Making it up as you go

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 always a pleasure to be talking with you today. Thank you so much for tuning in. Today I'm talking about making it up as you go along. Yes, I am talking about making it up as you go along. No, I'm not asking you to falsify data.

1:21 I'm not asking you to fletch the books. I'm talking about creating your career in motion. You know, I've heard the phrase, you are kind of strapping on the doors as the car is driving down the highway. So the sense that you are building it in motion, that's what I'm talking about. Creating your career journey while you are on the road. The reason I thought to bring you this episode today is because of a conversation I had earlier today. Actually, it wasn't a conversation. It was a conversation I observed. So I didn't have it. I observed it. And we were at a, you know, one of our career development sessions and people are bringing updates about their careers and things that were happening, what challenges they were facing.

2:08 And this particular young investigator said, you know, I am struggling to find the mentoring I need at my institution, but I'm trying to submit this career development award. And how do I make the case for mentorship when I don't have it? And the advice came from different angles. And one of the things I wanted to share but didn't because I just, you know, it was one of those things where it was like, this is a thought in my head, but there's so many other people giving recommendations. I'm not going to come forward and say it. I ended up not sharing. And to be honest, I don't remember who the person was. It's not, it's a big group. So I don't know people as that closely.

2:49 But the thought I did have in my mind and what I want to share as we go into this topic about making it up as you go along is that, you know what, most people struggle with mentorship. And this is not just my thought. This is empirically proven. Lots of articles have been written about the challenges of mentorship. Nobody needs to write an article about it for you to know that it really is a big problem. Very few of us are super excited to celebrate our mentors. Most of us are like, well, yeah, they did okay. And then there are many of us that are like, well, I just don't feel like I had them. And so I wanted to say, and I am saying to you right now that the problem with mentoring is a ubiquitous problem.

3:34 Like this is not like we just woke up in the 21st century and we're like, oh, we're lacking mentors. This has been an issue for a long time. And the challenge is when we see people who are successful, we assume that, oh yeah, they had great mentoring. Of course they're successful. And in reality, most people have struggled like we have struggled. And many of the people who succeeded have succeeded not because they got the golden spoon in their mouth, but really because they struggled to make it work. And because of that, they were able to forge their own way. So if so many people are struggling with mentorship, how is anybody succeeding?

4:15 I am so glad you asked because the answer, at least for today's episode, is because they are making it up as they go along. And that is what I want to talk to you about today. Number one, they're making it up so you should too. So the reality is that nobody has a perfect idea of what their career is going to look like. Nobody does because nobody can tell the future. And so this fallacy of, hey, where will you be in five years? It's not entirely true. Of course you don't know. You have no idea.

4:57 And I hope you don't know because how then will you be open to take advantage of opportunities as they come your way? Part of life is that it's a beautiful tapestry of serendipity and beautiful things happening, opportunities opening up to you that you take and walk through and totally transform your career. And so no, you can't look forward into the future and say in exactly 10 years, I will be doing XYZ. And I'm not saying you shouldn't say what you're going to be doing in 10 years because everybody's asking you. And of course you've got to have something to say. It's like when you're a kid and people ask you, what are you going to be when you grow up? Of course you're not going to say, I have no idea.

5:38 Even if you start out that way after several asks and years later, you know to make up a story, I'm going to be a fireman, right? Because people prefer to hear something than to hear nothing. So yes, when they ask you, where are you going to be in 10 years? Just do the math and say, how long does it take to get the promotion? Oh yeah, I'll be an associate professor. What is your institution value? Oh yeah, yeah. I will have three labs and 17 R01s. Yeah, absolutely in 10 years. You should say that. I mean, I'm not saying you should make up a story, but I'm saying that you should just look into the future, project, decide where people are, usually 10 years with these projections, and tell them, tell them what they probably want to hear, but just recognize that nobody knows the future, not to any level of detail.

