How to pivot in your research

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. Hello everyone, welcome to the Clinician Researcher podcast. I am your host, Toyosi Onwuemene. Today I'm talking about how to make a pivot in your research. How do you pivot? And the reason I want to talk to you about this today is because I've had to make a pivot and it's actually more common than you would recognize, and pivoting is okay.

1:27 And before I start, I do want to share with you that we have a master class that's coming up and you are invited how to negotiate your first, next, or current academic job. We do negotiation master classes. Sign up on our website, clinicianresearcherpodcast.com, and you'll get information to sign up, and please be a part of that. All right, so I started my career working on somebody else's project, and most of us will do that. We don't have a research program that we're leading when we start, and it is always helpful to just do what somebody else is doing so that you can learn all the other pieces. And so it's not about the project you're doing when you first start, usually.

2:12 It really is about all the things that you're getting. Well, so one of the projects I started working on when I first started was a project in heart transplant. And I will tell you, I'm a hematologist, and so heart transplantation is not... This is not part of our hematology trainings. Yes, if you Google me, if you PubMed me, you'll find my heart transplant rejection manuscript. There's really just one, for the most part. But the reason that I did it was because it was what was available to me, and it was like, well, this is a project that you can work on. And a mentor had recommended that to me, and so I went and I worked really hard on it.

2:52 And I finally was able to publish one manuscript from it. But I submitted a lot of grants on this project, and every time a rejection would come through, it was so hard to start over. Because literally what would happen is I needed to submit a grant. So I would do this work. Then I put it all together. I submitted the grant, and then the work would stop. So I was like, yeah, I hope I get the grant, and then I'll keep doing the work. It wasn't work I wanted to do, whether the grant was funded or not. That can be a challenge. If it's not the work you really want to do, it's hard to sustain it. Because you're just doing it, and you're pulling out all your reserves to do the work.

3:33 And in reality, you get rejected so much. This is work you need to keep moving forward, because you can't actually depend on other people to move you forward. You have to move yourself forward. Anyway, but I kept going in this area in which I was working. And finally, I attended a grant writing program. And this is a point at which I plug in Kemi's grant writing program. Get that grant. It's so awesome. And I finally learned that, hey, you don't have to do a project that you hate. You don't. You can do a project that you love, and still get all the things that you want.

4:15 And I hear people saying, wait a minute, are you kidding me? This is all my mentor is doing, and this is my mentor. It's like the most funded person in all of the universe. I get it. I get it. This person is your ticket. It's your ticket to success. But when you hate the work you do, it is so hard to do. I mean, you can muster enough energy, because that's the thing about clinicians, right? We have done a lot of training. We know how to put in those night hours. We know how to stay up late. We have made a lot of sacrifices to make training work. And so for many of us, our training was not about, I love this so much. It was just about this needs to be done, suck it up, and get it done.

4:56 And so because of that, this is kind of like the experience that we bring to life, the sense of suck it up and do what's needed. And the reality of sucking it up and doing what's needed is that you can only do it for a short period of time before you start to burn out on the sucking it up and get it done. And that is why love is one of the greatest forces in the universe. Yes, I am talking about love, loving the work you do. Because when you do it, you can just go the distance. When you love the project that you do, you can go the distance. You can go the distance. You're like, you rejected me, huh? Coming back again.

5:36 I'm submitting it again. You rejected my paper. I'm going to do this again. Because you really enjoy the work you do. And so I will tell you that even though for many of us, we start out doing work that we don't love, it's okay. Now that we know better, we have an opportunity to pivot and do work we actually like. And so this is the positive pivot. This is the where I wake up and I'm like, you know what? I hate this particular project. I don't care for this. I don't care for heart transplant rejection. It's an important problem. Please solve the problem somebody, but not me. And the day you wake up and figure out that this is not the work you want to do, congratulations.

