Proactively pursuing research opportunities with Dr. Dasha Babushok

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 I'm super excited about today's episode because I have a really superstar guest, Dr. Dasha Babushok, and she's going to introduce herself and just tell us a little bit about herself in the context of being a clinician scientist. Dr. Babushok, welcome. Yes, thank you very much for having me.

1:22 It's such a pleasure to be here and to share a little bit about my story. So I am Dasha Babushok. I'm currently an assistant professor at the University of Pennsylvania. I'm a hematologist. I see patients about one day a week, and then the rest of my time I do research, basic science and translational research, studying rare group of hematologic diseases. So the diseases for patients present to the clinic with low blood counts and the goal of my research program and really my sort of big passion of my life is to identify why these patients have problems making blood and how can we treat them better.

2:08 Thank you. So Dasha, you are like the rarest of the rare, in the sense that you are a clinician and you're a basic translational scientist. I feel like there's so few clinicians in that role. How did you get here? Well, it was a long and windy road. I don't have any physicians in my close and immediate family, so I actually wasn't initially planning to go into medicine or hematology. I was always driven to science, so I wanted to study biology, physics, chemistry, a variety of things. So this is what I wanted to do in college. I spend my college summers like many, maybe some of the listeners in various labs and basically was trying to find myself and find my passion and something that can sustain me over my career.

3:06 You may also, many of the listeners may also find that if they have an early research experience, they may catch these glimpses of something exciting, but a lot of it, especially early on is sort of you're learning the techniques. Some of it could be drudgery. You're trying, you may be failing, you're not fully getting it, and then your experience may end, so it was a summer. And so I wondered whether this is how it will be for the rest of my career. Is this what research really is like? When I was looking for something where I would have this, something that can sustain me essentially and would give me a greater purpose to pursue this.

3:52 So for example, in college, one of my, I guess my defining research experiences was studying a small protein that this interaction between an RNA and a protein molecule is very basic. And some of the questions that came to me as I was finishing my junior and going into my senior year of college, so will this be it? This is what I will be doing. And so I started exploring medicine as basically, can I do research in something that would more directly benefit people? And so then I learned about MD-PhD programs. And so this was relatively late and college sort of a shift in my thinking that, look, maybe this is what I was always meant to do is to do medical research.

4:42 So I explored these and I eventually applied and entered an MD-PhD program at Penn. And so then sort of fast forward the story. It was eight years of research. I did basic genetics research, studying mobile DNA elements and genome evolution. So this was not exactly immediately relevant to human disease, although of course there are many, many exciting connections that I will not belabor right now. And then I then proceeded to start as many, many of the medical students do. They enter then a period of training of residency program.

5:25 So I decided to pursue internal medicine. And again, I wasn't exactly sure which one was my calling. I really enjoyed doing internal medicine, seeing patients, and it's really can be all consuming. So residency is such a grueling time where your whole life revolves around taking care of the sickest of the sick and being on the front lines and research sort of falls by the wayside frequently. And during that time, I usually missed being at the bench. And so I started looking at opportunities to at least read about it, even if I wasn't doing a research project, but sort of really thinking about some of the diagnostic problems that he would encounter in the same way that when as though he was in the lab.

6:21 So for instance, I would see a patient with a blood condition and somehow hematology started to really appealing to me at this time period. And so I would look at the patient's blood counts and sort of be a detective. Oh, so we see some clues. We see the clues in the numbers and sizes of red cells and various other findings. And so then I applied for a fellowship. So again, this is such a long road for many, many of us. So applied for fellowship. So this is now right eight years of MD-PhD program, three years of residency applying to fellowship. And in fellowship, I moved back to Penn.

7:03 I really enjoyed the community here. And I think it's really, really important for you guys if any of you are considering a career of being a clinician, researcher or physician, scientist, whatever you call this entity to find a place where you have people who are doing the same, walking the same walk, who basically can support you and they can be your friends and supporters and peer mentors on the same journey. So it's a long road, but it can be funny if you have the right people surrounding you.

