Corey Fehnel, MD, MPH, FNCS
Brandon Merical, MD
In our inaugural Currents Researcher Spotlight, Beth Israel Deaconess Medical Center (BIDMC) neurology chief resident Brandon Merical profiles mentor Corey Fehnel, a neurointensivist at BIDMC and Assistant Professor of Neurology and Clinician Scientist at Harvard Medical School. Brandon credits Dr. Fehnel with shaping his own career trajectory, which will culminate in a fellowship in neurocritical care at the University of Pennsylvania starting later this year.
Dr. Fehnel’s journey toward neuroscience as a clinician and researcher began as an undergraduate majoring in psychobiology, and this led him to eventually pursue a neurology residency at BIDMC and a fellowship in neurocritical care at Massachusetts General Hospital (MGH). After completing his clinical training, his first junior faculty position was at Brown University’s Alpert Medical School, which also gave him the opportunity to obtain an MPH to help build his research skillset. He eventually returned to BIDMC, where he is now the Co-Director of the Neuroscience Intensive Care Unit and an Assistant Scientist at the Hebrew SeniorLife Marcus Institute for Aging Research. Dr. Fehnel’s work straddles the intersection of geriatrics, neurocritical care, and neuropalliative care, and through his research he has become an influential figure in this emerging field. He has received research support via several career development awards, including the AAN/ABF Research Training Fellowship, an NIH/NIA GEMSSTAR award, and most recently, a K23 award from the NIA.
Brandon Merical (BM): Let’s start by talking about who you are and what brought you to neurology in the first place.
Corey Fehnel (CF): I'm a product of my parent's influence—my mother was a counselor and my father was a chemical engineer at Eastman Kodak in Rochester, NY. My mom thrives when helping people, and balancing the complex lives we present outwardly and within, while my father loved to explain how things were put together and worked at a structural level. This translated into a psychobiology major in college, and while in medical school at the University of Rochester I was really torn between going into internal medicine or neurology. Neurology won out thanks to the inspiring mentorship and masterful teaching of Dr. Ralph Jozefowicz and the rest of the department of neurology at Rochester. Neurology merges the fundamental skills of a physician—a strong history and physical exam along with the interpretation of data from cutting-edge technology. During residency I couldn't decide whether to pursue vascular neurology or neurocritical care. Neurocritical care won out because I got to carry forward many of the internal medicine skills as a core component of what I do day to day in the neuroICU.
BM: Okay, so after you settled on what you wanted to from a clinical standpoint, what was your transition from fellowship to your early career as junior faculty at Brown like? How did you first develop your research trajectory and what did you do to build on it?
CF: The process started while I was a fellow at MGH working with Dr. Natalia Rost. With her mentorship we examined characteristics of patients with strokes that were associated with cocaine use compared to stroke patients without cocaine use. The project required an analytical framework that was quite challenging for me and exposed me to the process of peer review and publishing for the first time. Natalia really took me under her wing and provided the early support to complete the project. She provided approval for access to the analytical cohort, which I then populated and cleaned, and she then ran the statistical analyses. I quickly came to appreciate the need for familiarity with statistical software and analysis to improve my capabilities for future research.
BM: Is that why you decided to pursue an MPH while a junior faculty member at Brown? Would you recommend this path for others?
CF: Yes, this gave me advanced training in biostatistics, something that helped me a great deal in both the development and analysis stage of my future projects. Looking back the coursework was really important, as were the connections to senior researchers at Brown’s School of Public Health. The degree itself was great, but I would recommend any experience that offers a similar depth of skills and training with the opportunity for genuine networking. Many certificate programs can offer this with even greater relevance to junior investigators.
BM: How did you balance the MPH coursework with your clinical responsibilities as an attending neurointensivist?
CF: This required immense flexibility from my neurointensivist colleagues who, as a component of my hiring, agreed to adjust their clinical schedules to accommodate my coursework. I did extra weeks during the summer, and holidays to compensate for the reduced clinical time during the semester. On a personal level, my wife was also in residency during this time with a very heavy clinical schedule. We planned our few vacations well in advance, but otherwise this was an exceptionally busy period of time. If I wasn’t on service in the ICU, I was at the public health school or feverishly de-bugging code for my problem sets late into the night.