6:20 What an opportunity to change direction. Now for some people, it's like, I just quit. I'm never going to do this again. No, don't quit. Please don't quit. And this is why we have Academic Negotiation Academy, because you don't have to quit. How can you keep the work you're doing and make it better? How can you negotiate something different from where you started? You don't have to quit. And if you're thinking of quitting right now, please reach out to me by DM. I'm on Facebook. I'm on Instagram. And just say, hey, I'm wanting to quit. Can we talk about it? Because you don't have to quit. What you do need to do is pivot. And sometimes pivoting requires negotiation.

7:00 It's not part of our training. And that's why I coach clinicians on negotiating their careers, because it's something that's important for us to do so that we can have the careers we actually want and not the careers that other people have dreamed up for us that we hate. They don't know whether you hate it or you're like it. They just made a recommendation and you took and ran with it. The moment you wake up and you're like, yeah, that's not work I want to do. It's time to pivot. Don't quit. It's time to pivot. And it is important to do that. Or for some of you, you're like, ha, ha, too late. Everything broke down. Everything failed. And then I had to pivot. Like I had to. This wasn't even like I want to. It was I had to.

7:41 And that's OK. Either way, it is important to pivot. And so I'm going to talk about ways to pivot and still land on your feet. So the first thing I want to talk about is the importance of recognizing the pitfalls of success. That sounds funny. The pitfalls of success. What? I only want to be successful. How can there be a pitfall to success? Well, there are pitfalls to success. And the specific pitfall I'm talking about is that the moment you start succeeding in research, then people start believing that's what you do. They're like, oh, heart transplant rejection? OK. And then they think about heart transplant rejection. They think about you because you're succeeding in this area.

8:24 And the problem is if it's not work you actually want to do and you start succeeding in it, wow, you know what success does? Success breeds more success. You succeed once. You've increased your chances of succeeding again. And that's usually a good thing, except when you're in the space you don't want to be. And so I don't want to be here, but now I'm succeeding in this space. I'm creating more of what I hate. Oh, not good. And so it's important when you start thinking early on about developing a research project or working with a mentor to develop a research project, be very clear about what you're getting out of the project.

9:09 It is a problem for many of us clinicians who are like, we get to a mentor and we're like, just save me. Save me. I have no idea what I'm doing. Just help me. And they're like, oh, great. I have these three projects. Which one do you choose? And you choose one. And none of these projects is a project you really care about. You're just like, just save me. I want to publish manuscripts. Please give me a project. But it is important to recognize that you're going to start succeeding because as a clinician, that's what you do. If you've come this far, you're a success. You know how to be a success. They tell you what the metrics are. You go do it. You kill yourself in the process. You like stop sleeping. You stop eating.

9:50 You stop drinking to make it work. You're good at this. It's not even always good. You're good at succeeding. And so the moment you take a project and you just take it because someone gave it to you, not because you care about it, you're going to start succeeding. And then all of a sudden, you're going to get to a place where people are going to be like, well, this is what you do. Or you're going to be like, well, this is not really what I want. I just started this in fellowship just to do it. This is where I really want to go. And they're like, no, no. You published a lot of papers in this area. This must be where you fit. And then all of a sudden, you struggle. You struggle to move to the next area because people are like, well, this is how we see you. This is where you've been succeeding. This is what you've been doing.

10:31 And the reason you recognize the pitfalls of success, the success leading to success syndrome, is that you want to start where you actually want to be successful. And that's why it's important to clarify for yourself what that starting point is. For example, let's say I am a hematologist and I don't want to do breast cancer research. But you know what? The mentor available to me, if it's a breast cancer researcher, what do I do? Do I quit my hematology aspirations and then pursue breast cancer? No, I do not. What I do is I define for myself, what is it within this breast cancer research program that leads me to hematology? I'm very focused on hematology.

11:13 And I know I'm being very broad with hematology, but let's just stay with me here. Nobody has a research program in hematology. You have to be more focused than that. But let's say I'm on my way to hematology and working with a breast cancer researcher. I might be doing a project that's in breast cancer, but don't get me wrong, I'm not here for the breast cancer outcome. I'm here for the hematology outcome. And so I'm always thinking and crafting my projects. Like what is the hematology aspect of this breast cancer project that I can bring so that at the end I'm taking hematology out of this project? It's not breast cancer. It's really important because when you start to succeed, you want to succeed in an area in which you can carry forward. If your mentor is now like, oh yeah, I recognize that you're really interested in thrombocytopenia in patients undergoing breast cancer therapy, but the project I have is really about how does the tumor respond to therapy?