6:28 Now here's the caveat I do want to give to that is that you are an academic, right? You are a scholar. And so producing scholarly work is your job. And in reality, the more scholarly work you produce, the more opportunities you tend to get, as long as people know and read about or hear about your scholarship. And I hope you're the one telling them about your scholarship, because if you're not, then nobody is telling them about your scholarship. And maybe in 20, 30 years, they'll be able to talk about your scholarship. But if you don't talk about your scholarship today, it's not likely that anybody's going to be talking about you. So there are some primary components that matter.

7:11 Publishing matters. And it matters not necessarily because it's publishing, but because it's one avenue of disseminating your work. Giving talks matter. Again, it's another avenue of disseminating your work, showing up in spaces, going for interviews, attending, like, you know, giving podcast interviews, all the things that allow you to move forward. Those are the things that really help to advance your career. And the more you do that, the more you're known for the work you do, the more people have an idea of what you do, the more opportunities will come to you. And so, okay, yeah, if you keep doing the right things in terms of checking all the boxes as far as your research and your writing and publishing and applying for grants, yeah, in five years, I could see you becoming an associate professor.

7:57 I could see that. Or maybe you're an associate professor now. Yeah, I could see if you gave that up, kept working and moving the needle on your research and submitting manuscripts and getting them published. I could see how in five years you could totally be a full professor. Yeah, I could see that. And you should say that when they say five years from now. Where will you be? Do the math. Say, I'm publishing daily. I'm doing this. Therefore, I'm going to be XYZ. Do all of that and recognize that it's all one big farce. It's just a lie because I don't know the future. I have no idea. I'm just, you know, doing what I'm supposed to do today and hoping for the best. I have no idea what's going to happen tomorrow. And I'm glad I don't because opportunities are coming my way.

8:41 And if I have a fixed mindset as to what the future looks like, then I will not recognize opportunity when it comes and slots me in the face. And so my point is that nobody knows what they're doing. When you look back and you write the story and the more you write these personal statements, the more you write these applications, the better you get at telling an elaborate story of how of course you knew that in the future carbon dating will become really important and therefore you invented it before it was even a thing. Okay, I made that up. That's just just a made up story. But my point is that you can tell the story much better, much sweeter, much tighter in retrospect.

9:28 And so when we look forward to these amazing people who we are calling our mentors, who are calling our sponsors, and they are great people, they've gone through a lot, they've succeeded a lot, they did not write this career path for themselves. They happen to be doing the things they were supposed to do, hopefully, being in the right place at the right time and opportunity came and they took advantage of it. And when you look back, they can make a good story out of it. But looking forward, they had no idea what opportunities were coming. And so the people we look up to and we admire so greatly, they really are making it up.

10:09 Everybody is making it up. Nobody knows what's going to happen. And so just recognize that everybody is making it up and you should too. Okay, you should be making it up too is number two. Okay, well, so if people are just kind of making up their future as they go along, well, why wouldn't you do the same thing? You're like, oh, no, no, no, it's too risky. Oh, no, no, no, I need someone to hold me by the hand and show me where to go. But when you find out that the people who are holding you by the hand also don't know where they're going, are you going to keep holding their hand?

10:49 Or do you consider letting go and making your own path? Would you consider letting go of the person who seems certain but is actually not and creating your own path for your own future? Again, nobody knows where they're going. Everybody has a sense of where they'd like to push towards and people are making their way towards that. And that's good. You should do that. You know you want to lead scholarship. You should continue to do that and push forward towards a successful career in scholarship. You should be working to write manuscripts and publish them.

11:30 Please do all those things. And recognize that even when you're doing all those things, opportunities will come and you want to be ready to seize them. But it is harder if you have in your mind what your career should look like because you have a mentor before you who looks like they've lived a perfect life and in fact they haven't. They're not telling you about all the failed opportunities. They're not telling you about how they had to pivot when one major project failed. They're not telling you because you know somehow we have an amnesia when it comes to those kinds of stories. It's like yeah I forgot how miserably I failed now that I'm a successful tenured professor.

