Before you start your research journey, ask yourself these five questions

0:00 Welcome to the Clinician Researcher podcast, where academic clinicians learn the skills to build their own research program, whether or not they have a mentor. As clinicians, we spend a decade or more as trainees learning to take care of patients. When we finally start our careers, we want to build research programs, but then we find that our years of clinical training did not adequately prepare us to lead our research program. Through no fault of our own, we struggle to find mentors, and when we can't, we quit. However, clinicians hold the keys to the greatest research breakthroughs.

0:40 For this reason, the Clinician Researcher podcast exists to give academic clinicians the tools to build their own research program, whether or not they have a mentor. Now introducing your host, Toyosi Onwuemene. Well, hello, everybody. Welcome to the Clinician Researcher podcast. I'm your host, Toyosi Onwuemene, and it is a pleasure to be talking with you today. So I have shared my story before, and I'm not sure if you've heard it, but I want to share it again, just in case you haven't heard it.

1:21 But I always wanted to lead research. I did. And even going through medical school, I wanted to be in an academic medical center, and leading research was kind of just a natural part of doing that. And what I didn't have was access to the research training that got me there. What I was instead doing was doing a clinical program, but I wanted to be a clinical researcher, a clinician scientist. And so the clinical piece was important. What I didn't recognize was that nowhere in the clinical training was research training.

2:04 Well, I went through medical school, and I had the opportunity to do research. It was great. I actually led a program of research. It was a very small program, but I still led it. I did a prospective study to evaluate a new, new-at-the-time technology called cone beam CT in patients with breast cancer. And so it was looking at accelerated partial breast irradiation, which was also a new technology in radiation oncology at the time. And it was an important paper, and that paper actually had been cited over 100 times. So it was an important study, my first prospective study.

2:46 And if I ever had the bug as far as being bitten by the bug of research, maybe that was it. It was awesome to develop my own protocol to recruit providers who would be part of that. And by providers, it was the radiation therapists who were administering the radiation. And then to recruit patients to the effort as well, it was such an amazing opportunity. And I think one of the things it did for me was it pulled together my love for organizing and collaboration and synergy. And I got to do that when I was a medical student. And that was my first, first journey to research, my first journey to leading a research program.

3:27 While I made it through medical school, residency, as you probably experienced, was super busy. And yes, there was a little bit of time in there for research, but to be honest, there was mostly time for being a great clinician. And then I went to fellowship. And fellowship is supposed to be the time when you are able to put aside all the clinical stuff and really, really focus in on a research question and answer it, especially in a second and third year. Well, I didn't have that opportunity. And our training program in particular was very big on making sure we had all the clinical training that we needed.

4:08 And so we had three half days of clinic during the week. And I have to tell you that three half days of clinic does not leave much room to grow a research program. And when I went around to different mentors, and especially when I went around to, well, potential mentors, especially the PhD mentors, they would say, oh, yeah, so when are you going to be in the lab? And I would say, well, I have three half days of clinic. And that would kill our potential mentor mentee experience. He's like, nope, you're not going to be here. There is no point. And I didn't get it at the time. I was so frustrated. I remember a time I broke down and started crying. And I was like, I wish I had never come to this fellowship program.

4:50 I was so, so, so disappointed. Anyway, I made the most of my fellowship program. I ended up getting a master's in clinical investigation, which turned out to be the right thing to do. And I did get some manuscripts written. And I also did apply for funding. And at the time, I got a clinical research training investigator award, CRTI. I'm sure the I is not for investigator. I don't know. I come to these podcast episodes and I forget, like, key things. But anyway, it was the ASH CRTI. And I got that. OK. So that's all I had. Going to my faculty position. And then I finally got to my faculty position. And only to find out that, you know what?

5:33 This research career you want to do, you're not actually qualified to do it. And I'm like, what? I'm not qualified? They're like, yeah, we can't really make a case for you because, well, you don't have much publication record to your name. You don't have any grant funding. So how are we going to make this case? I mean, they didn't say that at the time. I now can say that in retrospect because I understand what that means. I understand that when a faculty member comes looking for a job, people are asking, well, what skills do they already have? Not what future skills do we think they'll acquire, but what do we know they can do right now in terms of supporting the institution, right? Every institution runs based on funding.