12:05 Will you take it? Because I know what I want. Because I know that the piece of this breast cancer project that makes sense to me is a thrombocytopenia piece, I'm going to say no. Give me another project or help me develop a project that allows you to understand tumor response while I still figure out something hematologic. And if that cannot happen, then I have to think about is this the right mentor for me? And this is so important. You start with your why. You start with where you're going and then you make the decision surrounding the mentor. You don't let your mentor tell you where you're going. The mentors are awesome. Please kudos to all the mentors out there. Thank you for your work.

12:46 Thank you for what you do. But the mentor is not the one to tell you who you are or where you're going. You tell your mentor where you want to go and then they help you figure out how within the context of what they're doing, they can help you get there. So that when I start succeeding in this breast cancer space, I'm not succeeding as a breast cancer dog. I'm succeeding as a hematologist within the breast cancer space. I'm leaving breast cancer. That's very clear to me. So let's not get confused. I'm leaving this breast cancer space because I'm on my way to hematology. And that's why it allows me to be very clear about what successes I want to create here so I don't get stuck. And you're never really stuck.

13:27 But you can get stuck because the moment you start, you know, as a hematologist, now you're like, oh, well, I guess the only project here in this highly successful lab is the breast cancer tumor response. I'll just do that project for today. You're veering away from where you really want to be. It's not what you want to do. You're going to start succeeding in it. And then you're going to breed more success. You're going to find yourself 20 years from now, three R01s later asking yourself, why am I here? Don't be that person. Recognize the pitfalls of success and still start in the area in which you actually want to succeed. And if that area is not immediately available to you, figure out how you can use what you have in front of you to create what you really want and make it clear what you're getting out of that so that you can take it at the end and be successful in it towards the path you really want to go on.

14:17 So recognize pitfalls of success and the fact that if you've been successful in the past, there's an expectation you're going to be successful in that same way. And it's OK. You can overcome it. Just recognize. So if you have the opportunity to start well, you do it. You do it. Don't be like people like me who, like three, four years later, were like, well, this heart transplant thing's not really what I want to do. Now can we pivot? OK. That's number one. Recognize the pitfalls of success. Number two, decide to do hard things only if they're worth it. OK. So sometimes people say, oh, I want to do research. It's so much easier than clinical. OK.

14:58 Research is not easy. It is hard. And it may be harder than clinical work in some ways and easier than clinical work in some ways. But it is hard. It is hard to write manuscript after manuscript after manuscript and get rejection after rejection after rejection. It is hard to do work over the course of a year. And all you have to show for it is an abstract that people didn't even accept. It is hard to do research. That's why it is a full-time job. It's not a part-time activity. And so if you come to research and you're like, I'm going to do this, you're about to enter into a season of hard work.

15:40 If you're trying to ramp up a research program, if you're trying to get people to be part of the research program that you're going to lead, it's going to be really hard. You're going to be working hard negotiating for resources, sometimes working with resources that don't help you move forward in the way you need to, struggling sometimes over who's first author on this manuscript. It is a hard space. There's a lot of rejection here. So if you're going to do something hard, choose to do it only if it's worth it. So the moment you are starting out, figure out that, hey, this is going to be hard. What do I care about enough that even though it's hard, I still want to do it? And this is applicable whether you have to pivot because you're forced to, or you decide to pivot, or you're just starting.

16:26 But whatever you're going to do is going to be hard, and that's why you only want to do the hard things that are worth it. Please, only do hard things that are worth it. You're going to make a decision that this is going to be a hard path, no matter what I choose, and I go after it if it's worth it. And that, again, goes back to don't make the decision because there's a mentor in the field. Like, there is no other mentor in the world but this one, therefore I'm going to go into what exactly what they're doing. I'm going to do receptor signaling because this is it. It's going to be a hard path. Recognize that up front and choose it if that's what you want and if it's going to be worth the labor that you're going to put into it.

