Precision medicine is a phrase often used in healthcare but not well understood, especially by the general public. What type of precision are we talking about? Precision medicine is an emerging approach to disease treatment and prevention that considers differences in people’s lifestyles, environments and biological makeup, including genes. When the Precision Medicine Initiative launched in 2015 it was promoted as a great leap forward in understanding the various factors that contribute to human health and disease in the United States (U.S.). Read the Precision Medicine Working Group Report here.

The project has since been branded the All of Us Research Program and that title could not be more fitting. The goal of the program is to recruit 1 million individuals who will volunteer to provide their biological and health information in the form of medical records, genetic samples, and lifestyle data that is both self-reported and obtained from wearables (FitBit-like devices).

All of Us Seeks to Represent & Engage a Diverse Population
The All of Us program participants are to reflect the diversity of individuals living in the U.S. and are being treated as partners in the study. This concept of partnership speaks to the idea of participant engagement, an area Consuelo H. Wilkins, MD, MSCI, Executive Director of the Meharry-Vanderbilt Alliance and leader of the All of Us Research Program Engagement Core, knows quite a bit about.  Engagement differs from recruitment in that its goal is to involve participants in the design, implementation, and oversight of the research, not just to enroll them in a study. Engagement is also a 2-way line of communication where research plans are transformed based on the perspectives of all those involved in it: researchers and participants.

Participant Engagement is Critical to the Success of All of Us
So far, All of Us research participants have been “all in” to contribute to the program. Alecia Fair, DrPH, Research Assistant Professor with the Meharry-Vanderbilt Alliance, has been in the public health and health promotion/education field since 1992 and has never seen the degree of investment participants in the All of Us pilot program have displayed since it began in 2016.

Individuals have strong motivations for volunteering as participants. Many have loved ones who are sick or died prematurely from disease and hope their contribution to the program as a participant, and also as a voice of participants, will make a difference in the health of others. Generating a high level of individual involvement, investment, and trust in participants is critical as they can volunteer as much or as little information as they want to the program. In order for deeper insights and knowledge to be gleaned from the program, participants will need to be willing to share information from their electronic medical record, genetics, wearable devices, and self-reported daily lifestyle choices.

For a Deeper Dive:
About the All of Use Research Program

New England Journal of Medicine special report on the project (published 8/15/19)

Want to take part? Enroll in All of Us here: https://www.joinallofus.org/en
Have questions about the program? See FAQs here.
Want to engage your community in the program? See resources here.

Read more about Engagement and the All of Us Program Here: 
https://catalyst.nejm.org/precision-medicine-initiative-everyone/

Vibrent Health’s Role in All of Us: 
https://www.vibrenthealth.com/knowledge-center/2018/05/vibrent-health-power-technology-history-making-us-research-program/

As the calendar approaches August, it is that time of year again - the academic job search season is upon us. Faculty job advertisements start to be released in August and some application deadlines are as soon as mid-September.
Many bright and motivated graduate students and postdocs will be applying for these positions.

Landing a Faculty Job is Challenging
I think most know that it has become exceedingly difficult to land a tenure-track academic position (see a nice description of the process from one applicant here & see also). Data from the biomedical sciences estimate only ~20% of all Ph.D.s are working in tenured or tenure-track academic positions. In 2006, ~15% of US doctorates in biological sciences were in tenured/tenure-track positions within six years of completing their Ph.D.s with ~18% in untenured roles (postdocs, lecturers, research associates), this compared with ~55% in tenured/tenure-track roles in 1972.

The aspiration of many Ph.D.s is to strive toward an academic position, though interest is declining. But what will make you more competitive on the academic job market?

Predictors of Academic Job Market Success
For some insight, see this nice piece on preparing for the job search. Quantitative studies have also begun to shed light on the hiring process. Perhaps not surprisingly, the number of first-author publications (particularly in high-impact journals) are strong predictors of who becomes a principal investigator, PI (i.e., faculty member running a research lab). In addition, making sure your research builds on but branches out from that of your graduate school and postdoctoral mentors is critical.