6:14 And as a clinician, you are able to support your institution because you bring in clinical revenue. And when you say, I want to actually work towards bringing in research revenue, then people start to look at your qualifications. And they're like, hmm, no manuscripts published. Hmm, no grants ever acquired. Hmm, yeah, no. So that was me. So I started my career as a faculty member doing 100% clinical. And they would tell me that it was 80% clinical, but I was seeing patients five days a week.

6:55 So to be honest, I was spending all my time doing patient care. And it wasn't just my eight to five from Monday to Friday. It was my eight to five on Saturday and Sunday too. Oh, and the night times. Oh, yes, middle of the night too. Because at the time I had a young baby. Wow, it was challenging. But they told me that, you know, you take this clinical position, you do all this clinical work and we will support you the moment you start getting research manuscripts out the door. The moment you get funding, you'll get the support you need. And what I didn't realize is that that transformation does not happen.

7:38 You do not become a research leader by doing clinical care. You don't. Clinical care can give you ideas to lead a research program, but clinical care and the whole infrastructure of clinical care is not the same infrastructure that leads you to leading a research program. Okay, I didn't know this. And so when I signed on, I was clearly naive. And I think that while my case always felt unique at the time, I realized that more and more clinicians are here in this boat where you want to lead a research program, but you're coming just with years and years of clinical training.

8:23 No one really believes that you can. And honestly, no one really supports you to do it. So what do you do? How do you make that transition? How do you, while being a full-time clinician, make the transition to leading a research program? Well, that's the answer that I came to share with you today. Or actually, I didn't come to share answers with you as much as that I came to ask you questions. I'm going to talk to you today about five questions that you should ask on your journey to becoming a clinician scientist. Like, do you want to do this? And these are the five questions you should ask and answer. So you're going to answer the questions to determine whether you should take this step or not, whether you should do the impossible and make the transition from clinician to clinician scientists.

9:16 The first question is to ask yourself, what do I care about? What do I care about? And this may be the most important question that you need to answer before you move forward. It's an important question because in our clinical training, actually, I can say our because I know this was your clinical training too. You did what you have to do, whether you liked it or not. It was just part of your training. You went to medical school and they told you you had six major rotations you needed to finish by the end of the year, right?

9:56 By the end of your clinical year. For many of you, that was your third year. For me, that was my second year. And it's pediatrics, it's surgery, it's internal medicine, it's psychiatry, it's obstetrics and gynecology. These are the required rotations. And then maybe you have one or two electives in there, things you choose. For the most part, there's a very, very, very specific core curriculum that you need to go through as a medical student. And whether you love surgery or not, you wake up before AM, you do the surgery things, right? You don't say I care about surgery or I don't care, I'm not going to do this part of the curriculum. You just suck it up. You show up and you be the best surgeon that you can be.

10:37 And that is the challenge of our training. I mean, it was important and I'm glad we did it. And we are better physicians for all the things we did that we hated to do. But it's just not the way we live life. It's the training, but it's not the way life is lived. All the stuff you had to do is no longer relevant when you start to move into someone who's shaping your own career into a faculty position. Now you stop doing things just because you're obligated to. To be honest, there are not many things you're obligated to do anymore. But you start doing things because you care. Like, no, this is what I care about. The electives, this is my life now.

11:19 I do elective. Elective time. This is your elective time. All the elective time you didn't do in your training, this is your elective time. So what do you care about? And this is a hard question because you've been so used to doing things you have to do. And because you've done that for maybe 10 years of your life at least, now you're like, well, this is all my life. I only do things I have to do. And the reality is you don't have to do things you don't care about. What you should do, what you need to do. I mean, in reality, you live in a community that cares about certain things. You should know what things are required in your institution for forward motion. You should align the things you care about with those things.

