How to take massive action

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 the Clinician Researcher podcast. I'm your host, Toyosi Onwuemene, and it is such a pleasure to be talking with you today. Thank you for listening. I am in the process of talking about five keys to 2024, and yes, we are a couple of weeks in. And even if you feel like your 2024 is already set and you don't need keys anymore for 2024, these will help you for your life as well.

1:28 And today we're talking about action. Oh, you know action is so important. In fact, as clinicians, we don't need to be told that action is important. We only ever take an action. We're always, always taking action. But one of the stories I share about my action taking is that I'm a massive action taker, and sometimes I take action in the wrong direction. For example, when I started out in research, I started out in a project in cardiac transplant rejection, and there was nothing wrong with the project. It was a great project. I was just not a cardiologist, and I didn't know anything about cardiac transplant. But it made sense because I'm an apheresis jock, and many times we provide apheresis for patients who are experiencing cardiac transplant rejection.

2:10 And so there was a connection there. It was a space I was in clinically, and it made sense to do research in that space. So a mentor mentioned to me that, hey, you know, you should think about studying this and really understanding the efficacy of plasma exchange in this group. And I just took it, and I ran with it. And I took massive action. I submitted grant after grant after grant after grant. And every time I talked to a program officer, they would express puzzlement, actually really more bewilderment as to why a hematologist was doing a project in cardiac transplantation. I mean, I think they would be nice, and they would say, so where are your mentors in cardiology?

2:52 And I'm like, well, my mentors are not cardiologists. They're hematologists. Like, so why are you doing a project in cardiology? Like it's not really cardiology. I was taking massive action in the wrong direction. I eventually stopped taking action in that direction, and I pivoted and moved in a different direction, which was a little bit more accommodating, and I've been more successful in. But just to say that just because we're taking action doesn't mean we're moving forward. And so it is important to take action, but it's also important to be very strategic about the action that we're taking. And so that's what I'm talking about today. The key to your success, taking action, but not just any action, the right kind of action.

3:36 Okay, so the first kind of action, or the first type of action I want to talk about, is action that is informed, informed action. And going back to my story of where I was pursuing a research project in cardiac transplant rejection, I wouldn't say it was an uninformed action, but it wasn't informed. So it wasn't uninformed because I intentionally took the action, but I had opportunity to find out more information, and it wasn't until a couple of years and many rejected submissions later that I finally figured out, oh, this is why I keep running into this barrier. And so what was the barrier? Well, the barrier was that I am a hematologist.

4:16 And you know, there's a lot between hematology and cardiology in many ways. I mean, we talk about plaque rupture. I mean, that's, you know, it's really arterial thrombus, right, that causes an MI. Or we talk about, you know, thrombocytopenia that occurs in patients with heart failure. There's just a lot of things in which hematology and cardiology come together. And so it's not wrong. It wasn't wrong for me as a hematologist to be doing a project in cardiology. But what I wasn't informed about was what it takes to convince people that you're going to be successful in a project that is primarily thought to be the focus of cardiologists, specifically heart failure cardiologists.

5:01 So transplant rejection, you know, if I was going to do a project in transplant rejection, I really needed mentors who were cardiologists and or were doing heart transplant rejection. And so it wasn't that at the end of every grant, I didn't have a letter from a transplant cardiologist. I just didn't have a transplant cardiologist who was my primary mentor. And that was a red flag for many of my career development awards that I was applying for. So a lot of my action was important action. I was doing I was doing the things I was submitting grants all the time. But it wasn't informed because if I had recognized what was necessary to be able to build a convincing picture that I was actually going to move forward with long term and be successful in my project in cardiology, I would have taken a different track.

5:51 Maybe I might have moved into a hematology project that was closer to where my mentors were because the hematologist I knew, hey, I worked with them all the time, the cardiologist I was begging to have meetings with, right. And so informed information allows you to take informed action, which allows you to be strategic in the things that you do. It allows you to build in a way that makes sense in a way that is helpful to you. It allows you not to waste energy. It allows you not to waste effort. Informed action really honestly is the only kind of action that makes sense. Many times we are kind of spontaneously taking action, right.

