An NIH Site Visit Need Not Provoke A Tension Headache

News that a National Institutes of Health grant review committee intends to make a site visit causes many principal investigators to reach for aspirin and antacids. And indeed, a poor presentation to the committee virtually assures a research group that NIH will not fund its project. Yet a site visit need not be a traumatic experience. In fact, a clever PI can often turn the site visit into an opportunity to convince the NIH committee of the value and scholarship of a project. And remember: Site visits are expensive, so NIH would not be visiting a lab unless it considers a proposal promising. In any case, living through such a review can be a lot less painful if the researcher understands the reasons for--and nature of--a site visit. When a grant review board (known as a study section) cannot make a recommendation about a proposal without additional information that is unobtainable by letter or telephone, the reviewers may decide to defer consideration of the application until a team of representatives from NIH has visited the project site. During every NIH grant cycle (there are three per year), some 50 potential grantees around the country are visited. Site visits may be recommended at any time during the review process. Most often, however, site visits are requested during the study section's consideration of proposals that are very complex, highly ambitious, or particularly specialized. According to Donna Dean, former executive secretary of a grant review board, a veteran site visitor, and now chief of NIH's Biological Sciences Review Section in the Division of Research Grants, a site visit may also be recommended if there seem to be inconsistencies between the content of the grant application and the PI's level of experience. "If the PI has published a brilliant paper but the application is not so good," she says, "the study section may wonder who is really generating the ideas behind the project." Concern about the adequacy of the facility where the research is to be carried out, or the extent of an institution's commitment to and support for the PI's project, may be another reason for a site visit. Because site visits are costly, NIH now uses them less for Individual Investigator Initiated Research proposals (R01, R29) and more for Program Project Grants (see accompanying story) and other larger, more complex programs. Whereas only 1 percent to 5 percent of potential R01 and R29 grantees are site visited, about 66 percent of PPG application sites are visited. The site visit team usually consists of the executive secretary (administrative head) of the study section that is reviewing the proposal and, for an R01 or R29 project, two to four other people. One or two of these other participants are generally members of the study section. The others may be scientists with special competence related to the project in question. A member of the program staff of the relevant NIH institute or funding agency may also accompany the site visit team, but only as an observer, and does not participate in the proceedings. NIH takes great pains to avoid conflicts of interest or philosophical differences when setting up site visit committees. Thus, a PI can save an executive secretary time and work by identifying, prior to the formulation of the site visit team, individuals who would be inappropriate for the team. Site visits are scheduled to accommodate both the committee and the individuals to be visited. It is wise for the PI to be as flexible as possible about scheduling to give the executive secretary more options in putting the site visit team together. However, if, say, the PI needs four more weeks to do some experiments that will tighten up the presentation, he or she should be candid about the need for more time. The best insurance for a successful site visit is for PIs to get themselves and their research team members prepared physically and psy- chologically. The first steps are to think of the site visit in a positive way and to try to find out in detail what issues the visitors will want to address. When a site visit is recommended, the executive secretary sends the PI a letter outlining the reasons for the visit and the specific concerns of the study section. Dean strongly urges PIs to "make it their business to find out as much as possible about the items of concern to the site visit committee, and what the site visitors expect the PI to provide," by calling or writing to the executive secretary. The PI may be asked to prepare budget information, a description of collaborative arrangements with other departments or institutions that may be pertinent to the application, and materials that the committee wants to see before or during the site visit. In addition, the PI may be expected to provide a list of personal commitments (such as teaching, training activities, private practice, or consulting work), other sources of research support for the project, and the people who will be seen by the site visit committee. Richard Pharo, who served as director of research administration at the Eye Research Institute of Retina Foundation (ERI) in Boston from 1973 to 1989 and who coordinated many site visits for ERI, notes that "while responding to the specific requests of the site visit committee, it is important that the PI subtly try to maintain control of the site visit by being thoroughly prepared and fully in command of the information she or he wants to transmit to the committee." Pharo advises PIs that "it is also important that your institutional administrators become fully involved in and supportive of the site visit effort. They are usually experienced with site visits and can help you prepare for it. They also can help to create a congenial ambience." Think about who should be present at the site visit; when appropriate, "at least one other faculty member of the research team should be present to support and endorse the project concept," says Pharo. "In addition, if the project involves some complex technical procedure, the person who will carry out the procedure should be available to answer questions about the practical aspects of the technique." However, if the PI brings in too many people, it may be considered "overkill," says Dean. During the weeks before the "big day," it's a good idea for all participants who will give a presentation at the site visit to rehearse what they will do and say--as many times as necessary--in front of knowledgeable colleagues. National Institutes of Health Program Project Grants (PPGs) are grants with multiple principal investigators whose individual projects are all geared toward solving a common problem--often from several different perspectives. Site visits for PPG applications are essentially similar to those for NIH's R01 applications. The main difference is that there are more reviewers for PPGs; therefore, all aspects of the project are covered, a formal briefing session is required before the visit, and the site visit is longer, with the executive session generally being held