17:10 Because at the end, you're going to birth a baby. Is it the baby you want? Okay, number two is decide to do hard things only if they're worth it. Number three is to have a heart to heart with yourself. And I think this is important because it is hard for us in medicine to know what we want. For the longest time, throughout our training, we're just on autopilot. Somebody says, hey, this is the medical school curriculum. And most of us don't argue with that. We're like, okay, let's go medical school curriculum. Maybe you have electives and you're like, okay, at least I get to choose what electives I do. But for the most part, there's a lot of just doing whatever is in front of you.

17:52 And so you do whatever is in front of you and then you get to residency and they're like, well, these are the competencies you need to graduate. These are the rotations we've already scheduled for you. Okay, you can have an elective or two in there. Go for it. And so by the time you get to the end of your training, if you've been well trained, you are used to going with the flow. You're used to going with whatever you're told. And if you're really going to succeed in your pivot, whether you're just starting, is really hard to do. Have a heart to heart with yourself. What do you want? What do you want? And I have to tell you that that is one of the hardest questions for clinicians to answer. Sometimes, especially when people at the end of their training and just at the beginning of their faculty careers, I hear things like, I just want a job, a real job that pays real money.

18:40 And that's great. And you deserve that. And congratulations if you're already there. But goodness, I hope there's more to your life than just a job that pays you money. What do you want? What do you really want to contribute? Where do you want to really invest your life? That's what you're doing. You're investing life energy. Where do you want to invest your life? And it's important for you to be very clear about what that looks like so that when you are making a pivot or even just starting afresh, you know that this is where I want to be.

19:21 Because it helps you to get creative. It's like, this is where I want to be. This is a hard space. It's going to be hard to succeed in some ways. But is this really what I want to do? And how can I make it work? When we are very clear about where we want to go and what's important to us, and there's really no mountain high enough, we're going to get there. We're going to climb it. We're going to get to the top of it. We're good at doing that for the things we don't even like. And so if we've been able over the course of our careers to service dreams that are not ours, then what about our own dreams that we really have? And that's why it's important to work with a coach. And maybe it's not a formal coach.

20:01 Maybe it's a friend who really gets you and has a lot of hours to spend investing and helping you get to the place where you are very clear about what you want to do, how you want to contribute, how in 20, 40 years from now you're going to look back on your career and say, that was well worth the investment. You want to make sure that at the end of your career, you can really be like, that was good. I made a good investment. And to be honest, on the flip side of that is people who are like, oh, I wasted so much time. I can't believe I wasted all that time. You don't want to be that person. And so part of pivoting, a part of really moving in the area in the direction you want to and maybe even starting there is really being very clear about who you are, what you want to do, how you want to contribute.

20:52 And so you want to have a heart to heart with yourself and really pull out what are the things you enjoy? What are the things that matter to you? And honestly, that does change from season to season. Have a heart to heart with yourself and recognize that as the seasons of your life change, the things you want change. And so it changes the course of how you lead your research career. And it's okay. And that's why negotiation is an important skill. And that's why we teach negotiation skills to clinicians in our academic negotiation academy because as life changes, you got to change with it. And yes, the job you negotiated seven years ago was an awesome job for the person that you were seven years ago.

21:38 But what does that job need to look like today? And those are ongoing micro negotiations that do need to happen so that you continue to align your career with your life, not the other way around. So have a heart to heart with yourself, figure out exactly what you want. And if you can't do it on your own, work with someone who can help you do that. Step number four is to commit to your dreams. Hey, what do you want to do? 20, 40, 30, 50 years from now, how do you want to be remembered? How do you want to have felt like you contributed? If you imagine your obituary, maybe even write it, what will people have said about the involvement you had in research?

