On Being an Early-Career Researcher in Digital Health: Part 2

Recap. Research in digital health (eHealth, mHealth, big data in healthcare) is a hot area with considerable room for growth. But working in this field has some potential pitfalls that early-career researchers (ECRs) need to consider before jumping in. Last time, I described some of the expenses associated with this work and some ways that ECRs can plan for these. I also noted that this work is time-consuming, which is today's topic.

Time is a commodity in academia, and the stress of effectively managing one's time is especially high for ECRs - we're just getting the hang of what works and what doesn't, after all. Of course, any research project* can be time- and effort-consuming, and perhaps more so for ECRs. We're less likely to have large collaborative networks, and in our networks, we have less clout than more established researchers. We're also just establishing our labs and identifying responsible RAs. So projects aren't always completed on our intended schedules, and we end up doing much of the work ourselves. This stalls our progress and creates undue worry about achieving tenure. 

In digital health, it's possible that you're actually unable to do all of the work yourself. For example, if I wanted to design a web program to deliver a new intervention, I would need a computer programmer's assistance. Same goes for collecting data in real time via smartphone app. As with reducing costs and/or accessing technology, maximizing the benefits of collaborations is essential for time management. If you're collaborating with non-academics, there is a good chance that your ideas about "complete" and "timely" work will not align with theirs. This could lead to a great deal of time and effort spent chasing down the products you need. See here for some signs that your collaborations are toxic.

Two other considerations about time management in digital health research. It's intuitive to expect that technology will decrease the time and effort that you need to spend managing data collection. Indeed, something like switching from in-person to internet survey administration frees up many hours that would have been devoted to participant supervision. But this exchange is not equal across all devices, platforms, and methods.

Take the aforementioned real-time data collection as an example. Once the app is set up, you just let it run and the data come rolling in, right? Anyone who has ever worked with this type of ecological momentary assessment procedure is laughing right now. Bugs in your app, device problems, and most of all, participant error will take more time to address than you can imagine. And managing the resulting data is a job I would never, ever want.

Similarly, take a web-based behavior change program. Once the platform is set up, even if it's been plot-tested, monitoring use, responding to problems, and managing any participant interaction takes more time than you expect. Students are fantastic and helpful in some respects, but they have myriad other responsibilities and will never treat the project with the same care you will. One more reason to pursue funding as early and often as possible: if you have professional staff, you don't have to bear this burden yourself. (It is my goal in life to get a grant that allows me to hire a professional research coordinator.) 

Finally, keeping up with advancements in the field presents unique challenges in digital health. As noted, the field is exploding, with new papers and journals appearing every week. Moreover, technology evolves, especially in commercial industry, at an alarming rate. By the time you hear about a device or platform, design a study, learn how to use the technology, hire/train others, and collect the data, your technology is out of date. Then you have to write papers, wrangle any collaborators, deal with peer review and rejection.... by the time you actually publish your findings, the current technology is much more sophisticated than what you used. If behavioral science is your field, then the technology matters less than the way it's used. But if not, have a plan for how you'll deal with criticisms about living in the digital past.

What other challenges do you see for digital health ECRs, or ECRs more broadly? Post your comments below.

*I'm currently reading Joel Cooper's Cognitive Dissonance: Fifty Years of Classic Theory, which describes many of the key studies in this social psychology area. It's reconnected me with my incredible respect for social psychology research. You want time-consuming? They use rigorous experimental methods to test complex theories, using multiple moderators, confederates, and elaborate cover stories. Impressive.

On Being an Early-Career Researcher in Digital Health: Part 1

We're back! A late Happy New Year, with wishes that 2015 has started off well. If you're an academic, it's likely that your Spring semester has started. Scranton has the luxury of a long intersession, so we still have 10 days to go. (If I'm being honest, I'll acknowledge that I've been back to work every day in January. Who can resist the call of flexible time to write papers?) You can rub it in when I'm still teaching in May.

