How to keep going in the face of rejection

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. Welcome to today's episode of the Clinician Researcher podcast. I'm your host, Toyosi Onwuemene, and it is a pleasure to be talking with you today. So today we're going to be talking about how to keep going in the face of rejection. Ugh, rejection. Yes, we're going to be talking about how to keep going in the face of rejection. And one thing I want to invite you to do is if you are interested, please sign up on our website for more information about our coaching programs.

1:28 That is ClinicianResearcherpodcast.com. Academic Negotiation Academy will be enrolling its next cohort soon. Sign up to get on the wait list at ClinicianResearcherpodcast.com. All right. I am talking today about how to keep going in the face of rejection. And you know, I will tell you that no one prepared me for the rejection that was coming in academic medicine. And there is a ton of rejection. Oh my goodness, so much rejection. You get rejected in your grant submission to get rejected in your manuscript submissions. There's a lot of rejection. And many times that can feel very personal.

2:10 And it's hard to separate yourself from all that rejection. So when I recently submitted a grant, I was so pumped about this grant. I mean, it was maybe one of the best applications I had ever written. We had time. I had submitted this application as an MPI application. So I had another PI who was equally invested. And it was just such a wonderful writing collaboration. The best grant I've ever written, just considering all the energy and just it was good. It was good grant. It was good. And so I was so sure that this grant would be funded. I was so sure. Like, no, grants are not to be funded the first time.

2:51 It was like, this one's going to be. And even if it's not funded, it's going to score really, really well. And so imagine my surprise. And really, I was shocked when it came back as not discussed. Shock, shock. I mean, I don't know. You have enough grants that are not discussed. You're not really shocked, shocked anymore. It's like, oh, that happened again. But I was surprised at this one. And it did kind of it was like a sucker punch to the stomach. This one took me a little bit to think about to think about going back and looking at it. And actually, when you first find out that the grant is not discussed, you don't necessarily have the opportunity to go find out what the summary statements are.

3:32 So it takes a couple of weeks. Anyway, it took a couple of weeks. And by then, you already know that the grant is not going to be funded. So by the time the summary statement comes, to some extent, you're prepared. But even then, you're still not prepared because you're like, I don't want to look at this. But I did look at it. And I will tell you, it is the first time I read a summary statement. And at the end of it, I was like, oh, OK, is that what you need? OK, bring it on. This is going to be good. It was just an opportunity. And at the end of it, I think why I was so pumped by reading that summary statement is that we wrote a grant we really wanted to do.

4:14 We wrote a grant we were super excited about. And it was such a wonderful writing experience. And so to read the summary statement and realize that, you know what? This project is still pretty awesome. And these are the things that are recommended to get the project to funding. OK, we can do that. And it's just the sense of the value of the work is such that it's not going to stop. We're going to find a way to move it forward. We are going to find a way to move it forward because we are committed to the work, because the work is important and it needs to see the light of day. And it's just such a wonderful place to be, I think, from just the perspective of what are you writing that ignites your fire?

4:58 What are you writing about that keeps you going? And I think that's probably what I'm talking about today is how do you keep going in the face of rejection and what are some of the ways that you can think about rejection and how do you rejection proof your experience? So I'm not saying I'm taking away rejections. I'm saying how do you take those rejections and make them into more than just rejection? So today I'm talking about four things to think about in fortifying yourself against rejection. So number one is start with a project. So there's a book by Simon Sinek that says start with why.

5:41 And if I wasn't saying start with a project, I would say start with why. Many times when we are coming to our careers as clinician researchers, we are kind of starting off on the project that was handed to us. And there's value in that because, again, we are thinking about research training. It takes time to do research training. And over the course of PhD training, people start from where they were just contributing to a project to where they're actually taking pieces of projects and creating their own projects out of that to where they are actually leading their own projects. And so when you think about clinicians doing research, in a way, you're trying to fast track and accelerate the process.