6:34 We are reactively taking action. And sometimes it's that someone's like, you have not closed that chart. Your deadline is midnight tonight, go. And all of a sudden you're like rushing frantically to close the chart. When that is not what you started out your day planning to do. You started out your day planning to finish a manuscript so that you get it out the door and send it to be reviewed. And instead, because of the anxiety driven by someone who gave you a deadline of midnight, you changed your plan, right. And so it's kind of frantic action. It's all over the place. Anyway, so I'm talking about informed action that allows you to take measured action that allows you to do the things that you don't regret in the morning.

7:18 You know that feeling when you wake up in the morning and say, what was I doing yesterday? What was I taking the whole day to do? You know, that kind of action. The other piece of the informed action that I want to talk about also is the informed action about what it means to be a faculty member. OK, so we're clinicians. Our training is clinical for most of us who did not do an MD. I mean, a PhD program as part of our MD. For some of us, we did do research, not to a great extent, certainly not to the extent that the PhD researchers did, right. But for many of us, we've done a little bit of research, but not that much, right. So we've done a lot more clinical training than we've done anything.

8:00 So when we come into faculty positions and we're like, I want to lead a research program, what we don't have is information about what it really takes to successfully lead a research program and what is necessary in terms of differentiating from being a clinician and being a researcher. And that's important because information allows you to recognize the limitations of continuing to drive your clinical program significantly while also trying to build a research program. And so if you're saying I want to build a research program and I also want to be a master clinician seeing patients five days a week, both of those things actually don't go together.

8:40 They don't. So to say I'm 80 to 100% clinical and I also want to lead a research program actually doesn't really work because being 80 to 100% clinical really is a full-time effort. And as you know, clinic just likes to spill over into many different things and you're still doing the notes three days later. And so clinical work is a heavy workload. It's a whole career in itself, right. People do this full-time who are not in academia. But as academics, if we're going to have a program of scholarship, then we've got to be able to carve out time for that program of scholarship. And some of us start with a good chunk of clinical and we're trying to grow the pie that is scholarship.

9:25 But there's a certain way to be able to do that successfully. And information allows you to know what actions make sense. And so when someone comes and says I'm giving you protected time to do your research and that's 10% time on Friday mornings, while you're also covering the pager for the infusion center, you recognize that that 10% time is not going to get me very far because you have information. And so you always want to have the right information to drive your action. You don't want to just take action without information. The challenge sometimes is that we don't know yet what we don't know. And for that reason, it is our responsibility to go out and look for information.

10:10 Go to places where you haven't been before. Go do the career development program in another city, in another state, in another institution so that you start getting a sense of what other people are thinking is the information you should have. And I hear some of you saying, oh, I don't need to go anywhere. My mentors are fantastic. And I want to reiterate that your mentors are probably the most awesome people in the world. And if you've been with them even up to a year, you probably know a lot of the stuff they know. You have a lot of the same information sources that they have. And it's helpful to diversify your information sources. Because what you'll find is that some things are emphasized a little bit more strongly at your institution compared to another institution.

10:53 But there are some things that are emphasized just as strongly. And so what you'll find, especially if you're growing a research career, is that grants and manuscripts tend to be emphasized anywhere you go, depending on what type of scholarship program you're building. If it's an education scholarship program, there's different emphasis. And so let's just say for everything you do, there is a specific type of emphasis. And information allows you to take the right action so that you can grow well into that emphasis. OK, I spend a lot of time on information, but informed action, so important. Number two is focused action. Focused action. What does that mean? Wow, as clinicians, we have so many jobs, right?

11:36 We're clinicians, we are educators, we are researchers, and some of us are administrators as well. That's a lot of jobs, and they're all very different. In fact, people are full-time educators. People are full-time administrators. People are full-time clinicians. People are full-time researchers. So as a clinician, you likely have three or more full-time jobs in one. And because of the perfectionist that you probably tend to be, you want to do all four of them equally well. And so here you are pushing in four different directions equally. What do you get? Unfocused action. And so if you're going to be successful, you're going to want to focus your action.