I am also working with a team from the Future_PI Slack group to better understand what metrics predict who receives academic job offers. We are still analyzing that data but what I can say is that the objective metrics of funding track record and high-impact publications are important but the effects are rather small. What that means is that what separates those who get job offers from those who don't is not such much the volume or quality of their work or their ability to attract funding. Rather, I believe, it often comes down to the more subjective measure of "fit."
UPDATED 4/21/20: See preprint of our Survey-based Analysis of the Academic Job Market

From my own experience on the academic job market, here are some points to keep in mind:
1) Leverage your network to find out what search committees really want (i.e., are prioritizing).
2) If you are in doubt regarding your fit for a position, reach out to the search committee chair.
2) And thoroughly research the department to see if YOU think you would be a good fit.

It is important to learn more about what search committees want as a job advertisement often doesn't tell the whole story. Sometimes, committees don't even know what they want.

I will give you an example: I was forwarded a job advertisement for a genetic epidemiologist faculty position at a large, research-intensive institution a couple of years ago. I don't consider myself to be an epidemiologist. Though, I did some behavioral genetics research. Nevertheless, the department where this position was located looked like a great fit: interdisciplinary, growing, filled with faculty interested in understanding complex problems such as drug addiction (which I myself was researching) at all levels. I figured it was worth inquiring with the search committee chair whether I would be a good fit. I emailed him, attached my CV, and asked if I should apply for the open position. He replied back that this was an interdisciplinary position and they were looking for researchers doing a variety of interesting work in relation to the study of drug addiction.
I applied and SURPRISE, this was the only position I applied to (out of 26) where I got an onsite interview that year.

LESSON: NEVER assume you aren't a potential fit for a position. Research the department to see if YOU think you could fit in there. If the answer is YES, I encourage you to apply and make the case in your cover letter. Also, reach out to the search committee chair for some guidance. Sometimes they will give you the blanket "we encourage all interested individuals to apply." If that is the case, doing your own homework to make a decision on whether to apply or not is critical.

At the start of our call he mentioned that SURPRISE he was on the search committee for the position. And guess what? This was one of those places with no search committee chair contact information was listed on the advertisement. What luck! He gave me the inside scoop and told me the department was prioritizing a faculty candidate doing diversity research. That was not apparent to me at all in the job advertisement. So, I was glad I spoke with this professor. I tailored my application to reflect the fact that the work I did was focused on how reward and decision making behavior varied based on participant sex, age, and genetic makeup (i.e., biological diversity). I didn't expect to hear from this department, though, knowing their priorities for someone studying diversity as a construct. And, after I submitted my materials, I didn't hear back from them. Having the knowledge that my fit was poor for the position, though, made the rejection easier to process.

Do your research & connect with potential future colleagues
Hopefully these personal accounts show you the importance of not just blindly submitting your materials to as many open positions as possible. If you take the time to do your research and talk to faculty in the department, you can better prioritize where to apply and how to tailor your materials to make the best use of your precious time. Applying to faculty positions takes a lot of work and energy but putting in the extra effort to connect with the search committee chair or other departmental faculty is more than worth it.

Speaking of skills and interests, if you have some lingering doubts on whether a faculty job is the right fit for you but are unsure how your skills and interests translate to other potential careers, I highly recommend taking assessments through myIDP and ImaginePhD. These online tools (and see) will map your skills, interests, and values to potential career options and give you the vocabulary and references to further explore them. You will be amazed by the variety of careers out there for Ph.D.-trained researchers.

And what if you get that faculty job offer? First congrats! Second, reflect and ask yourself: Do you see the institution and department as a good fit? Will you enjoy living in the area? You shouldn't take a position because it is your only offer. You want to make sure it seems like the right place for you. And if you accept the offer but wonder if you can succeed as a faculty member or are afraid of "failing" while on the tenure-track, read this superb piece for some encouragement and inspiration.

In closing, don't forget to also listen to your gut. What feels right in terms of a career for you?

I was barrelling down the road to a tenure-track position and got as far as an on-site interview and the dreaded waiting game to see if I was going to receive an offer. Looking back now, I am glad I didn't. It would have been hard to turn one down.