BM: What would you say your biggest challenge was in your transition from trainee to clinician scientist?
CF: It's a great relief to finish your clinical training program. It can be really easy to get lost in the fog of overnight calls and difficult cases in the ICU and miss the larger picture of your career trajectory in academic neurology. Many neurocritical care fellowship graduates’ schedules have been largely set for the preceding decade of training. However, your career ahead requires a lot of planning and the possibilities are overwhelming during this transition. Some of the best advice I ever received was from Dr. Eric Rosenthal (currently at MGH), who helped me to map out on paper exactly what I would be doing at different key time points during my career. Not only did he dole out the advice, but he then edited several drafts of my plan, and strengthened the feasibility of my proposed career path. Some goals I achieved, while others I had to adjust as time went by. Having a detailed, feasible, well-constructed plan was really crucial. I advise my mentees to do the same as it helps immensely in garnering resources within your department and hospital throughout your career.
BM: Along those same lines, what other advice would you offer to someone hoping to follow your trajectory as a neurocritical care researcher? Can you talk about some of your early success and failure?
CF: Perceived barriers to entry can be the hardest part. My advice would be to find small projects that help you identify your interests, skillset, and weaknesses. Importantly, don’t overextend yourself, and limit your projects to ones that are feasible within a relatively short timeframe. Learn to politely decline other opportunities that might distract your valuable time and attention away from your primary project goals.
Multidisciplinary mentoring relationships have been really beneficial. I actively sought mentoring relationships with established investigators outside of neurocritical care. As an intensivist, you offer new and unique clinical perspectives to your mentor’s ongoing research. I would encourage others to think about what they can bring from neurocritical care to existing research groups within their own institutions that could be of mutual benefit. This is much better than trying build something new from the ground up, which takes time and resources that you are unlikely to have as a junior investigator.
I was lucky enough to obtain a research training fellowship through the AAN/ABF in 2015, with the generous mentorship of Dr. Vincent Mor at Brown University’s Center for Gerontology and Health Care Research. I was familiar with the funding opportunity through my involvement in the AAN, and most importantly, I had already applied to two other foundation grants without success. It took perseverance, and a bit of luck. My project for the AAN grant utilized large Medicare databases to better describe outcomes among older patients being admitted with critical neurological illness. The study set me on a path that I’ve continued developing ever since. The rejection letters for something you’ve put so much energy into can be really crushing, but the process takes time, and good mentorship support as an early career researcher is so critical to help you learn from and cope with defeat.
BM: You mention mentorship as an important part of your career development, can you elaborate further on that? What other kind of support did you receive?
CF: Finding strong mentorship makes an enormous difference. Dr. Vincent Mor and Dr. Richard Besdine were especially integral to my early success and career development. Their influence really shaped my trajectory in pursuing a career in aging research as it relates to neurocritical care. The Center for Gerontology and Health Care Research is a wonderful resource at Brown, and I was lucky to benefit from the robust research infrastructure during my time there. Luckily, I also had the support of Dr. Brad Thompson, the Division Chief of Neurocritical Care at Brown, and Dr. Karen Furie, the Chair of Neurology, which helped guard my time so I could pursue advanced research training.
Most recently I’ve benefited from working with Dr. Susan Mitchell, a senior scientist at the Marcus Institute for Aging Research at Hebrew Senior Life in Boston. I was connected with Dr. Mitchell through another mentor, Dr. Mor at Brown. She has been incredibly influential with my research and a fantastic colleague and mentor. She played an integral role in my obtaining R03 and K23 awards with the National Institute on Aging. Her feedback on my proposals, often covered in red-pen after her review, were crucial to my early success.
BM: What was the grant application process like? Do you have advice for others following your career path?
