Teamwork, Training, and Fully Funded Research

Rishi Dhawan, MD, a clinical hematologist and assistant professor of clinical hematology at the All India Institute of Medical Sciences (AIIMS), remembers the exact moment he knew he needed to continue his education. He had already completed his residency and postgraduate work in India, but when he came to the National Institutes of Health (NIH) as a clinical volunteer in their National Heart, Lung, and Blood Institute, he noticed the size, scope, and depth of the clinical trials there. 

Calling the experience "transformative," he explains, "That was the time when I first realized I had a knowledge gap: I lacked the skills for translating my research ideas into a persuasive, concrete research proposal."

Dhawan just graduated from the Harvard Medical School (HMS) Global Clinical Scholars Research Training (GCSRT) program in December 2021. He says it's the experience he needed to continue moving forward in his career. And, indeed, he has already been awarded prestigious funding for a grant in his specialty—which he says wouldn't have been possible, had it not been for GCSRT. 

Filling a Gap in Medical Training

After his experience at the NIH, Dhawan went on to complete a fellowship in adult blood and marrow transplantation (BMT) from the University Hospitals Bristol NHS Foundation Trust. But he still felt the gap in his knowledge, citing that research methodology didn't form a large part of his medical training. 

So, when he returned to India, he was looking for the opportunity to hone his research and epidemiology skills. Perusing through the New England Journal of Medicine, he spotted an ad for an HMS program and found GCSRT. It was exactly what he was looking for. Simultaneously, India went into a strict lockdown because of the COVID-19 pandemic, which meant that he had more time to complete the work.

Once he began the course, he says his classmates—who come from all over the world—felt a similar gap in their knowledge. "It's especially useful for physicians who are faculty in the early stages of their career, where they're expected to launch a research project, write papers, and generate data and evidence for research questions. They are the ones for whom the course is the best fit—and I am one of them," he says.

Dhawan's tenure-track position at AIIMS meant that he couldn't commit to full-time continuing ed outside the country, which made the hybrid model of GCSRT appealing (he was looking forward to the three weeks of on-campus work, but the program went all-remote due to quarantine). Classes were conducted twice to fit in all the time zones for the students, and he says the faculty worked diligently to make the learning educational despite the time differences and remote work.  

From Capstone to Fully Funded Research

Dhawan's capstone has real-world significance, through which he aims to obtain an NIH-level grant. Blood and marrow transplant patients in India can increasingly suffer life-threatening infections after a transplant because of multi-drug resistant bacteria. The developing world, Dhawan says, has a huge challenge with antimicrobial resistance: “The estimated mortality will be higher than cancer and diabetes combined by 2050." In a study in their department at AIIMS they found over 60 percent of acute leukemia patients to be colonized by multi-drug resistant bacteria at the time of admission, and these patients had significantly higher treatment interruptions and infection-related deaths due to bacterial bloodstream infections. 

Dhawan wrote his capstone project on developing fecal microbiota transplantation (FMT) as a tool to eradicate multi-drug resistant bacteria in patients planned for BMT. HMS has top FMT and BMT programs at Massachusetts General Hospital and Dana-Farber Cancer Institute, respectively, which gave Dhawan another reason to complete the GCSRT program—since his capstone was subject to peer review within HMS. In fact, he learned he received commendation from the faculty before graduation.

Dhawan has also seen the real-life benefit of the GCSRT program: earlier this year, he had the opportunity to apply for an American Society of Hematology (ASH) Global Research Award, which provides funding to early-career investigators for pursuing research projects that will help them get to their next step in their careers. Dhawan is one of only 12 researchers selected for this honor. Dhawan worked at the Hematology Branch at the National Heart, Lung, and Blood Institute at the NIH under the supervision of Neal. S. Young, who specializes in aplastic anemia (a rare and serious disorder in which the body stops producing enough new blood cells). In India, Dhawan sees hundreds more aplastic anemia patients at AIIMS alone than what are referred to the NIH from all over the U.S., so he wanted to explore the reasons behind this enormous geographical discrepancy. 

The US Department of Defense is funding Young's team to analyze the prevalence of aplastic anemia globally using a genome-wide association study (GWAS). Mentored by Young and in collaboration between AIIMS, Delhi, and the NIH, Dhawan is performing the GWAS on his own on an Indian cohort of immune aplastic anemia patients. Data from this study will be meta-analyzed with the NIH multi-ethnic GWAS project data.

Dhawan had the capstone project guidelines nearby as he wrote up and submitted the application, remembering with a laugh the instructions he'd been given by HMS faculty: "However crappy the grant is, the least you can do is format it in the right way!" But the capstone guidance was essential for obtaining the award, he adds. The program has been helpful from a content perspective, too: "GCSRT has a genetic epidemiology elective: that has acted as a primer for everything this project involves."

The Value of Teaching and Teamwork 

In addition to the research and grant-writing, Dhawan says the biggest value to him is the "soft" skills, like how to give an engaging talk, how to pitch your study in an engaging way, and how to work with a group of people. The GCSRT program completes five team assignments over the course of the year across a global cohort, and for Dhawan it's been invaluable.

"One message that has been repeated throughout the program is: what we can say about teamwork is from the Book of Job 38:11—Thus far shall you come, and no further," he says. "Everyone brings their skillset, but for having an impact and increasing the quality and efficacy of research, you have to learn teamwork."

In particular, learning from faculty and participating in remote lessons has helped Dhawan on his quest to be an even better educator himself. "I think the best way to remember things is to teach it," he says. "If you're able to make someone understand a difficult concept, you retain it better. One of my responsibilities as a faculty is to teach—undergrads, grads, trainees. I'm quite excited to implement what I've learned in the training programs I'm involved in."

Learn more about Global Clinical Scholars Research Training.

Written by Katherine Igoe