I couldn't help feeling during that time though, that being a faculty member at a research-intensive university might not be the best fit for me. Did I really want to have to constantly be thinking about and writing the next grant application? Always be drafting and revising that next publication? Did I want to have to develop a large research arc for my lab that was both practical but also innovative? I realized that I really didn't want to do all those things. They were what I had come to expect from myself over 10 years of graduate school and postdoctoral work but they weren't things I enjoyed doing.

During my time as a graduate student and postdoctoral fellow I also really enjoyed mentoring and helping others with their career plans. I got involved in the Vanderbilt Postdoctoral Association and now I work in Postdoctoral Affairs. It is a better career fit for me than the tenure-track. I am still in an academic environment but I get to spend my time mentoring and helping talented postdocs navigate their career search and support them in their professional development. The work-life balance is great and I have a lot of autonomy in my new role. I think it is the right place for me at this stage in my life.

I hope all those reading this piece find what that right fit is for you, too. And realize it may change over time and that is OK.

Happy hunting!

Further reading & resources:
Great resources are available on getting your faculty application materials in order:
The Academic Job Search (from University of California, Berkeley)
Academic Careers: Start Here (from the University of California, San Francisco)

You can also find examples of my own application docs on my Job Search Resources page.

Making the Right Moves: A Practical Guide to Scientific Management for Postdocs and New Faculty
resource from Howard Hughes Medical Institute.

Growing up, especially in middle and high school, I was not the most social person. I was (and still am) quite introspective...OK spending lots of time with myself and my thoughts. Interacting with people, especially during those awkward teenage years, seemed wrought with uncertainty and peril including the possibility of rejection, judgement, hostility, and pressure to conform. Human beings are complicated and unpredictable...do I really need them in my life?

Loneliness

I was pretty much a loner. A LONER...a kind of dirty word in the gregarious 21st Century, social-media driven society we currently live in. I am OK admitting it, though, as I don't see it as a completely negative thing. Sometimes you need to be alone with your thoughts to understand who you are and what you want out of life.
I was/am not alone in feeling alone. Data suggests many people (especially adolescents) feel alone and social media may make the situation worse. Loneliness is associated with increased mortality (see also) and the problem is getting worse with over 50% of Americans in one survey reporting they have no one outside their immediate family to discuss important matters with. But, we really need human connection, including people to confide in and advise us as we make important decisions in our lives. These people could be members of your family but it helps to have a deep professional network as well.

The Solitary Nature of Graduate & Postdoc Work
Pursuing a graduate degree, you can very much focus on yourself and your work - your task is to do a lot of thinking, analysis, and writing. These are often solo tasks and it is easy to think that your productivity and success are self-driven.

I would argue this sense of focus and unwillingness to seek outside support ramps up as a postdoc. As a postdoc, there is no longer a thesis/dissertation committee to naturally serve as a board of advisors. Postdocs should definitely work to expand their mentoring network beyond their primary research advisor. You should really form a "board of directors" for you consisting of people (ideally from a variety of backgrounds) whose opinions and advice you trust. These individuals can help you expand your horizons - encouraging you to think about the skills and experiences you should pursue as you work toward the next step in your career. They can also help you expand your network, often a critical component to securing your next job. 

The reason this type of "networking" is often so difficult is because students and postdocs don't start networking in earnest until they need a job. Their desperation ramps up the stress/anxiety for the subsequent interactions.
It is impossible to deny, though, that networks are often crucial to securing employment...see links at the end of this article on the "hidden job market."
This realization comes down to the fact that trust is a key component in the hiring process. If a perspective employee comes recommended by someone a potential employer trusts, we give that person an edge in the hiring process. It is human nature.

So, while interacting with people you don't know can feel awkward and comes with much uncertainty leading up to it...what to say to break the ice, how to fill the awkward silence that sometimes arises, etc..., it is crucially important to build genuine human connections. And not just for selfish reasons. We are social creatures and our mental and physical health is closely tied to interacting with others. Being with others makes us feel good. Furthermore, you never know what can come out of such in-person interactions.
A "stranger" is someone you just haven't connected with yet.