12:00 And you can always make it work. For example, if scholarship is important in your institution, well, do scholarship on what you care about. If international renown or being known nationally is important in your institution, well, be known nationally for things you care about. Do you see what I'm saying? So yeah, there are things you have to do, but you make your own curriculum and you do the things you care about and make them count for the things you have to do. But that's the first question you have to answer. What do I care about? Because it is time to stop doing the things you hate. Because you cannot sustain a 30, 40 year career doing things you hate.

12:42 You can do it for a six week rotation. You can do it for a 12 week rotation. You can even suck it up and do it for a year. You cannot spend your entire career doing things you hate. So what do you care about? Answer the question. Number two is commitment. Am I committed to research leadership? This is a really important question. Am I committed? You know, research leadership is kind of like a marriage relationship or maybe people would say a strong committed like time relationship. It really is. It's like, look, I mean, it's great that you love me and all, but are you committed to me like, you know, for richer, for poorer, for better, for worse and sickness and in health rate?

13:29 Are you committed? The funding comes through, it doesn't come through. Are you committed? People support you. They don't support you. Are you committed? The mentor shows up, the mentor doesn't show up. Are you committed? And that's an important question. Sometimes I hear people saying, well, I just want to try and see if I like it. It's like, yeah, no. Sometimes this journey is hard and there are real roadblocks along the way and there are real people who don't want you to win for whatever reason. And so it's not the kind of thing for the faint of heart, but it is the kind of thing that people who are committed can see it through because you're like, yeah, I'm not here for the flowers and the roses.

14:19 I mean, I love those, but you know, I can get through because I'm committed to this journey. So are you committed? Because research leadership is a commitment and you only start the journey if you're committed to seeing it through. And I think this is so important because everybody doesn't have to lead a research program. You don't have to lead a research program. You can participate in research. You can work with a group of other investigators and just contribute as needed. You can do that. But if you say I'm leading a research program, it is a commitment because what you're doing is you're building an infrastructure where people come and they contribute to a program of research that you've conceived, that you are building, that you are funding, you are leading, and therefore you're making a commitment.

15:12 And answer the question, am I committed to research leadership? And if the answer is no, then don't do it. You don't have to. There are other ways to succeed. But if you are committed, then you're ready. You're ready for the journey. Number three, I'm calling classified information, is that there is information you don't have access to. And I know this because you're a clinician and your clinical training was about being a great clinician. It was not about being a great researcher. I always talk about the fact that PhD scientists actually do research training.

15:52 Research training is about getting a PhD. It's just part of their training, right? And there is a certain set of tools for success as a research scientist. It's a very clear set of tools. It's not even really a secret. It kind of sort of is to MDs because here you are in clinical land and you're feeling like this is a ripe field for research and it kind of sort of is because clinical care is the foundation for the work we do as researchers. But let's just say your clinical training doesn't really give you these research skills, right? And there are many of them. I've talked about them in prior episodes. But you don't have access to the information you need to succeed as a researcher until you've gone to where there are researchers who are succeeding and found out what they do.

16:42 And by the classified information, what I'm saying is one of the things they do in secret where nobody can see them, that fuels their success. How much time are they actually spending writing every day? How many times are they submitting grants? What grants are they submitting? What research skills do they have? What kinds of commitments are they making to their writing? You know, I will tell you a couple of weeks ago, a group of collaborators and I sat down and we paid a boatload of money. I call it a boatload because it was an hour and a half. And actually, I'll just tell you, it was an hour and a half and it was $2,500.

17:25 We sat down with an expert writer to go through our writing. And I will tell you that everybody doesn't do that. And I'm not necessarily here to say you should go do that. But I'm telling you that there is a certain kind of commitment that people are making to become good at what they do. It is not an open thing. It is a secret, right? Secret because it's hidden from you. That's why it's classified information. But what classified information do you need access to? What is needed to succeed in research? What are people doing who succeed? It's not common knowledge. But there is a clear set of tools for research success.

