Title: A Sabbatical: The Gift That Keeps on Giving
Abstract: Scott Friedman is the Dean for Therapeutic Discovery and Chief of the Division of Liver Diseases at the Icahn School of Medicine at Mount Sinai, a former president of the American Association for the Study of Liver Diseases, and a leader in liver fibrosis research. He speaks often of the transformative role his sabbatical played in his career, and this month encourages other researchers to consider similar academic experiences, providing advice on what to do–and not do–to make a sabbatical worthwhile. REBECCA G. WELLS, MD, AGAF Associate Editor Cellular and Molecular Gastroenterology and Hepatology I was pleasantly surprised by the invitation from the editors to write about my sabbatical year since it took place more than 20 years ago (1995–1996) at the Weizmann Institute of Science in Israel. At the time I was an Associate Professor of Medicine at the University of California San Francisco (UCSF) School of Medicine, supported by one RO1 grant and spending 75% of my time in the laboratory. Despite the intervening years, the glow and enduring value of that experience makes it easy to recall and share the many positive lessons that emerged. Without question, the year was the most meaningful and transformative experience—personally and professionally—of my academic life. Although there are countless logistical challenges to organizing a sabbatical, its lasting value makes it worth the effort. The opportunity to step away from the grind of real life and explore new questions, a new culture (scientific and otherwise), and spend quality time in sharing memorable experiences with one's family is a priceless gift. It is not just my opinion: in 1 case-control analysis of 258 faculty members, of whom half took a sabbatical, the sense of well-being of sabbaticants was consistently increased; they perceived a positive impact on their families and their home institutions and were less worried about loss of resources than those who remained home.1Davidson O.B. Eden D. Westman M. Cohen-Charash Y. Hammer L.B. Kluger A.N. Krausz M. Maslach C. O'Driscoll M. Perrewé P.L. Quick J.C. Rosenblatt Z. Spector P.E. Sabbatical leave: who gains and how much?.J Appl Psychol. 2010; 95: 953-964Crossref PubMed Scopus (71) Google Scholar For academic physicians, sabbaticals offer equal value whether an individual's investigative focus is laboratory- or clinically based.2Stelfox H.T. Straus S.E. Sackett D.L. Clinician-trialist rounds: 27. Sabbaticals. Part 2: I'm taking a sabbatical! How should I prepare for it?.Clin Trials. 2015; 12: 287-290Crossref PubMed Scopus (4) Google Scholar, 3Straus S.E. Sackett D.L. Clinician-trialist rounds: 26. Sabbaticals. Part 1: should I take a sabbatical?.Clin Trials. 2015; 12: 174-176Crossref PubMed Scopus (1) Google Scholar, 4Palmer R. Clinical sabbatical aims to beef up trial-management skills.Nat Med. 2010; 16: 1170PubMed Google Scholar Moreover, although a sabbatical is traditionally a privilege of academia, clinicians in practice may take a sabbatical to bring new skills back to their group or institution.5Dodek A. How to plan a sabbatical.Can Med Assoc J. 1984; 130: 612-613PubMed Google Scholar For academic physicians, the first step is to review your institution's sabbatical policies, which vary greatly but typically allow sabbaticals every 7 years to senior faculty (some require tenure) at partial or reduced pay, depending on the time away. In my case, I received a senior Fulbright Fellowship, which provided partial salary support, and the remainder was covered by my National Institutes of Health (NIH) grant salary support because my project was continued under my oversight from afar. Convincing your Division Chief and Department Chair, who usually must approve your sabbatical, becomes much easier if you can cover the cost of your sabbatical and not impose a financial burden on your home institution. In addition to the Fulbright program (www.cies.org/Fulbright), other potential funders include the Fogarty Program of the NIH (https://www.fic.nih.gov/programs/pages/default.aspx), the Guggenheim Foundation (www.gf.org), the National Science Foundation (www.nsf.gov), The Human Frontiers of Science Program (http://www.hfsp.org/funding), the European Union Marie Curie Fellowships (https://ec.europa.eu/research/mariecurieactions/about/individual-fellowships_en), as well as disease-specific foundations, and regional, national, or other international funding agencies. Remarkably, very few faculty are aware of their institutional policies, and even fewer take advantage of this opportunity when eligible. In 2 reports, the fractions of physicians who took advantage of their institutions' sabbatical policy were only 9% and 16%.6Bernstein E. James T. Bernstein J. Sabbatical programs and the status of academic emergency medicine: a survey.Acad