I have had a productive intersession so far, and both papers and a fellowship application have given me plenty of opportunity to consider where I want my work to go next. Most signs point to digital tools for health behavior change, though as an early-career researcher (ECR), I hesitate to throw all of my energy in this direction. For a few reasons.

Full disclosure. Digital Health is not my area of specialization, but it is one of my interests, and my work moves more and more in this direction. In fact, this theme has come to unify a few of the disparate threads of my research. This post is a reflection on the opportunities and challenges for an ECR with interest in digital health who does not already have ample funding.

Digital health is a term that encompasses the use of technology in health promotion and healthcare, including mobile health (mHealth, or mobile applications), eHealth (electronic health, or web platforms/email), and wearable technology (Fitbits and the like). As such, it brings together computer programmers and software designers, engineers, medical specialists, big data analysts, entrepreneurs looking to design "the next big thing." And - arguably the most important - behavioral scientists. I'm biased, of course, but hear me out.

For example, I can hardly count the number of recent scientific papers and news articles that point to the simultaneous potential of wearable technology and/or mHealth apps and their failure to promote lasting health behavior change. Nearly all of these articles explicitly name behavioral science as missing or underappreciated in these domains. Indeed, what interests me in this area is identifying the missing link; my recent and forthcoming work has shown preliminary support for improvements to our use of technology-connected online social networks to facilitate and sustain behavior change. 

Each of these publications, including mine, involves a call to arms for larger, more rigorous, more cost-effective tests of improvements to digital health interventions. The time is now to strike in a hot area, which few ECRs ever get to to. Perfect! Except.... damn, this work is expensive and time-consuming. Today, I'll focus on expense; part two will cover the time commitment.

Expense. With wearables, it's the device ($90-$150) for each participant; with new apps or web platforms, it's their development (which I would have to pay someone to do); for either one, the convention is to offer some sort of monetary compensation for participants' time. I did get away with offering only the device and treatment in a recent study; I had 100% retention of 12 participants over four weeks. But this sample size and time frame aren't that impressive.

An obvious source of funding for these needs is a new faculty member's startup package. If you're a new faculty member at a research-oriented institution, and your institution understands the resources required for digital health, and you did your homework before negotiating, skip this section. But let's examine whether this is a common situation. Startup packages seem to be the privilege of only those hired to the tenure track. (A good friend of mine just accepted a non-tenure track, teaching/research faculty hybrid at an R1, and got only enough to cover her statistical software needs.) If you're at a non-R1, you might have to play hardball to get an administrator who is not familiar with digital health to pony up more startup money than s/he believes you deserve.

On, and you may have heard that, in the US and elsewhere, the tenure track is disappearing. So if you're hired into a short-term teaching faculty position, you'll need to write a grant proposal. Are you eligible for internal grants? Pray that the answer is yes; at many institutions, your status excludes you from both internal funds and government grants. Unless you can get a longer-term commitment based on your grant award. Meaning you have to get the grant. 

The same goes for many postdoctoral fellowships in the US. If you're in a formal training program that provides individual funding, great! Again, skip. But a good number of fellowships do not come with project funding, and same goes for internal and external grants. For example, at my postdoc institution, available funds went to graduate students and faculty, not postdocs. (I have heard that this is changing, which is great for the new class.) In health psychology, many organizations that offer small grants for which students are eligible, not postdocs. 

What are your remaining options? Again, without a longer-term commitment from your institution, you won't be eligible for many internal or government grants. The NIH K-series* is one exception (see Part 2). Aside from the K, I took advantage of every possible opportunity for funding on postdoc; most required that I be listed as a co-investigator, as I was not eligible to be the PI, though the project would have been mine. I also applied for ECR grants and fellowships through professional organizations. No luck for me, but I do recommend this route. It can't hurt to try, and your vita will show that you're knowledgeable about the process.

Your other option is collaboration. On postdoc, I was fortunate to be able to collect some pilot data by adding components to existing or new studies that were initiated by my mentors. And, as noted, I ran a pilot with no funding, using devices leftover from a previous study. This worked for me, but it's not the same as having control over study design and fund allocation. For behavioral scientists, sometimes partnering with those in basic science or computer programming will make your applications or final products look stronger to those evaluating them.

Whatever you do, think beyond your first study. If funds are limited, your devices or program will need to last you a while. Can you design a second study, perhaps even in a topic area that isn't quite digital health, so that will benefit from the money you spent on project one? For example, after my upcoming pilot intervention study, my devices will be used as assessment tools in a larger longitudinal project. It was a huge relief to realize that the devices could work for a distinct purpose and interest.

The bottom line. If you're a graduate student or postdoc with interests in digital health, think strategically. Use whatever funding you have or startup you get to purchase materials that will serve multiple purposes. Same goes for any early-career faculty member thinking of getting into the area. Apply for grants as early as possible, and use the money to build toward bigger and better projects. Collaborate. And try to keep up with the newest developments; unfortunately, your ideas and technology will be obsolete in a few months. More on this next time.

First-Year Faculty: Survival Skills

Evaluating advice. As a new faculty member, I've had a lot of people offer their advice on how to be successful. (I've also sought a lot of advice, as noted.) Much of what I've absorbed as been spot on and immensely helpful. Though I have raised my eyebrows in surprise and skepticism more than once, which also has been useful. As we come to the end of the first semester, here are my tips for surviving the first year.

(1) Read, read, read. You're not alone. Thousands have made this transition before, and hundreds have shared their advice in books and blogs. Make a habit of searching for their tips; download Kindle books, search Google and Twitter, follow links from blog to blog. No matter how busy you are in the few months before you start, you can set aside a few minutes per day to prepare yourself. My list included:

• From Student to Scholar: A Candid Guide to Becoming a Professor - Cahn & Stimpson
• The Academic Self: An Owner's Manual - Hall (particularly good for promoting self-awareness and reducing egotism)
• What They Didn't Teach You in Graduate School - Gray & Drew
• Preparing for Your First Year as a Faculty Member - compiled by Brown University
• Get a Life, Phd (blog) - Tanya Golash-Boza

(2) Trust your training. Much of what you'll read warns that an academic job is unlike training. It's true that you haven't done this job before, and that neither grad school nor postdoc fellowship prepared you for exactly the challenges you'll encounter in your first semester (e.g., politics, managing your own time, managing TAs, preparing lectures, choosing service "opportunities"). But if you made it through graduate and postdoc training successfully, then you know how to juggle classwork, academic writing, meetings, requests from supervisors, and student assistants. 

The difference is that no one tells you which of these to work on at any given time. This may require some adjustment, and might seem overwhelming at first. Rely on the techniques that got you through training - lists, designated work time, working (or not) from home, or whatever helped you be successful to this point. Those can keep working for you if you adapt them to your new situation.

(3) Work on long-term mind. You kept your eyes on the prize (an academic job) for years, and it helped get you through some tough moments. Well, it starts all over again, with the new prize of tenure several years away. As frustrating as this can be, you know how to do it. And what's different is that now you can work on the projects that are most meaningful to you. Write the papers that matter to you; choose your assistants based on your own values and goals. Chip away a little bit at a time and mix in some relaxation. Remember that you don't have to do everything at once. You have a few years to make your tenure case, so plan thoughtfully.

(4) Pick your battles, but stand up for yourself. As the new kid, well-intentioned colleagues will offer you their insights, and only some of these pearls of wisdom will be solicited. Some of it will inspire gratitude, and some of it will make your blood boil - particularly if it comes across as unnecessarily condescending. No matter what the culture of your institution or department, they hired YOU, and they hired you to be a colleague. As long as you're being reasonable, don't let seniority equal disrespect. When necessary, make your expectations known, and provide warm but firm feedback. (Because not everyone is willing to do this, unacceptable behaviors persist. Often, people are grateful when someone finally says something.) *If you don't preserve your self-respect, you may find yourself bitter and resentful right quick.

Of course, not every technique is optimal for everyone, so I refer back to #2 - do what works! Though do adapt it to your new environment.

I had a fantastic first semester, which included manuscript submissions/acceptances and earning a teaching grant to purchase materials for a new course. It can be done.

#AcWriMo - Academic Writing Month (Part 3)

Ambivalence. As #AcWriMo2014 winds down, I have mixed impressions of my success. I produced what I set out to (and then some), which is gratifying during such a busy time of year. As planned, I:

• Completed and submitted a teaching enhancement grant application
• Completed and submitted my first year self-report
• Finished and submitted two in-progress papers (including my first solo-authored!)
• Make significant progress on a (major) revise and resubmit invitation for my dissertation manuscript

I also submitted four conference abstracts (three with student co-authors), attended the Association of Behavioral and Cognitive Therapies conference to present two posters (one an Obesity & Eating Disorders SIG citation selection), and received word that my submission to the Society of Behavioral Medicine annual meeting was accepted as a paper presentation. All of this is fantastic, and I'm delighted to share the success with students.

Up next, I'll find out whether my department votes to keep me (i.e., the result of my first year report) on Tuesday, December 2nd; I'll hear about the teaching grant sometime before the end of the semester (December 16th). Manuscript submissions? As always, it's anyone's guess. (Though very nice to have them on someone else's plate, so they can linger for a while without complaint from me.) I hope to send the R&R off to co-authors for feedback in the next few days.

So why the ambivalence, if I met my goals? The goal that I didn't meet had much less to to with outcome than with process: I committed to writing for one hour per day (or two half hours), and as noted, I did not meet this goal 2-3 days per week. Even after recommitting to blocking out time, the MWF teaching/office hours/seminar schedule got the best of me. I did meet my goal on two of four Mondays and one of four Wednesdays and Fridays, which is decent considering everything else going on. But every blog, book, and tweet about being a productive writer, from productive writers, recommends a daily writing habit, and there is something alluring about such consistency. 

Perhaps what #AcWriMo has taught me is that I don't need daily writing to be "productive" at my desired level. I can continue to strive for this goal or knuckle down when I need to finish something, but beating myself up isn't necessary. Maybe relief, or disbelief, is manifesting as ambivalence? Either way, maybe it's time to lighten up.

Credit where it is due. I'm immensely grateful to Charlotte Frost at PhD2Published, who started the initiative, and to the hundreds of academics who posted tweets of progress and support. Especially @ATRWibben, @JosephsonJyl, and @iladylayla (aka the Global #AcWri Team) for their company and encouragement during writing episodes. Being part of the community has made the frenzy of #AcWriMo enjoyable. Sign me up for next year!

#AcWriMo - Academic Writing Month (Part 2)

November. The first semester has hummed along at a steady clip for two months. I've had time to get to know colleagues, write and submit, run, and even relax a little. It seemed that I might achieve work-life balance after many years without it. 

Then, BAM - November! This is me on 11/14:

Now I know why November is #AcWRiMo - so easy to get caught up in other tasks! Tomorrow = reflection on the first two weeks, and planning.
— Dr. Danielle Arigo (@DaniArigo) November 14, 2014

Let's review. I knew that it would be a busy month. I had decided to apply for a teaching grant (due 11/3) to buy materials for a new course. I'm traveling for a conference the weekend before Thanksgiving, and then again for the holiday, plus I agreed to  do a guest lecture on eating disorders in a sports psychology course. And that first year self-report, due the 24th, which needs to be drafted early enough that generous colleagues can provide feedback. So I needed to get ahead of the game. 

My #AcWriMo goals included a mix of necessary tasks and additional objectives, which I thought were reasonable:

• Complete teaching enhancement grant
• Complete first year self-report
• Finish and submit two in-progress papers
• Revise and resubmit dissertation manuscript

It started with the teaching grant application. Syllabus for a new course I've never taught, timeline, budget, proposal, and letter of support (which I wrote myself). Despite my head start, there was a bit of cramming the night before to make the pieces cohere. Fortunately, the eating disorders lecture occurred in the same week span as the same topic in my own courses, so there was only a bit of extra work there. Though I learned that four straight hours of teaching with no break = fatigue and the 10,000-step buzz from my FitBit by 1:00 pm. Conference poster is nearly done, I've made steady progress on the revision and first year report. And I submitted one of those in-progress manuscripts.

So where am I? The concrete achievements sound pretty good, except that the workload is catching up to me. I set a goal of writing for at least one hour every day, as I would really like to get into a daily writing habit. The first week went well; I skipped one day, but exceeded the total for the week. I realized that finishing the revisions for an invited resubmission is NOT reasonable, considering the work involved. So I edited that one to "address revise and resubmit invitation," which I can make progress on for the next few weeks. 

But this week, I skipped three days of writing - my teaching days, which are exceptionally busy, and require either early mornings or late evenings to squeeze in writing. One hour isn't that much, so I could have done this. Though I realized that I really, really enjoy having nights off during the week. Right now, I don't think I'm willing to spend two or three nights per week working. I've done it for years and I'm tired. I could feel guilty about this, but I think it's reasonable. I think about Tanya Golash-Boza's commitment to a 40-hour week and wonder if it's possible to achieve it as a junior faculty member. So I have to think of another way.

Some options include:

• Spending less time on Twitter
• Breaking the hour into 20-minute blocks
• Closing the door after office hours, no matter who wants what
• Accepting that MWF are not writing days

I don't like the first or the last; I get a lot from the academic support and suggestion network on Twitter, and I learn about valuable research in my area. And I'm not a quitter. So this week, despite travel, I will schedule time to write each day and commit to sticking with it. Wish me luck.

#AcWriMo - Academic Writing Month 2014 (Part 1)

It starts! November 1st marked Day 1 of Academic Writing Month - a month-long effort to set goals, work toward them, and hold yourself accountable. You can read the history and full instructions here; in brief, you set writing goals, identify your plan for accomplishing them, and check in each day using the publicly shared accountability spreadsheet. Many academics say that this burst of community-oriented writing invigorates them and increases their productivity. As this is my first year participating, it's a good time to (1) discuss goals, and (2) reflect on how to improve my writing process.

#1: Goals. November already is a busy month for me, so setting goals wasn't terribly difficult. Here are the ones I included on the accountability sheet:

• Finish and submit a teaching enhancement grant (i.e., a proposal to earn extra money for teaching equipment and other resources)
• Put the final touches on two nearly-done manuscripts, and submit both
• Complete requested major revisions to my dissertation manuscript, and resubmit
• Complete my first year faculty self-report (i.e., a summary of what I've done so far/why my institution should rehire me for year two/goals for next year)

The teaching grant and the self-report have hard deadlines, which are early and late in the month, respectively. (At the time of this post, I've already submitted the teaching grant. Hooray!) In the middle, I have two manuscripts that require a few hours each, and a set of major revisions that will take several days (at least). 

My plan is to focus one hour per day on writing, either all at once or split up into chunks. It's not much every day. But considering that teaching prep takes a good deal of time, and I have endless stacks of exams to grade this month, an hour every day will be an accomplishment. Writing here, counts, as well :)

#2: Process. I realized long ago that being a great writer takes more effort than I've been willing to give. For example, this excerpt from an advertisement for Hands On Writing sums up my process while in training (red = my edits):

This is how I (unrealistically) thought I would improve my academic writing back at the start of my PhD. Please feel free to laugh:

• I write something. I send the first un-revised draft to somebody (usually) more senior than me asking for feedback. 
• I will go to “track changes” and accept all of them automatically (so I save time). 
• Write some more and re-do the feedback accept-all-changes step. 
• Rarely - When the reviewer says it is good enough, read the document, try to find the 13498986 differences with my first draft so I can  learn some lessons for next time I have to write. 
• Forget everything quite a lot the next day.

I internalized some basics, like how NOT to use a colon and striving to keep sentences short. And my academic writing has improved dramatically over the past few years; I can tell when I read others' writing and I find ways to improve clarity. But I wonder how much better my writing would be today had I paid more attention to the process during training. 

These days, I still rely on others' feedback. I'm rubbish at finding the holes in my own logic and even worse at spotting typos. So a good friend and I trade documents and give each other comments, which has been helpful. I also include my undergraduate students in the process, by encouraging them to compare early- and late-stage cooperative pieces and asking them to proofread for me. And I read as much as I can. I often read about writing, of course. 

But I've also recommitted to reading books, for several reasons. One of which is that staying immersed in others' writing helps me stay in tune with what writing should (or shouldn't) look like. I'm partway through David Quammen's Spillover (about zoonotic diseases) and William Deresiewicz's Excellent Sheep (about problems with higher education). Both informative and timely for entirely different reasons. (More to come on these, I suspect.)

It's Day Four of #AcWriMo, and I'm going strong. Fingers crossed that we all keep it up!

The 50-Minute Lecture

50 minutes. Depending on the activity, this could sound like a lot. Actually, having 50 minutes of uninterrupted reading time, or 50 minutes to go for a run, or 50 minutes to watch an episode of House of Cards sounds luxurious. But in the context of teaching a subject you know well, it's nothing. Nothing! It amounts to consistently running out of time and having to cut from your carefully-designed slides. Which throws off the schedule and gives students an excuse not to read ahead. And leaves me considering whether to leave material out completely or expect that (undergraduate) students learn it on their own. 

Let's figure out why 50 minutes is so difficult. Well, the first few minutes are occupied with housekeeping, announcements, collecting or returning homework, and students coming in late. (The last is something to work on.) So 45 minutes at best. Any review takes up another 5 minutes. (I do this once per week in my 100-level class.) So as not to bore students to tears, I try to craft learning exercises, which take up 10 minutes at the very least.* Add or substitute one video clip with any discussion whatsoever (5 minutes). For example, today we covered psychotic disorders in Abnormal Psychology, and I worked in some Ryan Gosling. Effective, but time-consuming.

That's 20-30 minutes of actual lecture. How many slides can you get through in 30 minutes? I can get through 10, if it's a really good day (i.e., if students have read and there aren't any tangential questions). How many do I have prepared for each lecture? Minimum is 12, mean is 14. Compounded over a week, that's almost a full lecture behind.

So what goes wrong? Well, most students don't read, so we waste time with me waiting for them to answer my questions. (Sometimes they don't even seem to have opinions about concepts like identity or friendship, which is beyond me.) Maybe I should pick out only one or two main concepts, and cover those in detail. Maybe I should give more quizzes to ensure that students are reading, so that I don't feel any pressure to review everything important in class. Something needs to change; my midterm evaluations were quite positive, but it seems as though we've gone downhill since then. Though I'm not yet sure how much is me and how much is middle-of-the-semester laziness.

Based on several sources of recommendation (e.g., word of mouth, student feedback, this recent article about using PowerPoint in the classroom) I've started breaking up even non-wordy slides to make sure that each one is visible and useful. My "lecture" style relies heavily on eliciting responses from students; I naturally pause at least once every 2-3 minutes to ask students for factual information (from the readings) or their opinions about concepts. What keeps my prep time down is that I don't plan out these questions in advance. Keeps the lecture conversational, but likely wastes a lot of valuable time.

I need resources. What else do you recommend as a source for tips on planning lectures? I regularly read research/academic writing sources, but I haven't found the treasure trove of teaching wisdom yet. Share your favorites in the comments.



*I admit that sometimes I dispense with this.