well does the proposal address review criteria found in the FOA? Medical writers bring legitimate insight into these questions as well, but peers can take it to an important next level. Sometimes part of our role is to encourage seeking that help from a couple of trusted individuals and plan it into the writing timeline. Many institutions seek to elevate the presubmission grant review process by organizing internal mock review panels often targeted toward their junior faculty and train- ees.23,24 Not only does this facilitate feedback from 4 or 5 reviewers at once, but it also introduces the dynamic of a live panel discussion. Data collected at one institu- tion demonstrated the effectiveness of internal review for increasing success of submissions to NIH.24 The greatest challenge in leveraging this resource is proactive plan- ning. An investigator must request review by a mock panel and supply a draft of at least the specific aims page, several weeks before the funding agency’s deadline. When such an opportunity exists, medical writers should encourage work- ing far enough ahead to secure this assistance. Table 2. Examples of Tailoring Verbiage to a Specific Proposal Grant Section Points of Emphasis Tailored Sentence Example Facilities/ Resources Access, relevance Dr Smith has an agreement with the Gait Analysis Lab to support monitoring participants’ fluidity of motion post- surgery (see letter of support). Equipment Location, features, purpose The PI’s division houses a PET/CT scanner (make/model) with respiratory and cardiac gating to reconstruct phase-matched images. It will be used to screen study enrollees for lung cancer recurrence. Biosketch– personal statement Commitment, role As a co-investigator, I will coordinate the key informant interviews in Aim 2, to include securing IRB approval and ensuring protocol-adherent interviews, transcription, and coding. PI, principal investigator; PET/CT, positron emission tomography/computed tomography An excellent way to demystify the components of a com- plete application is to provide examples of proposals that were funded in the past. Ideally, an investigator has men- tors who will share recent grants as models. A staff medical writer can facilitate the sharing process by gathering and managing a small library of model proposals from willing faculty. Furthermore, multiple NIH institutes provide online access to lightly redacted copies of grant proposals they have funded.19 Examples of applications to other funders can be more difficult to find; however, one online resource, Open Grants,20 maintains an open repository of proposals submit-ted to a variety of public and private sector organizations. Hurdle 4: Shedding the “Bunker Mentality” Clinician-scientists are often forced to fit their grant writ- ing into odd pockets of time around their more rigid clin- ical schedule. Those who have received minimal research mentorship may not fully appreciate the benefits of robust initial review by a colleague before a proposal goes to an anonymous review panel. Consequently, grant writing tends to be a solitary endeavor; this “bunker mentality” can deprive proposals of objective external feedback and edit- ing. Medical writers can help investigators resist this bunker http://www.amwajournal.org AMWAJournal.org 44Grantsmanship Hurdles of Early Career Clinician-Scientists and How a Medical Writer Can Help Finally, medical writers can play the role of document editor to help maximize a proposal’s clarity, completeness, conformity to instructions, and professionalism. This ser- vice may range from early partnership in the conceptual stages to copy editing at the final stage. It is important to remember that many early career clinician-scientists are looking for more than a batch of corrections. We can create a true professional development experience if we partner with our clinician-scientist colleagues and help them think through the communication strategy. A 2020 post to the AMWA Blogs cogently described the editing technique of providing “informational support,”25 that is, you “focus on an author’s development by explaining why changes are being suggested and offering to answer questions about editing recommendations/comments.” A sense of partnership and a supportive tone help ensure investigators will return for assistance with resubmissions and future proposals. CONCLUSION Grant seeking is an integral part of the landscape in aca- demic medicine. Clinician-scientists who aim to advance their research programs and find backing for their ideas will continue to need skilled grant writing assistance. Medical writers can add value across the full scope of documents needed in any given proposal. We can also help our clini- cian-scientist colleagues see the finished product from the vantage point of funding organizations and peer reviewers. This will not only increase the likelihood of a funded pro- posal, but also cultivate a clinician-scientist’s grantsman- ship expertise for future applications. Acknowledgment I thank Heather C. McNeill, MA, ELS, and Jennifer K. Peterson, PhD, for their constructive reviews of the article. Author declaration and disclosures: The author notes no commercial associations that may pose a conflict of interest in relation to this article. The author received partial salary support from NIH funding for the Nebraska Pediatric Clinical Trials Unit (UG1 OD024953). Contents of the article are solely the responsibility of the author and do not necessarily represent the official views of NIH. Author contact: matthew.sandbulte@unmc.edu References 1. What is an academic grant writer/editor? AMWA Blogs. Published 2022. Accessed June 16, 2022. https://blog.amwa.org/what-is-an- academic-grant-writer-editor 2. McKinney RE, Jr. The daunting career of the physician- investigator. Acad Med. 2017;92(10):1368-1370. 