7:47 So anyway, so I went to Penn and I joined the Penn Hematology-Oncology program. And during that time, I met my eventually this very inspiring physician scientist who became my mentor for my postdoctoral work. It was Monica Bessler and she was just truly a pioneer. And she, somebody who cloned a gene in this rare bone marrow failure disease. She said, I haven't checked this myself, that she assembled the flow cytometer that she was working on.

8:28 So anyway, she was very quirky and incredibly wise. And basically, I decided that I want to work with her and look at new genetic changes in patients with these marrow diseases. And so this is how it happened. And this was something that I'm still working on now, gosh, so 2023. So it's over 10 years later. Wow. What a beautiful story. Thank you for sharing it. I see so many pieces of your story. For one, it's the organic nature in which you came to be where you are. All along the way, you were recognizing your interests as they were just growing and you pursued your interests, which is super awesome.

9:16 And then there's also, you talked about the importance of community. And so your community at Penn was important in helping you kind of shape your sense of self as a physician scientist as well. And then this mentor who really just helped to lay a path for you that you were like, I love this, I want to follow it. And I think it's so awesome. One thing that you talked about that I really want to just come back to is you talked about how well you were in the clinic, clinical space. There's so much, I mean, it was so busy and you were still drawn to the lab and still drawn to thinking about the lab and thinking about how do I keep things going in my research, even though I'm here in the clinical space. Sometimes when fellows come to interview, they say, I want to be a researcher and I'm thinking maybe 50-50, or I'm thinking maybe maybe 75% clinical because I really love patient care.

10:05 Can you speak to that? Can you speak to what is really needed for a physician scientist to succeed as a researcher, even though the clinical space is still important to the work we do? It's such a great question. And I think it's different a little bit on the type of research that people want to pursue. And I'm not a purist, so I'm not someone who just says just the basic lab research is what is research. Absolutely not. There's so much we can do. People can do incredibly meaningful work in a variety of spaces. So clinical research, translational research, and by that I mean something that involves, let's say, patient samples or, for example, health, economics, a variety of other types of research.

10:57 But I'll speak for what I do. So to be successful and run one's own lab as a principal investigator in a basic or translational lab takes a lot. So essentially, even if I'm in clinic, I try very consciously to focus on my patients. And what benefits me is that I study the diseases and I see the patients with these diseases. So it's essentially I have only one topic to master, but I can definitely tell my patients this is what I do, this is what I think all the time, day in and day out.

11:41 But it is that type of effort. And especially, I'll say for people with families, when your hours are constrained, you really have to have that intense focus because you have to balance also your family life, maybe if you have children, time with them. And then additionally, you usually cannot slack off as far as your research. So yes, so maybe you would be 75 or 80, 20 or 60, 40, 70, 30, but it's not out of a 40 or a week, right?

12:22 So sure. But I think you can, for instance, if there are any listeners who may be fellows and just thinking about starting research relatively later, or you absolutely can start later as well, it does require training and true commitment, but you can be very successful and there are ways of integrating research into your career that would also make your career much more fulfilling, I think. Right, I'm very biased, but I think it's definitely possible to be successful and with a smaller amount of effort, you just have to decide.

13:06 So sure, maybe you're not running a basic science lab, but you can, for example, run clinical trials or you can participate in other types of research that is a little bit more confined. Sure. Thank you for pointing that out. So a couple of things that I want to highlight from what you said, you talk about it as a leader, as a PI of a program. That's so important because what you're doing is you're leading a program. You're leading other people to do the work and you're not just leading people to do the work, you're thinking about it all the time and you're thinking about what's the next step in growing the program and funding the program, there's a lot of thinking time involved and then even in thinking about the research projects that you're doing.

13:47 And so I like what you talked about in you really are focused in your clinic, your clinic supports your research and vice versa. And so for that reason, you're able to make time actually go further because you're not trying to gather stuff from this other clinical space and it doesn't quite fit in your research. You really are focused. And I think it's important for people who are listening to just think about if you just want to dabble in research, if you just want to be a supporter, it is a different investment. It is a different level of commitment. But if you're going to be the one leading projects, writing the grants that fund the program, it's a higher level of commitment. And you also talked Dasha about training and how you do need training.