22:21 What came out of that? And then commit to your dreams. It's like, this is what I want to do. I'm committing. And it's so awesome to be able to commit to your dreams because you've committed so many times to other people's dreams and you've committed to other things that people have had for you. But what a great opportunity to commit to your own dreams to say, well, this is the dream I have for myself in research. I want to lead a research program that doesn't just answer important problems, but that becomes a stepping stone for other people's careers. I want to lead a research program that helps other clinicians to make that transition from clinician to clinician researcher. I want to lead a research program that changes the way we do patient care. I want to lead a research program that just changes paradigms and shifts the way things are.

23:05 That is my dream. And I'm committed to it. And part of being a clinician researcher is the fulfillment of that dream. Not here to play. Not here to do somebody else's dream. But it's hard work. And it takes commitment to make that hard work happen. Because some days you're not going to want to go to work. And some days you're going to not accept that rejection. And some days you're going to be shocked that anybody would reject this amazing manuscript that you spent half of your life writing. But you commit to your dreams. And because you know, because you're clear about what your dreams are as a clinician researcher, then you pursue it.

23:51 You don't take no for an answer. You never take no for an answer. They reject the grant. You say, OK, how do I come back with a grant that's changed and transformed so it can be accepted? Or who do I find? Who's going to fund this work? Committing to your dream allows you to keep moving forward in the face of rejection, in the face of people saying this is a silly project, to asking how? How do I make my dream happen? Commit to your dreams. And yes, I am talking about your clinician researcher career. You have dreams for what you want to come out of that. Have the dreams, own the dreams, and then commit to the dream.

24:32 And sometimes it will be hard, but your commitment will get you through. OK, number five. Take baby steps in the direction you want to go. So you know what, in medicine and medical training, we do things big. You were going to med school. You went all in to pull off this med school thing. You in residency went all in to take the call, to do the overnight shifts. You go all in. So sometimes when it comes to clinician researcher transition, the transition from clinician to researcher, we want to go all in too, and we should. But sometimes we can't. Sometimes all we can do is take baby steps.

25:13 And it is important to take those baby steps, because baby steps, they, over time, come together to make a lot of steps in the direction you want to go. And so if you're pivoting, it's like, well, I've been doing this thing for a long, long, long time, and now I'm changing direction. You want to go all in. You want to quit all together. Sometimes you just start with one baby step. It's like, that's the direction I want to go in. You start. And over time, those baby steps start to compound into huge steps because you've been taking baby steps all along. So it isn't easy to pivot. It isn't easy to go in the direction you want to go.

25:54 It's not easy to say to the mentor you've had for the last seven years, hey, this is not really the project I want to do. Here's how I want to take it and shape it. The key is to keep moving in the direction. So maybe you can't take baby steps. Now you just roll. You roll in the direction you want to go. But the important thing is to start and to start going in the direction you actually want to go in. And yes, it'll be challenging, but it'll be the direction you want to go in. You'll bring a different energy to your work than you've had before. And I encourage you to come into this space. And so to recap, number one, recognize the pitfalls of success.

26:37 Choose only to be successful in the thing you actually want to do. Recognize the pitfalls of success. Number two, decide to do hard things only if they're worth it. This is a hard journey. You're going to be doing a lot of hard things. Make sure you're only doing hard things if they are worth it. Number three, have a heart to heart with yourself. Make sure that you are clear about the direction you want to go. Clarify your dreams. Clarify how you get there. And number four, commit to those dreams. Commit. You're going to have to make a commitment. This is hard work. And number five, take baby steps. Take baby steps in the direction you want to go. Make sure it's the direction you want to go.

27:18 And then take baby steps in that direction. All right. It has been a pleasure talking with you today. If this episode has been helpful to you, if you know someone who's making a pivot and needs to hear this, please share. If you're a mentor and you're like, my mentee needs to hear this, please share. And if you're like, I want to learn to negotiate my academic career, you should join us in our upcoming class. Negotiate your first, next, or current academic job. That's happening on August 21st. So definitely please join us. All right. It's been a pleasure talking with you today. Go forth and prosper, thou clinician researcher. Take care.

28:05 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.