6:23 So you don't necessarily start out with your own project. You're looking to see is there a mentor who's already working on a project and I can get skills that I need. So there's definitely the elements of that. But as you start to think about leading your own research program, and I would argue that when you are a fellow making that transition, to really start thinking about what do I care about? What do I really, really care about? And to focus on getting involved in projects you really, really care about that you see yourself continue projects that really energize you. And it's important because there are two pieces I think about in making and doing the training or in making the transition from clinician to researcher to leader of a program is number one, you do need to learn how to do you need to learn techniques, but you learn how to do not so that you keep doing, but so that you are able to supervise people who do because as a clinician, you are a leader and your job ultimately is not to continue to do things for yourself.

7:28 Your job ultimately is to lead people to do the work of your research program. And so it's important, I think, to separate the doing of the research from the leading of the research. So there are two components to the training. Number one is the doing. Number two is the leading of the doers because your job and actually maybe I would argue that you're leading the doers and ultimately you lead thinkers as well. Your value to your research program leadership is your thought, is the way you think. This is how we can take this huge complex problem and boil it down into a research question that can be answered. And these are the set of experiments that allow us to answer the question, or these are the set of analyses that allow us to answer the question.

8:16 And then you get your team to do the analyses to answer the question, or to do the experiments that answer the question. Your thought leadership is so key. And so when you are thinking about your experiences for training, think about how do I get the thought leadership? How do I get the thought patterns that allow me to do this well? And so you think about your projects in terms of what skill is this bringing me? Is it giving me the skill to do, which is fine, but ultimately the goal is not to get good at doing, your goal is to get good at leading the people who do.

8:57 And you get good at leading the people who do things by being able to think well. And so yes, sometimes it's like, well, but I have to teach the people who do things. I would say that think about how do you structure your research programs such that you're working with people who already know how to do these things. And sometimes that is about collaborations as well. Who already has the infrastructure to do what you want to do? And how can you collaborate with them so that your group can focus on what their area of expertise is, and you're not necessarily investing all the time trying to learn new techniques each time. Anyway, so there are nuances depending on the field of research that you're in.

9:37 But you do want to really love what you do. You want to be invested in the patient population. You want to know that this work leads to something meaningful to you. And for different people, that means different things. So for me, I'm not a basic scientist. I don't work in a wet lab. I lead a research team that includes biostatisticians and data analysts. And we do different work from someone who say at them at the bench. So maybe taking an example from the bench and thinking about, OK, maybe this person is doing receptor signaling and this work is so important to them.

10:19 And they're like, this receptor signaling work that I'm doing is going to really help us solve problems in patients who have a certain type of cancer. And that's their why. It's like this cancer needs to be cured. Receptor signaling research allows me to do that. And it allows me to contribute in this way. And so for that reason, the research project that they're doing is not about receptors. It's not about signaling. It's about the patient at the end that's going to benefit from what is coming out of this work. And that's great. I wouldn't resonate with that. I resonate with how do we answer clinical questions using big data so that we can have insights to help many more patients?

11:04 I want to be a little bit closer to the patient's population. And for that reason, the population of patients in whom I am asking questions is so important. And so you want to make sure that you actually enjoy what you do or that the why is so clear to you because you know that the work you're doing will be done whether people pay you to do it or not. You want to do this work. In fact, if you could, you would pay to do the work. And for that reason, you want to make sure that you're doing work that matters so that when rejection comes, you keep it in perspective. It's like, okay, it's one rejection, but this work is so important, it still needs to move forward.

11:46 And you don't let rejection stop you from doing the work. What happens when you do work that you don't care about or work that other people have asked you to do and you've kind of taken on as your own is that the moment rejection comes, you're like, you know what? This sucks. I quit. I'm done with this. And so, you know, when it's work that you value, it's a patient population you absolutely want to contribute to no matter what, you don't let the rejection stop you in your tracks. You think about a different way to deal with it. And so anyway, it starts with why. It starts with really thinking about the reason for which you're doing the research. Number two is to reframe the way you think about rejection.