12:15 Right? I mean it's easy to forget but in reality everybody has those moments of challenges that they've experienced in their career. They didn't know how it was going to work out and they took risks and it did work out. And so if other people are making it up, you should be making it up too. And that is number two. Number three is that when you make it up, better make up a good story. Make up a good story. Okay so have you ever sat and had a thought and in before you knew it, 10 minutes, 12 minutes, 13 minutes later you found yourself, you imagined yourself dead somewhere in the middle of nowhere.

13:00 Nobody knows where you are. It's like the starkest, ugliest, terriblest imagination that you could have. Right? You totally, I don't know, maybe this doesn't happen to you. Your mind is so beautiful, so perfect, so pure. You don't have dark thoughts, right? But it does happen to me where I'm sitting down and I hear a scream and immediately my mind goes to oh that must be someone who's getting harmed right now and the person who's harming them is going to come and they're going to find me and it just, and I'm like how did I get there? How did that train of thought, what? It was just a scream. But that happens not infrequently where our minds are spinning these ugly tales of disaster. And so if our minds do that when they're unfettered, right?

13:42 Kind of like the weeds, they just grow everywhere. What could your mind look like if you actually cultivated it so that it would have thoughts that moved your future into a place you actually want it to be? So what if you could create in your mind an amazing future? What if you stopped imagining a future where you have no grant funding, you can't pay your salary and they fire you? What if you stopped imagining that future and instead started imagining a future where you are successfully funded, you run a large enough lab full of people, they help you do the work that you need to do to move forward, you are well known in your field, people are so excited to have you and yes you have three or four side businesses that bring you millions of dollars in revenue every day.

14:36 Yeah I just added that in there because why not? Right? Why not imagine a great future for yourself? Why not imagine the impossible? Because it all starts with imagination. Yep that's number four. If you're going to make it up, you want to start first with imagination and already I've talked about how our imagination when they're not disciplined they tend to go everywhere and do all sorts of things and if you're really disciplined about creating a future you want or working towards a future you want you first you first have to imagine the future.

15:19 You've got to imagine it, you've got to think okay this is where I want to go and then that's where you go and in reality you've done this a lot. If you are a clinician listening to me, you went through med school, you did the residency thing, you did all of that fellowship, you did all the training until you could get no more training and then you had to graduate, you did all that and you already know how to do it because you first of all imagined a future where you were you were the one you were the senior resident being congratulated on three great years of internal medicine fellowship of internal medicine residency.

16:00 You imagined it and you went about creating it and so the future you want for yourself is an imagination away and I'm not being flippant I'm not saying just imagine your future and that's where it is. You imagine a future that you can work towards because without seeing where you're going without having a sense of where you're going you can't make the investments to get there. It's like having a GPS and you don't know the destination you're not really going to make much traction you could do a lot of great driving. You have no idea what the destination is and the GPS can't help you in that way.

16:41 Likewise you're imagining an amazing future for your career is the GPS that allows you to begin to navigate in that direction because don't get me wrong as much as I'm saying you should make it up as you go along life is not the kind of thing where you just coast and you hope that it's going to work out because you've been dreaming it it's not like that. It's the imagination that gives you the power and the strength to do the work that's necessary to achieve the outcome that you desire right. It's the step by step process. I imagine I want to go to med school what does that mean well it means I study hard right it means I take the MCATS I don't know if people are still taking the MCATS these days but bear with me right you you you're like I want to go to med school I see myself wearing that white coat walking down these hallowed halls at Harvard I see myself doing that well you're going to apply there right you're not going to say well I see myself walking there but why don't I not apply and see what happens.

17:46 That's why imagination is so powerful because it is the first step in getting us to a destination that sometimes seems impossible or rare because how am I going to make it I've never seen anyone like me before do that and so I'm inviting you I am inviting you to first of all imagine it and give yourself to imagining an amazing amazing amazing future. The next thing I want to say is that please do the imagining and then go do the work go do the work and now I'm talking to an audience that's largely cognition so doing work is something you are great at but here's the problem doing work is something you are great at it is both the gift and the problem.