Small Actions, Big Impact

Recently, I attended the 2019 Graduate Career Consortium annual meeting. The GCC is a group of individuals who work with graduate students and postdoctoral researchers to help them build the skills they need to secure meaningful employment. They are a super generous and supportive group and I heard only good things about them from colleagues at Vanderbilt and UNC.
The GCC conference was filled with many opportunities to interact with attendees outside the usual sessions and meals including morning walking groups and impromptu dinners together. It would have been mentally/emotionally easier for me to choose not to attend these various extracurricular networking events. I had a long day, spent hours interacting with others during the formal conference events, and had work I needed to do.
I am glad I took the time to take part in these events, though.

The next day, during a pre-conference event, all in attendance lined up by the number of years they had been working in graduate career/professional development and this young man was at the far end (year 0). After he mentioned to the group he was finishing up Grad School, I felt compelled to tell the room that he was looking for a job. I don't think this guy would have done that publicly but know he appreciated the gesture (he thanked me later that day). At dinner the night before he mentioned he was applying for a position at Duke and I know one of the people he was going to meet with at the conference. I made sure to put in a good word for him. Who knows what will come of my actions but helping this young man out felt good. I think this is what most senior individuals at organizations feel when you interact with them - if they see your potential and passion, they are willing to help you out and get personal satisfaction from doing so.

Helping Others Helps Us

Most people want to help others, especially others they know to be deserving. However, it takes knowing someone on a more intimate level than what they do, where they work, etc... (gleaned from small talk) to really understand their personality, their wants/needs, and the value they can bring to an organization. So, I urge the postdocs and graduate students I interact with (and it's good advice for everyone) to build strong connections, ask for help and advice, and go beyond their comfort zone. The little actions you take can add up to big effects on your life.

I am personally going to try to meet more people, build my own personal board of directors, and develop deeper connections with others who share my personal and professional interests. I encourage you to do what you need to expand your network and interact with others: volunteer, attend (graduate or postdoctoral) association events at your institution, take advantage of networking opportunities in your community or at professional conferences, or just talk to a stranger. These actions will make you feel more connected to the world, increase your mental health, and could deeply impact your life.
While such "everyday" interactions may seem trivial and tangential in the near term, they could have a lasting effect on you, long term. You certainly won't know until you try.

Dopamine is often referred to as the "reward" neurotransmitter, a chemical signal released to rewarding stimuli such as drugs of abuse. Its effect on motivation and reward is, however, more nuanced.

Prefrontal Cortical Dopamine and Cognition
In fact, dopamine signaling in an area of the brain known as the prefrontal cortex (PFC) is critical for a variety of cognitive functions, including attention and processes such as working memory. Interestingly, dopamine's function on cognition has proposed to be non-linear (inverted U shaped) with some optimal intermediate level of dopamine associated with better cognitive performance. My own work in collaboration with Charlotte Boettiger and Amanda Elton has used the inverted-U model of PFC dopamine's effect on cognition to explain differences in working memory and choice behavior seen in healthy adults. We have also shown evidence of U-shaped patterns in resting and task-related brain function.

PFC dopamine is thought to vary based on genetics and sex. Thus, biological factors affect where individuals fall on the inverted-U. Additionally, stress is known to boost PFC dopamine (and other neurotransmitters) and an individual's biologically-based PFC dopamine levels may explain why some people perform better under stress (i.e., their basal PFC dopamine is sub-optimal but it boosted "up" the curve to optimal range with stress) then others (whose PFC dopamine levels may start out more in the optimal range but are then pushed into a supra-optimal level "down" the inverted-U curve). Genetic variation in one key PFC dopamine regulatory gene in particular (COMT) has led to the use of the term "warriors" and "worriers" to explain the function this natural variation in PFC dopamine plays in human behavior.

Dopamine Signaling Declines with Age
Dopaminergic signaling declines with age. A 2017 meta analysis led by Teresa Karrer has demonstrated declines in both the receptors that are the key target of dopamine signaling as well as the dopamine transporters important in the regulation of this signaling.
This decline has effects on a variety of decision making processes. It also has implications for the inverted-U model as natural declines of PFC dopamine with age would be expected to shift where individuals fall on the U-shaped curve.

Dopamine's effects on cognition in particular and the fact that cognitive processes also decline with age (also see) that has lead to the correlative triad hypothesis. This hypothesis proposes that the decline of brain dopamine signaling explains much of the cognitive decline in aging.