12:26 Now, when you say rejection, it just sounds so bad, but what if we thought about rejection as the failure of a prototype? We've created a prototype and we've put it out there into the world and someone said, I don't like this prototype. Now, all the work that you have put into this prototype is still valuable. All the experience you had in creating this prototype is still valuable. You haven't lost any of it. But what you're going to do is take the prototype, keep the stuff in the prototype that makes sense and then create the next prototype.

13:06 And so when you have something that is rejected, it's rejected right now in its current format, but how can it be recreated so that it becomes something greater? For example, you just submitted a grant that was rejected and if you're lucky, if you're submitting to NIH, you get a summary statement that tells you these are all the things that we think could be improved about your grant. Now you never are starting from scratch when you resubmit the grant because there's a lot of it that's already written and a lot of components that don't necessarily need to change and then there are components that are going to change. And even if you're doing an overhaul, there's still a starting point.

13:50 You're not starting from a blank page. And so at the end, if we reframe the way we think about rejection, instead as well, well, this thing was not acceptable in its current format to somebody else. You can think about who else might accept it in its current format. So is there a different audience that might like it? Or you can think about how do we reformat this thing so that it is now acceptable to the people that we're sending it to? And so what you find is over time, rejection of one thing allows you to recreate it in a way that's now acceptable the second time around.

14:30 And so rejection really is a personal thing, or we can make it personal, but really it's just the prototype was rejected. This thing that you created was rejected. How can you recreate it so that it's now acceptable to the people that you're putting out there to? So it's either the funders or it's the reviewers on behalf of the funders or the reviewers on behalf of the journal. But let's rethink the way we think about rejection. So it's not personal. It's not being rejected me, but it's really clearly, okay, they didn't like this prototype. What do we do about it? And that's why number three is really thinking about creating multiple prototypes.

15:14 So it's like, okay, if you're creating something, you know that the very, very first version is usually not the best version. It's very rare that you create something that's the final version. I have submitted many manuscripts in my lifetime. Goodness, I feel like that number is at least close to 100. I mean, I haven't had 100 published, not right now, not at the time of this recording, but I've submitted a lot. And sometimes it's resubmitting the same thing across, you know, in different versions across different platforms. But ultimately, the first thing is usually not the first thing that's accepted. I've had one, yes, that's what I was saying. I was trying to say that I've submitted many things and I've only ever had one manuscript that was accepted the first time.

15:59 And that was a complete shock. I was like, what? And in reality, it wasn't the first draft that we submitted. I mean, this is work that we've been doing for a long time. We were proud of our work, but we also expected that the reviewers would come back with things that we needed to change. So we were surprised it was accepted the first time. That rarely happens. But each time you submit, it's one version, right? And it's not even the version you started with. And if you get rejection, then you recreate and you resubmit. So ultimately, you're creating multiple prototypes of the same product. And each time you create a subsequent prototype, the prototype actually gets better. And if you think about it, let's think about the iPhone, for example, as an example of a phone.

16:43 This is not a promotion. But if you go back to the very first iPhone and we still have the very first iPhone, I mean, it was really cool for its time. But multiple prototypes have been created such that the prototype that's currently available is infinitely better than the prototype that first started. And so over time, prototyping helps you get better. So in a sense, rejection is about forward failure, if you allow it to be. If you allow the rejection to give you information that creates the next prototype, it allows you to just realize that what you're doing is prototyping. In your career as a clinician researcher, you're creating multiple prototypes. And usually, each prototype, each subsequent prototype, is better than the last prototype.

17:26 And what's interesting is that you already know as you're creating a prototype how you can make it better. So let's say we submit a manuscript and we get reviews. Then the reviewers give us information about how the prototype could be made better. And we could agree with that, but we could disagree with that. But we have information. And so we take that information and we create the next prototype. And so think of rejection as failing forward because what you're doing is enhancing their prototype, is making the prototype better. And it really helps you create a better product. And I will say that I don't know a review that has not really enhanced my product.