18:38 The reason it's the gift is because it's because you're here and the only reason you're here the only the only way you're here whatever it is that you do the only way you're here is because you've put in a lot of hard work and effort into it but the challenge also is that the only reason you're here is because you put a lot of hard work and effort into it and for many of us clinicians we spend a lot of time and energy doing the things we actually don't really care about other things our employers don't really care about right we're we're good at working hard but not always good at distinguishing what we should be working hard at and so as we're considering the fact that we are making up this career yes let's daydream yes let's imagine the future and then we have to take the steps to make it happen you've got to take the steps to make it possible it doesn't happen without hard work but then you have to ask yourself well okay imagining a future versus like you know just going for it and just you know doing the work without imagination what's the different and the realities that both are needed your imagination helps you be clear about what you're building towards and it gives you courage an opportunity to begin to build so that you can head in that direction and so imagination matters and work matters and it's not just

20:09 about the work it's about doing the right work the work that actually moves you in the right direction and that brings me to the last one number five and that is do work that matters do work that matters as physicians we are good at working we are good at being busy every day people ask us how are you doing oh we're busy we are so good at that how can you be busy every day if you're busy every day well why are you busy when are you not going to be busy and the truth is that we're busy every day but we are also busy doing the things that are not priorities for us the things that honestly if someone said would you pay me so that you can do this you would say oh no please i'm keeping my money i'm not paying you to do this and so in reality there's so much that we're doing that we wouldn't even pay to do and we're just doing it because you know it's just us and it's just our time that kind of thing but at the end of the day it's it's uh it's costing you it's costing you to be so busy it's costing you to do all the running around it's costing you to invest time and work that is not relevant to your forward motion but yeah you've got to do that because ultimately ultimately i'm talking about making it up as you go along and the reality is that people people have already done that they've i mean they look so great

21:41 but they made it up they made it up and if they made it up you're looking to them trying to chart the same exact career path that they have for yourself you'll be so frustrated if you chose if you chose to be in position to take advantage of every opportunity as it comes wow what an adventure that would be and in reality you're already in an adventure yes you are you may not want to acknowledge it you may be playing it safe the whole time but in reality this is an adventure that you are on you are on a wild ride and i sincerely hope you're enjoying it as you look at all those people on the roller coaster and there are people who are screaming and puking their eyes out because they're not having a good time they're so anxious they're afraid and i'm not saying there's anything wrong with that it's just you could either be scared silly or you just relax and really have a fun amazing great ride and that's what i'm encouraging you to do today is to have a great ride don't let other people tell you what kind of career you should have yes i get it i get that there are these milestones the assistant professor associate i get those milestones i pursue them myself but those are not the stuff from which life is made that those are not the things that make life sweet the things that make life amazing the

23:16 opportunities that come that you would never have been able to take advantage of except that you gave yourself a little bit of room to imagine possibility and so when it came you recognized it and you took it you took it on so i um i just wanna i wanna celebrate you i wanna celebrate you because you really are creating something new even though you're seeking what is certain you're seeking the person who can guarantee you this will be your life for the next two years without change the reality is that it's always changing always changing always changing yeah anyway so i just wanna encourage you that if you're frustrated you can't find a mentor just realize that you know what many people couldn't do and they sort of they just made it and just decide that you're gonna make it too and start looking around and asking who else can help me especially if they are not in the clinical space who else can help me all right i'm gonna pause right there and i'm gonna just um celebrate you for being here with me today thank you so much for listening until the end i am so honored so pumped and so excited to be bringing you the next episode sometime in the near future all right it's been a pleasure talking with you today so glad that you're here and

24:46 i look forward to the next time that we can speak again on the clinician researcher podcast thank you so much 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