12:20 How do you focus your actions? It's like, well, I have four jobs. Hello, I need to do the four jobs well. I cannot focus. And the reality is that, of course, you can. And one of the ways you focus, decide what to focus on, is to prioritize. You choose the one that is the most important, that moves you forward the fastest, that is most significant to you, the one that people value the most, and that you value the most when those overlap. And you focus on those things first. And everything else you do well enough, but maybe not perfectly, like you are working to do the thing that is most important. But focused action is so important because you know that like a laser or like, you know, when you take a magnifying glass and you focus the beams or the rays of the sun, you can accomplish so much more with focused action compared to action that is completely diffuse, right?

13:17 So focused action is so key, so important. And so I invite you to think about your activities, all your jobs, because if you're listening to me, you have more than one job for sure. And you know, we haven't even talked about the jobs you have outside of your career. Say you're a parent or you're a caretaker for your elderly parents, or maybe you really do have a second job outside of medicine. I don't know. You have many jobs. And it's about focused action. And it's also about focused action while you're at work. So one of the things that's interesting, I'll talk about my story, I love to talk to people. I really do. I like I'm always talking to people. And so I have work to do.

13:59 I would prefer to just spend time in the hallway with you talking to you and asking about your mom and your dad and your sibling and how they're like, I love all that stuff, right? And what I'm saying is that focused action tells me that I'm at work to work. And we can catch up at the coffee shop later. But right now I'm at work to work. And so how do I take this time and make it count? Or for example, I'm in clinic, I get into trouble with this also in clinic in the clinic setting where instead of churning out the notes, I'm like, I prefer to talk to you, please. I don't want to write a note right now. I'll do the notes later. Focused action would say, hmm, while in clinic, let's do all the things that pertain to clinic so I can try to fit them in to the best of my ability right now.

14:43 And that is some of the focused action that really allows you to move a mountain of work forward faster and intentionally as well. So focused action is key to moving forward. All right. The next type of action I'm talking about is sustained action. Okay. So for this one, I'm going to use the example of writing. All right. I don't know about you, but I used to be, actually I'm still a recovering binge writer. As a binge writer, a binge writer is somebody who wakes up one day, finds eight hours and then spends the whole time writing. And usually there is no one day where you wake up and find eight hours.

15:24 So don't judge me. I was a binge writer who would like write in the middle of the night and be like, well, there's eight hours of sleep. I'm throwing it out the window and I'm converting it to my writing time. And I would just hustle and get that writing done. I'd be so proud of myself in the morning, bleary eyed, but done with the draft, maybe with the final version. But I said, don't judge me. Anyway, so I was and am still a recovering binge writer. And the thing about the binge writing is that you can only pull an all nighter so many days in a row before you're going to need to pay back the hours stolen from your body, hours of sleep that were necessary.

16:06 And so, you know, you take one eight hour window and you recover for four, five, six days. You take another eight hour window, recover again. There's only so much action in terms of moving your writing forward that you can do. Now, if you take sustained writing action where you're writing for at least 30 minutes a day, maybe more if you can fit it into your schedule, it means, hey, eight days later, you've completed those eight hours and you're not looking for more sleep. Eight days later, well, I guess if you're doing eight hours of writing, you get to eight hours. Anyway, if you're doing 30 minutes a day, it may take you 16 days, but it's sustained. And every day that you revisit your work, you get fresh ideas.

16:48 You are able to move things forward in a different way. You think a little bit differently about the way you wrote the sentence or the way you worded this paragraph or the way you structured this discussion section. Sustained action leads you so much further compared to the sprints. And so the binge writing is an example of a sprint and the writing every day is an example of sustained action. What are the things that are most important in your career as a clinician, scientist, and how can you do them every day? How can you move a little bit forward every day? Because this is the story of the tortoise and the hare. Even though the hare can leap and jump, the hare gets tired because it's expended all this energy and the tortoise, the turtle or the tortoise, it's a tortoise, is moving slowly and carefully and steadily, doesn't get tired, doesn't need to take a nap, can just keep going until the end.