You can explore these data showing variations in age-related decline of brain dopamine via an online application created by my colleague, Kendra Seaman, here.

Aging, Dopamine, and Decision Making
While our own data does not unequivocally support the correlative triad hypothesis of dopamine, aging, and cognition, this does not mean dopamine changes with age don't impact some aspects of human behavior. Work from the Samanez-Larking group and others has shown older adults are more likely to choose skewed gambles than younger adults, are less sensitive to monetary losses, and decrease their selection of risky monetary choices with age. See two excellent review articles on some of this aging & neuroeconomics literature here and here.
Our group, in work led by Kendra Seaman, has also found evidence that different types of commodities (social interaction and health) may be more valuable to older adults immediately and with certainty than money.
Interestingly, the brain regions responsible for assigning value to potential rewards are consistently engaged across adulthood. Thus, older and younger adults are using similar brain mechanisms to assign value to rewards. It is possible, though, that changes in dopamine signaling in these key reward valuation brain areas (ventromedial PFC, ventral striatum) influences to amount of value assigned to rewards as we age.

Summary & Future Directions
An increasingly aging human population makes it critical to understand how decision making processes may differ between younger and older adults. Natural, age-related declines in dopamine probably play a role in reward and choice behavior differences between young and older adults. Understanding the differences between choice behavior with aging will allow more effective interventions to be developed to assist older adults in their financial and healthcare choices (see also).
More work is needed to determine if particular approaches (from pharmacology to exercise) can be taken to optimize PFC dopamine levels and/or prevent age-related declines in dopamine signaling. 

Naming my first Reflections blog post "Start Here" may seem a bit on the nose. But, the key to taking on any big life decision is to start tackling the problem. 

I am currently reading the book Designing Your Life: How to Build a Well-Lived, Joyful Life, by Bill Burnett & Dave Evans (see an excellent New York Times review here).
It is a really great read for anyone trying to improve some aspect of their lives: finding the right job, prioritizing your love/family life, doing something that makes a difference in the world, etc...

The book starts out emphasizing the need to Start Where You Are. This centers on the need for a person to figure out where they currently are in their lives and what problem(s) they are trying to solve. A key point here is that you need to focus on the right, actionable problems in your life.
You should avoid tackling what the book terms "gravity problems" or problems that we effectively have no chance of changing because they are systemic (like gravity). This doesn't mean you should tackle a difficult problem but you should address it in an actionable way where your actions have the ability to affect change.
Another key step to moving forward with your problem is addressing "anchor problems". Anchor problems often keep us stuck because we have become anchored to only one ideal solution. This is problematic because that solution may not be obtainable (think, achieving a particular job at a particular company - what are the odds of you achieving this?). Ultimately, to address these problems, you need to reframe them or approach them from a new perspective. Maybe you don't need to land that particular job but you want to do a particular type of work and there are other avenues you could pursue to find a career that is a good fit for you. Be flexible and don't get stuck on only one solution.  

The book defines "life" broadly as health, work, play, and love. You should start out assessing how your life is going in each of these areas (how full is your life in each area, what could be improved) and whether you want to tackle a particular problem in one or more of them. 

You may find work fulfilling but have no time for play, love, and health. So, that might mean you need to address how much time you spend on work and whether you might want to do something different that provides you the free time to spend on the other important aspects of your life. What is a good life and how "full" these four areas of work, health, play, and love need to be to achieve the life you want will vary considerably from person to person. 
Once again we come back to starting where you are. What one person might deem a life problem worth solving another might be perfectly OK with. One's "good life" is immensely personal. But you need to understand what that good life looks like for you. 
As this blog and my interests focus on career exploration, let's turn to what a "good career" looks like for you. Where do you start?

Other great resources include InterSECT Job Simulations and content from UCSF's Office of Career & Professional Development (see also the MIND resources from UCSF).

A key concept from Designing Your Life is to "prototype" your next move...ie, try out a new career before you make the leap. A useful way to begin to learn more about a career and start to measure its fit for you is via informational interviews. Another great way to prototype is to freelance or volunteer, performing the task "on the side" to see how you like it and begin building a portfolio of experience that will help to land a job in that space, should you want to pursue it. Some work is easier to freelance or volunteer for than others. Writing is in high demand from many organizations (think, your professional association and their newsletter). You can also get experience with working with and presenting data (and market yourself as a Data Scientist) via Kaggle and keep your work available on GitHub.