18:07 And I think a lot right now, I'm thinking about manuscripts where the reviewers were like, well, what if you did this? And what if you did that? And at first, we roll our eyes. We're like, this is ridiculous. When we come back, we're like, hmm, yeah, we can see how that might enhance the work. And when we respond, we get to respond in our own way. So we're not like, well, it's rare. It does happen. Sometimes reviewers will say, write this instead. But we get to use the information we see from the reviewers to create something that's so much better, to create something that's so much better. And so there's an opportunity to really continue to prototype in our work.

18:47 And that helps us not think of it as a rejection, but really an opportunity to create a better prototype. And then number four is to have a plan. Okay, rejection is coming. If you didn't know that, I've just announced it to you. If you haven't experienced it yet, congratulations. Your first rejection is coming. And what are you going to do when it comes? Are you prepared? So how do you prepare for rejection? Well, you have a plan. When you go to submit something, if you're submitting a manuscript, for example, have a list of journals that you're submitting to. This is tier one of the journals we still want to submit to. This is tier two that we want to submit to. This is tier three. And if the journal doesn't get into one, then we're going to go with two.

19:28 If it doesn't get into two, we're going to go with three. If it doesn't get into three, we're going to go with four. Start with a plan. And so there's already a plan of action when the manuscript is not accepted. You're not sitting down thinking, oh, what do we do now? Oh, my goodness, we didn't expect this rejection. Oh, no, we are stuck. You have a plan. You're like, oh, we didn't think this would happen, but we made a plan that we would go to manuscript two, tier two. And let's go ahead now revamp and resubmit to tier two journal. When you have a plan, it allows you not to get overwhelmed by the rejection because in a way you've kind of planned for it and you can execute on the plan.

20:10 How about a grant rejection? Well, I hope that you're not basing your entire career on this one grant that you're submitting. I hope that you have taken this grant and thought about how you're going to repurpose it. But let's say you have a grant and it's like, oh, my gosh, this is the most amazing grant I've ever submitted. And you've got to have a plan for if that grant is not accepted, if that proposal is not funded, what's next? You can take the summary statements, you know, revise the proposal, where are you going to resubmit to? And it may be that you say, nope, this is the last time we're submitting this to this particular funder. And if it's rejected, then we're going to change the focus of the proposal so that it can match, it can better align with this other funder.

20:55 And then we're going to go to this other funder. But you have a plan in place. And so it allows you to get away from the rejection that just paralyzes you for weeks and weeks or months and months. And you're like, whatever happened to that project? You're like, ah, we got rejected. But when you have a plan and after you've picked yourself up from the floor, you're like, OK, what did we say we were going to do if this rejection came? You have a plan. So for this particular grant I talked about, you know, we already had a plan to resubmit if it wasn't funded the first time. And we're in the process of talking about what does responding to the summary statement look like? What do we want to change?

21:35 What do we want to keep? What ways do we enhance the project so that when it goes in the next time, it actually is fundable? So when you have a plan, it does allow you to fortify yourself against rejection. I think one thing that it's important to mention is have a support group. Have a group of people that you can come to and say, ah, this was rejected and I feel so awful about it and I'm so mad. I want to quit forever so they can help you put things in perspective. This journey is not a journey that you should go at alone. You should have accountability and you should have support as well. And sometimes your mentor is not the person to help you work through your feelings, your emotions about rejection because they are probably so far ahead they don't even think much about rejection.

22:23 They're like, and get over it, but you can't get over it, not right away. You need people to come around you and say, you worked so hard and that was such a good paper and it's going to get published. Don't worry about it. You need a group of people to just enhance you. So if you're looking for a group, if you're looking for accountability, you can get that in our coaching programs, sign up at clinicianresearcherpodcast.com to get more information. If this podcast episode has been helpful to you, please leave us a review and help other people to find us as well. And better still, forward this to just one clinician researcher who needs to be encouraged in the face of rejection.

23:06 It's been a pleasure talking with you today. Thank you for listening. I look forward to the next time. 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 healthcare.