CF: Successful grant applications require time and practice. A good specific aims page requires months to go through several iterations with your mentor, and then critiques from other content experts. The path to a successful application is strewn with unsuccessful ones, but remaining open to the process with a supportive environment is everything. Foundation grants are a great starting point as their applications tend to be less time-consuming. Spend ample time seeing what other grants were recently funded by the foundation, and if you are applying to the NIH, the NIH RePORTER is a very useful tool. Once you have a general idea of what has been funded before, further hone your research question by identifying gaps with a thorough review of the published literature. This will allow you to write a strong aims page, and then you can reach out to your potential program official (PO) at the NIH seeking their advice on whether your aims fit the funding priorities of the institute, and funding opportunity announcement (FOA). Be sure to carefully read the FOA, and follow instructions. Most importantly, don’t be afraid! It’s daunting to start out, but perseverance pays off, and you will quickly identify those around you most willing to help. Leverage their offers for assistance and always be grateful!
BM: Besides research mentors, who else is important to a successful research career in neurocritical care and how does this factor into choosing a faculty position?
CF: Ultimately your department chair needs to reconcile clinical and financial needs of departments. The support of Dr. Clifford Saper, former chair of Neurology at BIDMC, helped to protect the time required and made financial arrangements needed to support early career faculty like myself. A clinician-scientist arrangement with a research home at the Hebrew Senior Life Marcus Institute for Aging Research was a key part of the negotiation in assuming my faculty position at BIDMC. The network of researchers that I interface with in aging and palliative care has grown exponentially because of this, and has provided many opportunities. I’ve benefitted from many individuals, too numerous to name here, who have been generous with their time and resources. An openness to critique, gratitude, resiliency, and adaptation have all helped to forge these connections in a meaningful and productive way.
BM: Can you talk about your research and why the study of geriatrics is important in neurocritical care?
CF: Neurointensivists have a unique perspective on the gaps in geriatric care. As a group, geriatricians have embraced the idea of optimizing the care of older persons using a multidisciplinary approach, and as a research community, they are incredibly supportive of non-geriatric specialists pursuing a geriatric focus in their research. The National Institute on Aging (NIA) offers funding strategies targeting this path, such as the Grants for Early Medical/Surgical Specialists’ Transition to Aging Research (GEMSSTAR). As an example, many would agree the approach to coma is profoundly more nuanced than current clinical practice patterns. This is highly relevant to the care of geriatric patients where a skilled practitioner of neurocritical care must assimilate baseline co-morbidities and cognitive function in the context of managing a patient with acute neurologic illness. Neurointensivists are in the very best position to be the vanguards of advancing care for critically ill older patients while geriatricians have a great track record for being wonderfully supportive research collaborators in the effort.
BM: I’m sure juggling your clinical responsibilities and research work can be pretty stressful—what kinds of things do you like to do to unwind, and why are they important for your work-life balance?
CF: Running has always been a passion for me, it is where I let my mind drift and recharge. In medical school I finished in 62nd place in the Boston Marathon and the experience really drew me to Boston and its history. I also took up surfing while in medical school (during vacations to Costa Rica), and I chose the Beth Israel Deaconess program in Boston over others due to its coastal location (despite the chilly water!). Time in the ocean is similar to running for me—you can't help but let go of time and the worries we all carry. Since having children, I've adapted my running schedule to shorter races and I bike commute to work for exercise, sometimes with the kids in tow. I run shorter races such as the Boston Brain Aneurysm Foundation 5K race this fall and help organize the annual Neurocritical Care Society Run for Research 5K with Dr. Susanne Muehlschlegel each year. In short, I've adapted to changing times in my life. Some hobbies I've let go of, while integrating some of my passions outside of work and family together in order to sustain them, and myself, going forward.
BM: Can you talk a little about your family life and how you balance it with your work?
CF: I met my wife Katie while in fellowship training at Massachusetts General Hospital. She is now a pediatric neurosurgeon at Boston Children's Hospital. The parallels between our careers have helped to ease some of the challenges of parenting two young girls (and a new puppy!) while fulfilling work obligations. Starting our family together dramatically changed the way our time is spent outside of the hospital. When our first daughter was born, I sold my surfboard to make room in our small apartment for the crib. We strike a balance by relying on a network of friends locally who are in a similar stage of their lives and often provide us with advice ranging from finding childcare, to the latest unicorn themed fashions. While a research career can add some stresses with writing deadlines or grant applications, it also brings flexibility. I am sometimes able to drop the kids off at school, or stay home with them when they are sick. This has been particularly helpful during the pandemic where clinical demands increased, but research could be more easily adapted to different times and settings.