A final point to keep in mind as you explore your career options, prototype your next move, and think about your ideal life: there is not one "optimal" life for you. The following quote from Designing your Life sums up this point: "A common mistake that people make, is to assume that there’s only one right solution or optimal version of your life, and that if you choose wrong, you’ve blown it.That’s completely absurd," Mr. Evans said, “There are lots of you. There are lots of right answers.”
I think this point is especially powerful as people grapple with the fear of making the "wrong" choices in life. It is freeing to know that one choice (or series of choices) doesn't have to define your whole life. The book pushes the idea of creating multiple "Odyssey Plans" for your life. Map out the next five years of your life in radically different ways: 1) pursue certificate in X, 2) intern at company Y, 3) transition to position at company Y OR 1) continue working in area Z while also working on improving writing skills by volunteering with association W, 2) do freelance writing for company D while still working in area Z, 3) move to a full-time writing career OR 1) continue working at company T, 2) take night classes in area U, 3) get promoted to new role at company T, etc.
This activity reinforces the idea that there are multiple viable options available to you in your career and life. I could do A, B, or C and be happy and fulfilled. Having this mindset means that if things don't work out with option A (you realize that career/life choice wasn't the right fit for you), you know you can pivot to option B or C and be equally (or maybe more) happy.

Remember that life is a journey, and there is no one way to undertake it nor one path to follow. With some deep reflection on your skills, values, and interests, you can start researching and planning the multiple paths you could take to achieve fulfillment in your life. 

Find more resources on the Designing Your Life website. ​

As some may know, I have written on postdoc-related topics for The POSTDOCket, the online newsletter for the National Postdoctoral Association, since May 2017.

Links to past POSTDOCket pieces:

• Postdoc Industry Consultants Program at Medical College of Wisconsin
• Services and Resources Available at Postdoctoral Offices of Varying Sizes
• Using Your Total Research Experiences to Make You Business-Ready
• Preparing for a Faculty Career at a Predominantly Undergrad Institution
• Vanderbilt PDA & Office for Postdoctoral Affairs Broaden Reach with Organizational Transition
• Thirty-Plus Years Enhancing the Postdoc Experience: Sam Castañeda
• Mentoring for Mutual Benefit: Leanne Redman
• Accelerate to Industry: A new Approach to Academic & Private Industry Collaboration to Improve Career Readiness of Graduate Students and Postdocs
• The Journey from Postdoc to Working in Postdoctoral Affairs
• Introducing My IDP & Me, a Career Development Resource from the NPA
• Dealing with Uncertainty in the Academic Job Market
  

From October 2018 to March 2019 I was a contributing blogger to the NIH BEST blog, writing about exploration and professional development, from my perspective. See that collection here.

I am now launching my own blog to continue to reflect on topics I am passionate about. These are varied and might include:

• Neuroscience-related topics, especially those focused on behavioral economics
• Personalized Medicine, especially how individual differences in biology (genetics) may affect treatment for a variety of diseases
• Career Exploration tips for graduate students and postdocs
• Professional Development resources and reflections for graduate students and postdocs
• Thoughts on the Evolving Scientific Workforce and how we can better prepare graduate students and postdocs for 21st-Century careers, inside and outside academia
• And more...

Example Personalized Medicine topics:
Using Data Science & Artificial Intelligence to Improve Healthcare
The NIH All of Us Research Initiative: A New Standard in Participant Engagement & Partnership

Brain & Behavior Blog, LifeApps:
Welcome to the Brain & Behavior Blog
Do You Wilt or Thrive Under Pressure? Genetics Offers Parts of the Answer

PassioInventa Articles:
The Ups & Downs of Aging: What Neuroscience Can Tell Us About Living Well
Career Exploration Series (as part of Science in Society content)

Inside Higher Ed Carpe Careers Columns:
The Importance of Informational Interviews

I hope my posts serve as useful resources for trainees, those who work with and advise them, as well as the general public interested in science, medicine, and the scientific workforce.
Stay tuned for more content!