14:28 Could you speak more to that? Because you're a PhD, you did the MD and the PhD and then you said you need more training. What's that about? So it's such an important question. And I'll mention also, so now, gosh, like, right. So I was doing my PhD. This was, this is right, starting 2002 to 2007. And the technologies that were available, the types of thinking they were doing was so different. So this was during that time, the human genome project was coming, just coming out. So all of this, and there was no such thing as CRISPR.

15:11 What's CRISPR genetic engineering was that it was a Herculean feat. And that is also not so long ago. And so just to think also our mentors, if you think of some senior faculty, when did they train? So there is a lot of training that's involved and everything will also change. So for me, you take some time for your residency and fellowship. You come back to the lab and you're doing something completely new. So there, I would focus on key transferable skills. And also, I think for all of us, focus is really important.

15:52 So transferable skills from PhD training is being able to ask questions that are testable, making sure that you are using the right techniques, different methods of validating how do you know when something is true, looking at problems in sort of unusual ways, and also reading the scientific literature, which will be different as you go. So sort of having those habits and then just the framework of thinking. And of course, yes, so basic, for me, it was basic genetics, cell biology, immunology, those types of skills.

16:33 And of course, that will be different if somebody is, for example, doing now a more computational project. So nowadays, I think data science is really important. It's incredibly valuable skill. So if someone is considering getting training, and people may have training, for example, doing a master's program that is sort of focused on the skills that you need, whether it be in translational research or if somebody needs additional skills. And let's say bioinformatic analysis of nowadays, we have a lot of multiomics or single cell technology. So all of those, whether you're an end user and you work, you learn how to partner, but bioinformaticians or teams and direct others, a lot of what I do is I haven't done it myself, but I know enough to be able to mentor someone to do it and analyze results and troubleshoot.

17:27 So all of that is very important. But anyway, just to get the practical, all about practical next steps. So if somebody is, for instance, contemplating doing training, so the types of training that are helpful and transferable, I think data science, a little bit of coding, you don't need to be a super programmer, but just knowledge of R or similar programming language would be very helpful. Knowledge of statistics, grant writing, that was something that I absolutely needed training in, additionally, and you just get better as you go. Writing, so manuscript writing is important.

18:09 That is, you will get better as you guys are doing it. And then of course, the subject matter also. And that would be, whether it's clinical trials or whether it is something at the bench in immunology or whatever you're pursuing. But yeah, absolutely. I think training is helpful and it can be in the form of a degree, formal program, but also just doing it with someone who can mentor you along. And that requires a lot more legwork and you, but also can sometimes be a little more targeted and even more fruitful and you probably will retain more.

18:51 Thank you for laying it out so well. It's funny. You think about the fact that, well, we went to medical school and then we did residency and then we did fellowship so that there are levels of training and you don't leave medical school ready to care for patients. You do more training and I think sometimes patients, people who haven't done an PhD, but even some have this feeling of like, well, I should know everything I need to know to start my research program. And I think this fallacy comes in a lot with people who are doing clinical research. The thought that doing clinical work and clinical research is the same thing. I love the way you speak about being able to even like decide what's a testable hypothesis.

19:32 It's not something that's taught in our clinical training. And so really being able to get the skills you need and to create space and time to do that is super important. You talked also about grant writing. That's not part of any clinical training ever. And it's a skill. It's a skill that you build over time. You get better at it. So I appreciate you talking about it and just laying out how much investment is needed in terms of even transforming as people in this venture and trying to be at least work our way towards being the physician scientist we want to be. Now as you were talking, one of the things that comes across is that you just seem to talk so easily and so effortlessly.

20:13 It's like it's been smooth sailing all along. I want you to talk about some of the biggest challenges that you have faced on this journey. