June 7, 2023
At least nine Nobel Prizes have been awarded to surgeon-scientists—including Sir Frederick Banting’s for the discovery of insulin in 1921.1 Of course, today, these types of revolutionary medical advances rely on significant financial support, often in the form of grants provided by the US government, specialty societies, or private foundations.
The early career surgeon may find grant writing to be an intimidating process, especially as these skills are rarely included within the formal curriculum during training. Fortunately, adhering to good grantsmanship protocols and seeking the advice of experienced mentors can help surgeon-scientists at all stages of their careers pursue funding opportunities, and myriad sources of financial support are available for investigators willing to put in the work.
An article published in the Journal of the American College of Surgeons in 2021 revealed an overall increase in National Institutes of Health (NIH) funding for surgeon-scientists from 2010 to 2020.1
Specifically, in June 2020, surgeons held $872.5 million in NIH funding compared to $614.7 million in June 2010. General surgery-based subspecialties topped the funding list, comprising one-quarter of the funded specialties and nearly 40% of the total funding.1,2
Although the NIH is the largest public funder of biomedical research in the world, investing more than $32 billion per year to “enhance life and reduce illness and disability,” some experts suggest starting with society-based awards to establish a history of recognized research projects.3,4
“I started with non-NIH grants, with smaller society grants, that were a little bit less arduous in terms of the time and energy that it takes to put these together,” said Timothy L. Frankel, MD, FACS, the Maude T. Lane Professor of Surgical Oncology and director of the Center for Basic and Translational Science at the University of Michigan in Ann Arbor. “Then I started to build the initial blocks of how to write a successful grant. With the help of both my primary mentor and co-mentors, I started to establish what I wanted my research career to look like and what I wanted to study, and then I put together my first major grant, which was an NIH K08 career development award.”
There are several approaches to good grantsmanship, but generally this term refers to the skills necessary to procure peer-reviewed research funding. One US university research development office defines grantsmanship as the ability to “match your agenda to the mission, culture, and procedures of funders, and doing so in a way that maximizes quality, is innovative, and is a positive representation of the requesting organization.”5
According to Luz Maria Rodriguez, MD, FACS, a dual fellowship-trained surgical oncologist and colorectal surgeon with the NIH’s National Cancer Institute, good grantsmanship begins with developing a question that is extraordinary.
“Think about the clinical significance of your proposal: How is it going to benefit the patient, the community, and the world? You need to be able to demonstrate how your idea will move the scientific needle forward,” said Dr. Rodriguez. In other words, the grant proposal should address a question that is unknown in the field and that warrants further study.
“Consider whether or not your idea will result in lasting and permanent change,” added Tammy Leonard, president of a grant writing consulting firm based in Orland Park, Illinois. “Whatever you are proposing, it has to be unique and not duplicative of previous work.”
If you’re looking for a source to fuel scientific discovery, attend a conference…and listen.
“What I often tell junior faculty members is, if you’re at a lab meeting or conference and you hear, particularly a senior person, say ‘That’s a great question—we just don’t know why,” that typically means the collective community does not know why either—and that’s something that funding bodies are going to be interested in investing in,” said Dr. Frankel.
Beyond developing an innovative idea, good grantsmanship involves the skills necessary to communicate your proposal in a clear and intentional manner, the ability to engage in strong time management, and a collaborative approach involving mentor feedback and guidance.
In an article presented at the Academic Surgical Congress in 2020, titled “Top Ten Strategies to Enhance Grant-Writing Success,” the authors asserted that “a grant that reads poorly is likely to be set aside long before the final page,” and they suggest writing in a style that is accessible to a general scientific audience.6
“Reviewer panels include individuals with different levels and types of expertise within your field,” explained Dr. Rodriguez. “You want to make sure that everyone in the room, especially the primary and secondary reviewers, understand precisely what you are talking about.”
“When you’re writing for a government scientific foundation, there are no fluff, there’s no adjectives, there’s no emotion—they don’t want any of that,” added Leonard. “Your writing should feature the fundamentals of good grammar and be clear and engaging, but also remember that the reviewers will be educated in your field, so they will generally know what you are talking about.”
Experienced grant writers also invest the time and resources to ensure there are no overt typos, unusual font changes, or figures and tables that are cumbersome and difficult to comprehend. “All of these can be problematic for institutions that are thinking about giving you millions of dollars to study something,” explained Dr. Frankel.
Ultimately, when it comes to successful grant writing, good science is not enough. A focused, well-written proposal that underscores the novelty of your ideas in an edited and organized manner is essential to winning financial support.
“Help the reviewers, help you,” advised Dr. Rodriguez.
Another facet of good grantsmanship—avoid so-called domino aims, which are goals that are dependent on each other in order to achieve success.6
“When I write my grants, I make sure that if any individual aim were to fail, it would have minimal effect on the next aim,” said Dr. Frankel. “A classic mistake is to propose finding an agent in aim one, and then testing that agent in aim two, because if aim one fails, you have nothing to test in aim two.”
Reviewers are more likely to penalize an application if the aims are interdependent. Certainly, the aims should have a common thread, such as studying a disease or process, but they also should be self-contained so that the success of one does not rely on the other.
“These are potential pitfalls of a junior person writing a grant,” said Dr. Frankel, referring to all of the best practices that embody good grantsmanship. Overall, perhaps the most important piece of advice for novice grant writers is to avoid being overly ambitious; in other words, don’t overshoot.
“If you propose things that are outside of your skillset and training, then this will be one of the first things that reviewers are going to comment on,” explained Dr. Frankel. “This is a non-starter that will kill the grant no matter how interesting the question or proposal. Also, ”if a grant reviewer comments that you are overly ambitious, this is not a positive comment in this context,” added Dr. Rodriguez.
Grant-writing experts suggest submitting a more focused proposal rather than an overly elaborate one that could be difficult to complete within the timeframe of the award. The authors of the “Top Ten Strategies to Enhance Grant-Writing Success,” article recommend avoiding “screens, descriptive studies, or ‘fishing expedition’ projects that are open-ended and not hypothesis driven.”6 These projects typically involve substantial amounts of work that may not result in significant findings.
Dr. Timothy Frankel
The process involved in assembling a grant proposal varies widely and is predicated on the type of grant that is being pursued and the mission of its funding agency.
The NIH, the world’s largest source of funding for medical research, has one of the most comprehensive application pathways and, therefore, provides a template for successful grant applications, generally speaking, no matter the source.
Right from the start—in the opening paragraph of NIH’s “Plan Your Application” website—the agency suggests that a research grant can be “subverted by poor planning, preparation, disorganization, and lackluster presentation.”7
“You have to have an early start. You may need as few as 2–3 weeks for a small project and as long as a year or more for larger projects,” said Dr. Rodriguez, who suggests approaching proposals in three stages:
A key component of the Planning Phase should involve researching the agency’s approach to funding, eligibility restrictions, and the types of grants offered by the program. For example, the NIH has 27 institutes and centers, and each has its own mission, priorities, budget, and funding strategy.
The NIH uses “activity codes” to differentiate the various research-related work supported by the organization: R series (research grants); K series (career development awards); T and F series (research training and fellowships); and P series (program project /center grants).8
Dr. Luz Maria Rodriguez
“Find experienced staff at your institution who can assist you,” advised Dr. Rodriguez in a blog post for the Association of Women Surgeons.9 “This person may be in a central grants support office, or it may be another investigator or department administrator.”
The grants office, sometimes called the Office of Sponsored Research depending on the organization, can provide guidance on registering with the Electronic Research Administration (eRA Commons); inform you of any institutional deadlines or criteria that must be met prior to submission; and offer advice on developing the application, especially regarding its budget.7
Seeking out mentors, specifically colleagues who are funded investigators, also is a key component of the team approach to successful grant writing.
“Mentorship is 100% recommended. After you’ve spent weeks or months working on your proposal, you’re probably not going to see errors, but a colleague reading it in a peer-to-peer review will help flag what you may have missed,” said Leonard.
“I met with my mentor every week in my first 6 months on faculty, just to pitch new ideas of what I wanted to study,” added Dr. Frankel. “The harsh reality was that I didn’t know nearly as much as he did. He would tell me ‘that’s been studied already’ or ‘that’s a dead end.’ That feedback was critical to making sure that I didn’t spin my wheels and waste valuable time.”
An example of an error that a mentor might detect could be something simple, such as a failure to follow directions. “One of the biggest mistakes people make in a grant occurs when there are several questions embedded within one main question,” explained Leonard. “People sometimes answer the first question, when there are actually several more that need to be addressed.”
The NIH uses a scoring system based on a 9-point rating scale, with a score of 1 representing the highest score possible, 9 the lowest, and a score of 5 representing a good medium-impact score. The NIH defines “impact” as “the likelihood that your project will exert a powerful influence on its field.”10
As noted earlier, Dr. Frankel’s first major grant application was for an NIH K08 career development award. “I received a good score, but I didn’t get funded, which I think was an important step in terms of learning how to address criticisms from reviewers and then resubmitting the grant. I was lucky enough to get the grant on the next round,” he said. The award funded a 5-year study totaling $875,000 that examined why patients with chronic inflammatory conditions are prone to developing pancreatic cancer.
In fact, rejection on a first submission is so common, grant-writing experts suggest planning for it by building into the overall timeline the days necessary to revise and resubmit a proposal.11
Before embarking on the resubmission process, review the original funding opportunity announcement to learn about any potential new deadlines and eligibility requirements.
When resubmitting a proposal or application, consider the reviewers’ suggestions for change (e.g., the need for more preliminary data). Collaborate with your mentor to determine what is fixable and what may be irreparably flawed, such as a question that wasn’t deemed significant or innovative.
“Being awarded grants takes grit and persistence,” Dr. Frankel said. “It’s very easy to get discouraged by the process because it is difficult and not something that we are typically trained to do. But once you do get your first grant, there’s no feeling like it in the world.”
Tony Peregrin is the Managing Editor of Special Projects in the ACS Division of Integrated Communications in Chicago, IL.