Emerg Med. 1999; 6: 932-938Crossref PubMed Scopus (13) Google Scholar, 7Jarecky R.K. Sandifer M.G. Faculty members' evaluations of sabbaticals.J Med Educ. 1986; 61: 803-807PubMed Google Scholar Sabbatical time not taken is almost always forfeited. The choice of sabbatical venue typically is driven in equal measure by the career opportunities and the location. Although working and living in an English-speaking country is more comfortable for Americans, the opportunity to immerse oneself in a new language and way of life is very rewarding, even more so for children than parents. It is essential to have a concrete set of goals and timeline, but equally important to remain flexible and open to new ideas. The choice of project should be aspirational in driving one's investigative focus into new areas, often using new methods. Just before my sabbatical my laboratory had cloned a transcription factor, KLF6, so I sought to work in a laboratory with expertise in transcription factor biology. In my case, the first priority was to study in Israel, so I reached out to investigators at 3 academic centers who had expertise in transcription. I quickly narrowed my search to the Weizmann Institute of Science in Rehovot, in part because it was most conducive to sabbaticants by offering visitor housing in a lush, enclosed campus, but also because of their breadth of expertise in the life sciences. Fortunately, Professor Moshe Oren, a renowned scientist there who previously had been among those to establish p53 (a transcription factor) as a tumor-suppressor gene, was willing to host me. Moshe was a gracious mentor who proposed a project that merged our expertise by exploring p53 function in hepatocytes. Not only did he welcome the prospect of hosting me, but he replied promptly to the multiple requests for documentation by funding agencies whose support I was seeking (not a trivial imposition). Moshe remains a treasured friend whose insatiable curiosity, leadership style, and humility I continually admire. His instinct to leverage my expertise in a project in which I could add value was both generous and a great example I have since applied toward experienced scientists who visit my laboratory. My actual project—to explore the role of p53 in regulating hepatocyte cell cycle and apoptosis8Friedman S.L. Shaulian E. Littlewood T. Resnitzky D. Oren M. Resistance to p53-mediated growth arrest and apoptosis in Hep 3B hepatoma cells.Oncogene. 1997; 15: 63-70Crossref PubMed Scopus (44) Google Scholar—crystallized only after my arrival and barely resembled the one we had proposed for extramural funding. As an MD who never had formal PhD training, I relished the chance to function as a graduate student for a year in Moshe's laboratory (Figure 1). I worked independently but relied heavily on the informal guidance of the graduate students and postdoctoral fellows in both Moshe's laboratory and those of another principal investigator who shared the space where we worked. Unfettered time to work at the bench without distractions of meetings or emails was a great gift of the sabbatical experience. A bonus was remarkable serendipity, because we later identified KLF6 as a tumor-suppressor gene in multiple cancers.9Narla G. Heath K.E. Reeves H.L. Li D. Giono L.E. Kimmelman A.C. Glucksman M.J. Narla J. Eng F.J. Chan A.M. Ferrari A.C. Martignetti J.A. Friedman S.L. KLF6, a candidate tumor suppressor gene mutated in prostate cancer.Science. 2001; 294: 2563-2566Crossref PubMed Scopus (380) Google Scholar, 10DiFeo A. Narla G. Hirshfeld J. Camacho-Vanegas O. Narla J. Rose S.L. Kalir T. Yao S. Levine A. Birrer M.J. Bonome T. Friedman S.L. Buller R.E. Martignetti J.A. Roles of KLF6 and KLF6-SV1 in ovarian cancer progression and intraperitoneal dissemination.Clin Cancer Res. 2006; 12: 3730-3739Crossref PubMed Scopus (94) Google Scholar, 11Kremer-Tal S. Narla G. Chen Y. Hod E. DiFeo A. Yea S. Lee J.S. Schwartz M. Thung S.N. Fiel I.M. Banck M. Zimran E. Thorgeirsson S.S. Mazzaferro V. Bruix J. Martignetti J.A. Llovet J.M. Friedman S.L. Downregulation of KLF6 is an early event in hepatocarcinogenesis, and stimulates proliferation while reducing differentiation.J Hepatol. 