18:07 And the way you find out is to ask research scientists what these tools are. So answer the question, what classified information do I need access to? Question number four is creating structures. What structures do you need to create to guarantee your success? Ask that again. What structures do you need to create to guarantee your success? And the reason this happens, this is an important question, is because success does not happen in a vacuum. Success does not happen because you kind of woke up and you got lucky and you're like, oh, look at you, you got successful.

18:52 Yay, yay, yay. It was like when people told me when I started, they were like, yeah, well, go be a full-time clinician, and whenever you can make the manuscripts happen and the grants get funded, then of course we'll support you. Like, it's not the kind of thing where you roll over in bed one day and you're like, oh my gosh, I made it happen, everybody, I'm so lucky. You create the structure that is necessary to guarantee your success. So what structures do you need to create? What structures are you missing? You now know, right? Because if you answer the information about the classified information thing, you go create a structure, right? What's the structure you have, number one, for consistent writing?

19:35 I've talked about the skills that you need to build as a research scientist. What structure do you have for consistent writing? What structures do you have to improve your writing? Yeah, your writing's good. And what structures do you have in place to take it to the next level? What structures do you have in place for accountability? Because no one's going to come knocking at your door saying, oh my gosh, did you submit that grant? Yeah, most of the time they don't do that. But they'll come knocking at your door if you don't show up to clinic. So what structures do you need to create for accountability? What structures do you need to create to get access to information you need so your mentor doesn't show up to your mentoring meetings or your mentor doesn't give you information that you feel like you need?

20:22 Who else can you go to to get the information you need? What structures do you need to create that guarantee your success? That's the next question to answer. Question number five is your clinical expertise. If you're going to be a clinician that's going to succeed as a scientist, then you've got to make sure that your clinical expertise and your research overlap. They just have to. Sometimes I see people say, well, my mentor is a breast cancer radiologist. I guess that's what I do now. And no, it's not what you do. Because remember, we started with care. What do you care about? If you don't care about it, please do not.

21:03 Oh my goodness. Oh my gosh. I've got to stop because this is about to get in a soap box now. Many other people who build their careers around mentors' lives. They're like, well, I don't care about this, but my mentor is super successful. And if I want to be super successful, I want to do what they do. And please do not do that. Because your mentor's career birthed probably 20, 30 years ago is a different career from your career. And they've been successful. And congratulations to your mentor. You are building something new. And the thing you're building is for this generation.

21:45 It's for now. It's starting 20, 30 years later. And you've got to care about what you're doing. And it's got to really be the area in which you have strong expertise and you care about. So you want to make sure they overlap. Don't go changing what you're doing just because it makes sense. It makes sense this moment. It's short term gain. But long term, that probably doesn't get you to where you need to be. So those are the five questions. I'll tell you that I actually have seven. But I think it's good to stop at five.

22:25 If you want to hear the other two, you should come to our upcoming webinar where I talk about how clinicians can transition to research leadership. And I'm doing that on November 20th, Monday, November 20th at 6 p.m. Eastern time. You are invited. For more information, you should visit our podcast website, ClinicianResearcherPodcast.com. But I'm excited because this is my dream. It's my vision is to see more clinicians lead research programs. And I think it's challenging. It's difficult. But I absolutely know it can be done because I'm doing it and I'm helping other clients do it as well.

23:11 And I know that if it is your dream, you can do it too. So to summarize, five questions you need to ask yourself on the journey to becoming a clinician scientist. Number one, what do I care about? Number two, am I committed to research leadership? Number three, what classified information do I need access to? Number four, what structures do I need to create to guarantee my success? Number five, what is my overlapping area of clinical expertise? Those are the five questions today. I want to thank you so much for taking the time to listen. And I look forward to talking with you again the next time.

23:53 Take care. Thanks for listening to this episode of the Clinician Researcher Podcast, where academic clinicians learn the skills to build their own research program, whether or not they have a mentor. If you found the information in this episode to be helpful, don't keep it all to yourself. Someone else needs to hear it. So take a minute right now and share it. As you share this episode, you become part of our mission to help launch a new generation of clinician researchers who make transformative discoveries that change the way we do health care.