3. Gosain A, Chu DI, Smith JJ, Neuman HB, Goldstein AM, Zuckerbraun BS. Climbing the grants ladder: funding opportunities for surgeons. Surgery. 2021;170(3):707-712. 4. Bensken WP, Nath A, Heiss JD, Khan OI. Future directions of training physician-scientists: reimagining and remeasuring the workforce. Acad Med. 2019;94(5):659-663. 5. Mistry MS, Williams AE. Read one, write one, get funded: two junior pediatric hospitalists delve into clinical research and grant writing. Hosp Pediatr. 2021;11(1):e6-e8. 6. Hall AK, Mills SL, Lund PK. Clinician-investigator training and the need to pilot new approaches to recruiting and retaining this workforce. Acad Med. 2017;92(10):1382-1389. 7. Simpson RL, Cornfield DN, Burris JE. Novel prescriptions from medical schools for physician-scientist training and engagement in the twenty-first century. Acad Med. 2021;96(4):512-515. 8. Santen RJ, Barrett EJ, Siragy HM, Farhi LS, Fishbein L, Carey RM. The jewel in the crown: specific aims section of investigator- initiated grant proposals. J Endocr Soc. 2017;1(9):1194-1202. 9. Sauer RM, Gabbi C. Grantsmanship: What? Who? How? Eur J Intern Med. 2018;57:22-24. 10. Monte AA, Libby AM. Introduction to the specific aims page of a grant proposal. Acad Emerg Med. 2018;25(9):1042-1047. 11. Gabbi C, Sauer RM. Grantsmanship writing tips: background, hypothesis and aims. Eur J Intern Med. 2019;61:25-28. 12. Sauer RM, Gabbi C. Grantsmanship writing tips: significance, innovation and impact. Eur J Intern Med. Jul 2019;65:26-28. 13. Gabbi C, Sauer RM. Grantsmanship writing tips: the experimental design. Eur J Intern Med. 2019;64:21-23. 14. Goldstein AM, Balaji S, Ghaferi AA, et al. An algorithmic approach to an impactful specific aims page. Surgery. 2021;169(4):816-820. 15. Guyer RA, Schwarze ML, Gosain A, Maggard-Gibbons M, Keswani SG, Goldstein AM. Top ten strategies to enhance grant-writing success. Surgery. 2021;170(6):1727-1731. 16. Ingraham A, Emamaullee J, Johnston F, Fahrenholtz M, Goldstein AM, Keswani SG. A practical guide to writing a competitive K award application. Surgery. 2021;170(5):1411-1417. 17. RNA Editing. Grant checklist example. AMWA. Published 2019. Accessed June 16, 2022. https://www.amwa.org/page/Resource_ Library_List#Grants 18. SciENcv: science experts network curriculum vitae. National Library of Medicine's National Center for Biotechnology Information. Accessed June 22, 2022. https://www.ncbi.nlm.nih. gov/sciencv/ 19. Samples: applications, attachments, and other documents. National Institutes of Health. Updated June 14, 2022. Accessed June 22, 2022. https://grants.nih.gov/grants/how-to-apply- application-guide/resources/sample-applications.htm 20. White E. Open Grants: about. OGrants. Accessed June 11, 2022. https://www.ogrants.org/about.html 21. Robertson JD, Russell SW, Morrison DC. How to find the appropriate program and grant mechanism for your idea. In: Robertson JD, Russell SW, Morrison DC. The Grant Application Writer's Workbook - National Institutes of Health version. Grant Central; 2019. 22. Research Portfolio Online Reporting Tools (RePORT). National Institutes of Health. Accessed September 7, 2022. https://report. nih.gov/ 23. Huang X, Dovat S, Mailman RB, Thiboutot DM, Berini D, Parent LJ. Building a system to engage and sustain research careers for physicians. Acad Med. 2021;96(4):490-494. 24. Thomas HS, Brodsky MB, Ewen JB, et al. Internal grant review to increase grant funding for junior investigators. Ann Neurol. 2017;82(4):497-502. 25. Bailey MB, Benson K, Weber-Main, AM. Applying writing tutors’ communication techniques as a medical editor. AMWA Blog. Published September 21, 2020. Accessed June 16, 2022. https:// blog.amwa.org/applying-writing-tutors-communication- techniques-as-a-medical-editor http://www.amwajournal.org https://blog.amwa.org/what-is-an-academic-grant-writer-editor https://blog.amwa.org/what-is-an-academic-grant-writer-editor https://www.amwa.org/page/Resource_Library_List#Grants https://www.amwa.org/page/Resource_Library_List#Grants https://www.ncbi.nlm.nih.gov/sciencv/ https://www.ncbi.nlm.nih.gov/sciencv/ https://grants.nih.gov/grants/how-to-apply-application-guide/resources/sample-applications.htm https://grants.nih.gov/grants/how-to-apply-application-guide/resources/sample-applications.htm https://www.ogrants.org/about.html https://report.nih.gov/ https://report.nih.gov/ https://blog.amwa.org/applying-writing-tutors-communication-techniques-as-a-medical-editor https://blog.amwa.org/applying-writing-tutors-communication-techniques-as-a-medical-editor https://blog.amwa.org/applying-writing-tutors-communication-techniques-as-a-medical-editor