2007; 46: 645-654Abstract Full Text Full Text PDF PubMed Scopus (76) Google Scholar Chance has never favored the prepared mind more! Not only did the scientific experience yield immediate benefits, it also durably imbued my work with greater confidence to tackle new challenges and assimilate new approaches by working with experts outside my comfort zone. Ironically, the experience also opened my eyes to the prospect of new growth opportunities here in the United States, and contributed to my decision to accept a faculty position at Mount Sinai in New York 1 year after returning from Israel. For those who simply cannot leave their hometown because of family or other reasons, an in-house sabbatical, or one at a nearby institution, can yield many of the same rewards. A colleague of mine at UCSF who took such a midcareer laboratory sabbatical completely transformed his work from clinical investigation to basic molecular biology, and he is now a highly cited scientific leader in his field. Planning at least 2 years in advance is wise. The many details required to uproot a family and career are daunting, but the digital revolution has greatly eased the task, providing easier access to online housing opportunities, banking and bill-paying, and facilitating advance scientific planning with potential collaborators, as well as with one's home institution during the sabbatical. At the time of my sabbatical in 1995–1996, email was relatively primitive, and scientific images could only be faxed, not emailed. Nonetheless, I was able to oversee my ongoing project at home with fresh insight thanks in part to my new skills and the advice of those around me at the Weizmann. The NIH got its money's worth by continuing to support my RO1-funded studies that year. Although individuals in a traditional sabbatical usually pursue a single project with a single mentor, atypical sabbatical experiences can be equally meaningful, including those at biotechnology companies, regulatory agencies, and even through the study of nonmedical disciplines such as history or philosophy.12Clevers H. Firestein S. Ringrose L. Bernards R. Darwin K.H. Vance R.E. Radical sabbaticals.Cell. 2015; 163: 788-789Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar Any of these options still incorporate the necessary ingredients of a productive sabbatical: a change in venue and chance to re-energize, and an opportunity to re-define one's professional identity and interests. In addition to assuming a new role during my sabbatical as a student, I sought ways to pay back the laboratory and institution for hosting me, not only by providing funding through my grants, but also by teaching a course in liver biology and pathophysiology. This challenge probably proved more enriching for me than any of my students. I also established close friendships with students and postdoctorals, who now, as senior faculty members throughout the world, remain valued friends. The opportunity to live in Israel in what turned out to be a highly tumultuous year, was deeply meaningful. Weekend trips with the family to ancient biblical and cultural sites and engagement in the political scene, while also immersing myself in classes to learn Hebrew, yielded a comfort level for us with the culture, history, and contemporary challenges that no amount of tourism could provide. The year also allowed me to refine and indulge my love of photography, enabling me to chronicle the remarkable experiences and people I had met, and share them with family, friends, and colleagues upon my return. Twenty years on, I continue to draw from the well of experience of my sabbatical. Upon my immediate return, I shared my experiences through a combined seminar/travelogue lecture to my colleagues at UCSF. I also recognized that it was important to assume a disproportionate clinical load for the next year in repayment to my colleagues for my time away. Re-entry was a bit disorienting, but it also provided a refreshing perspective on a familiar setting. I also sought opportunities to remain connected to Israel, which included participation in grant reviews for the US-Israel Binational Science Foundation and other Israeli funding agencies. I hosted seminars by colleagues from the Weizmann Institute, and helped them connect to training opportunities and collaborators here in the United States. My sustained visibility in the Israeli scientific community also led to collaborative and consulting opportunities with scientists and biotechnology companies there, and generated interest by Israeli physician-scientists to work in my laboratory as postdoctoral or visiting fellows. Finally, my indebtedness to the Fulbright program led to my continued connection to this wonderful organization, most recently as a current member of the Fulbright Association Board of Directors. Having benefited immensely from my own sabbatical, I also welcomed the chance to host sabbatical scientists in my laboratory upon my return, one of whom was supported by a Fulbright Fellowship himself, and is now President and Provost of a major European university. There is rarely a perfect time for a sabbatical, but I have never met anyone who failed to benefit enormously from the investment required to make it happen. At a time when the demands on academic physicians seem exponentially greater than 20 years ago, a sabbatical is just the antidote, allowing one to upgrade the quality of one's science and life. It is a rare opportunity for renewal that should not be missed. It continues to reward me every day of my career.