17:46 And that's the gift that sustained action gives you. Number four is repeated action. And that is action that you repeat over and over. Now, okay, so repeated action maybe sounds like sustained action. But what I'm saying is you do this thing and then you do it again and then you do it again and then you do it again. Okay. And that's just not saying, look, I wrote yesterday, I've done well, I've done my good deed for the day, I've done my good deed for the week, I've done my good deed for the month. You recognize that if you're going to be successful, especially as someone who's building a scholarly program of research, there are going to be some things that you are always doing, right?

18:29 You're always making offers for grants, for grant money. You're always submitting proposals. And by always, I don't mean every day, but I mean you're always thinking, what's my next grant? What is it going to be about? What's my next resubmission? So it's something that you do again and again and again and again. Sometimes I hear people say that the reward for winning a grant is writing another one. And that I would say is the talk of someone who doesn't understand what grant writing can do for you and what grant writing can do to enhance and accelerate your program. And I'll have to send you back to season one to see some of the episodes or listen to some of the episodes about grant writing and the benefits of grant writing to understand why grant writing is a critical and important and really a personal development piece of your growth as a clinician scientist.

19:19 But grant writing is important. And it's not the thing you do and say, well, I submitted three grants last year. What do you mean I need to write another grant? It's just recognizing that there are some actions you keep doing because honestly, you're putting in reps actually. The more you do it, the more feedback you get and apply, the better you get at it. And so the people who are really widely successful are not successful because they write the perfect grant. To some extent they do, but they write the perfect grant because it's what they're always doing. They repeat it and they repeat it and they repeat it again. And because they have all these reps, they're able to get better over time. And so repeated action is taking the things that are most important to your forward motion, to your career development and just doing them again and then again and then again and then again.

20:09 And so that's the importance of repeated action. Number five is the importance of intentional action. You want to make sure your actions are intentional. And so, you know, many times we are kind of in reaction mode and somebody comes and tells us, oh, this is the way you need to do this. And you're like, oh, okay, I'm going to stop everything and do it this way. Or someone comes and says, what, you're writing this grant? This is ridiculous. You write this grant. And you're like, well, I'm going to stop everything and do it this way. And that is scattered. And that is also reactive. What you want to do is be intentional. You want to set out in your day, at the beginning of your day and say, this is my intention.

20:50 This is what I plan to accomplish. Okay. And then you take that action. And yes, life happens. And so it may be that you say, this is what I was going to do. And then you didn't do it. That's fine. But at least you have a plan. The benefit of planning is in creating the plans. But you also want the flexibility to be able to adjust the plans. But when you have no plans, then it's hard to be intentional because what are you being intentional about? You are not even sure. And so planning allows you to take intentional action. And so that's why it is helpful to, at the beginning of the week, define for yourself, okay, these are my goals for the week. These are my top three writing goals.

21:31 And intentionally, you work towards making sure that these goals are met. They are accomplished by the end of the week. You're taking intentional action. And to be honest, that's what most action should be, especially with regard to your career development and your scholarship, is you got to be intentional about what you're doing. Don't let half-hazardness come into your experience. And to be honest, there is some of that. The natural garden, it looks beautiful, but well, there are a lot of weeds. And the landscaped garden always looks better, always looks better by far. And it costs a lot more too. But being intentional allows you to pay the right price in the right direction so that you get the outcome that you're actually seeking, not the outcome that's kind of accidental and not quite the one you want.

22:22 And so taking measures to make sure that you're intentional in the actions that you take, not allowing other things to crowd out the things that are most important, is super, super, super important and helpful. Okay, so those are the five things that I am sharing with you today about action. Number one is informed action. Number two is focused action. Number three is sustained action. Number four is repeated action. Number five, intentional action. And those are the five things I'm talking to you about today. As always, I want you to share this episode with someone. And I also want to invite you, if you are looking for a coach, if you are looking to work with a coach so that you can really clarify your scholarship and career goals and move forward in a way that's sustained and move forward in a way that benefits you, definitely reach out to me.

23:15 I still have group coaching slots available. Send me a direct message on LinkedIn or Facebook or Instagram, or even better still, go to our website, coagcoach.com. That's our coaching website. And sign up for a coaching consultation call so we can talk about what you need and how I may best serve you. It's been a pleasure talking with you today. I look forward to talking with you again 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.

23:58 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.