on the second day. "The director of the PPG should, if possible, be someone with site visit experience. This person's presentation often sets the tone for the rest of the site visit," says Terence Tao, a senior scientist at Boston Biomedical Research Institute, who has been on a number of PPG site visit teams. "If there are weaknesses in the program project director's presentation, the `vultures' set in." The PPG director should be prepared to answer a lot of questions about the common theme of the individual projects. It is important to convince the site visit committee that the whole is likely to yield more information than the sum of its parts and to explain the connections between the individual projects. In addition, the director should discuss the governance of the program. How are decisions made and who makes them (an individual program director, a committee, or a rotating advisory body)? What is the mechanism for replacing the program director if he or she should retire, resign from the project, or leave the institution? Will there be an outside advisory committee for the project? The director should be prepared to detail services available to the whole program--for example, animal facilities--and indicate what percentage of support for each of these services has been assigned to each project in the program. That way, if the site visit committee recommends scrapping one project, the budget can be adjusted accordingly. --L.R.-L. The PI should prepare a written agenda with a time frame for the site visit committee, making sure to build appropriate breaks into the agenda; however, it is also advisable to "hang loose" and give the site visitors the opportunity to change the agenda. Prepare various handouts for the members of the committee, such as a one-page description of the project; a flow chart of the project's stages and possible outcomes; brief outlines of especially complex issues you plan to discuss; relevant preprints; and recently acquired, analyzed data. But it is important to be judicious and not overwhelm the site visitors with material. The site visit usually begins with a few minutes of opening formalities. The protocol is generally for a representative of the institution to welcome the site visit committee. This person "sets the stage" for the meeting and informs the visitors about the institution's facilities. The executive secretary then details some procedural information before the PI and other personnel give their presentations and respond to queries by the visitors. A tour of the facility often follows, after which the committee is generally provided with lunch. During lunch--or before the end of the day--the site visit team meets alone in executive session. The PI and other members of the research team should stand by throughout this session in case the committee has further questions. Keep in mind that site visitors are not permitted to accept gifts and must therefore pay for their own lunch. Don't order pheasant under glass. According to NIH's Dean, the first two minutes of the site visit--often the introduction by the institutional head or other administrator--can give the committee a subtle message about the extent to which the institution supports the PI and the project. Disinterest may be detected by the committee members. On the other hand, if the signals indicate too much interference from the administration, the committee may wonder how much freedom the PI has to pursue the specified goals. Pharo advises PIs to be confident and to communicate clearly and concisely. Remember, the committee is there to assess the science and the ability of the PI and the research team to carry out the project successful--don't be glib, arrogant, or overly polished. It is important for the PI to be honest about acknowledging problem areas in the project. The PI should assure the site visitors that ample thought has been given to possible snags in the research, and should outline the alternatives to be used if the main approach falls through. Says Dean, "The worst thing the PI can do at a site visit is to simply recap the application or give an hour-long talk-- unless she or he has been specifically requested to do so by the site visitors." The PI must present the visitors with any new data or new interpretations that help to clarify the project and allay their concerns about it, and should do so succinctly. Terence Tao, who has been an ad hoc member of a number of site visit committees, advises: "Remember, this is not a talk but a response to queries. Don't bog the visitors down with a lot of data. Rather, rely on flow charts and good visual aids. Select a few bits of your best data to support your project and use these as the culmination of your presentation." It is wise to leave an amount of time for questions that is about equal to your presentation time. However, regardless of your own plans for the site visit, be sensitive to the needs of the site visit team. Tao, a senior scientist at Boston Biomedical Research Institute, also cautions that it is very detrimental to write one thing in the grant proposal and then present something different at the site visit. "Even though the change may be for the better, it is disconcerting to the reviewers," he says. "This does not mean that you can't present and highlight some new results--but don't change the project." Pharo urges PIs to be savvy about the materials they use in connection with their presentations. "Avoid giving the impression that you work at a company where money is no object. Slides should be neat and clear but not `slick,' " he says. The site visit report generally has the same format, contents, and headings as a summary statement (commonly known as the "pink sheets") for a reviewed grant application. The executive secretary prepares the committee report from individual reports written by each reviewer, which are assembled in draft at the site visit. The composite report is distributed to the study section members prior to their next meeting. Once the report has been considered at the study section meeting, relevant portions of it are incorporated into the "pink sheets." The original site visit report is not retained. But the results of the site visit generally have considerable influence on the final disposition of the application. Dean emphasizes that PIs should consider the site visit in a positive light. "On average," she says, "site visits are more often helpful to the PI than not helpful." In general, if the PI is clear about the purpose of the site visit, prepares carefully, rehearses, and keeps calm and flexible, he or she can turn the occasion into a learning experience rather than an ordeal to be survived. Liane Reif-Lehrer is a scientist, consultant, and freelance writer in the Boston area. She is the author of Writing a Successful Grant Application (2d ed., Boston: Jones and Bartlett, 1989). She has been a member of a site visit team and has also experienced a site visit.

An NIH Site Visit Need Not Provoke A Tension Headache

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