Unless you are totally new to NIH grants, you already know that the specific aims page is the most important page of the entire grant. The specific aims page sets the tone for the grant. Will the grant be easy to read and understandable, or dense and frustrating? Unlike you and your organic chemistry textbook in college, your reviewer is not obligated to spend days trying to understand your grant. He/she will do their best in the context of their “grant workload” and move on. Although you can lose a reviewer after the specific aims page, if you lose them at the specific aims page you’re done. In fact, one reviewer told me they scored an entire grant based on the specific aims page. This reviewer then read the entire grant, but the score didn’t change. I mention this to underscore the importance of this page. So, let me show you how to make a good first impression.

First paragraph

The first paragraph is your explanation of the problem. You need to start broad enough to capture the attention of your reviewer, but not so broad as to be meaningless. For example, your problem should not be cancer or cardiovascular disease, these are too broad. You could start with a type of cancer or a subset of cardiovascular disease. From there, you quickly (in a couple sentences) narrow the focus to the specific problem you are addressing. As you narrow, it may be appropriate to include a statistic that demonstrates the scope of your problem. For example, if your research involves a relatively unfamiliar disease, a statement about the monetary impact or numbers of people affected can be helpful, especially if you think this information might be surprising. Getting the reviewer’s attention with a “Hmm I didn’t know that” thought is a great way to start your proposal. Although I’ve read this in proposals, telling the reviewer that cardiovascular disease affects millions of people or is a significant part of health care dollars spent is not a particularly engaging fact. If your grandmother wouldn’t be surprised by this information, don’t use it.

Narrowing the focus of the problem you’re addressing can be easily done if you connect sentences, as described in one of my prior blog posts (see resources). As you lead the reviewer to your problem, think about what you want to emphasize in each sentence. The location of the phrase within the sentence (beginning, middle, or end) determines its emphasis. See Writer’s toolbox: Creating Sentences that Flow for more details. Once you’ve set up the problem, you want to mention what solutions have been tried to date and why these haven’t worked or are imperfect. You, of course, have developed a better widget, so before you describe your widget you need to tell the reviewer what’s wrong with the current ones. You describe that all important “gap in knowledge”. I tend not to use the word gap, although I’ve seen it in many proposals. I prefer to describe the gap without stating “here’s the gap”. This might seem counterintuitive, as I keep talking about the importance of clarity. Why not come out and say here’s the gap? Because it’s formulaic and boring. Anyone who has read more than a handful of grants knows that the gap is coming, but using the phrase “gap in knowledge” is akin to slipping the reviewer a Xanax.  Make your grant interesting by showing the gap rather than using the word “gap”. Of course, the onus is on you to be sure the gap is clear.

After “The Big Gap”, you should state what will happen if this problem isn’t solved and solved fast. What earth shattering event will happen? You want to be somewhere between critical need and Armageddon. Here is another spot where you can throw in an interesting factoid if you can find one. What is the rate of increase of this problem? Is it becoming more widespread? Epidemic? Perhaps not in the current climate but you get my point. I typically leave my reviewer with this “cliff hanger” and end the paragraph on this note.

As with your problem statement, you don’t want the gap to be too general. “Little is known” is a vague, general gap. A lack of understanding is also not a good gap, although I’ve read it in several grants. The NIH typically does not want to pay large sums of money to understand a disease process. I know, I hear the “but” coming. But, you say, you need to understand a disease process before you can cure it. Yep. I get that. But when you discuss the gap, you want to state how filling that gap will lead to progress in treating the disease you’re targeting. This progress does not have to directly lead to a cure for X but needs to have some relevance to human health or you’re barking up the wrong funding tree.

Make sure that you take enough time to clearly define the problem before jumping to the solution. Many newbie grant writers are so eager to get to their work, or solution, that they don’t clearly define the problem. If you do a poor job in defining the problem, you significantly decrease the interest in or value of your solution. This is an area where the “curse of knowledge” comes into play. You’re so close to your area of research that you think the problem is obvious. Remember that your reviewer will be in your general field of research but may not be familiar with your specific area.

I’ve put the above ideas together in an example below, where I revisit that age old quest for lost socks.

Every household is plagued by lost socks in the laundry. In the United States alone, lost socks cost on average 48 hours per person per year in wasted search time.¹ Replacement costs for new pairs of socks reached a staggering 1.2 million dollars last year, resulting in a particularly high burden for families of 4 or more.² Sadly, the psychological cost of the shame and embarrassment caused by wearing mismatched socks to school or work cannot be measured.  Efforts by the sock industry to decrease the number of lost socks have, to date, been ineffective. Strategies such as selling 6 pairs of socks in a pack or 3 socks at once have only increased costs and sidestepped the true problem. Without ways to specifically find the lost sock, this problem will only continue to grow. Given the exponentially rising costs of replacement socks, plus the burgeoning number of feet worldwide, by 2040 the problem of lost socks will be the number one drain on family budgets unless a way to recover lost socks is found.

Now let’s “unpack” the above example. The first sentence states the problem and hints at the magnitude of the problem “every” household has problems with lost socks (unless you live in a culture where no one wears socks but let’s assume you do). This statement is followed by two “facts” to help the reader understand the impact of the problem. Although I suggest leaving smaller details out of the specific aims page, this is one place where they can be useful. As I mentioned above, the use of statistics to convey impact depends on the problem. Try to find information that will surprise the reviewer and get his/her attention. The next sentence builds on the problem, and I lead off the sentence with an adverb for accent. Although you’ll want to minimize the use of adverbs, sometimes they can signal the reader to pay attention to what is coming next. In this case I use the adverb “sadly”, which signals that something negative is going to follow. Adverbs are ok in small doses, just don’t overdo them. After defining and providing an idea of the magnitude of the problem, I go on to say what’s been tried so far and why this hasn’t worked. Finally, I project what will happen if the problem isn’t solved, generating a sense of urgency.

There you have it! The first paragraph is done. Now that I have you on the edge of your seats (The Handmaid’s Tale, anyone?) you’ll need to wait for the next installment. Tune in next time for, wait for it, the second paragraph.

About the Author

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Lucile Wrenshall, MD, PhD

About Me

Career scientist and surgeon. Like to figure out how things work - including people, animals, cells, and sentences. Visit drlucywrenshall.com for more on writing grants, manuscripts, and 1:1 feedback.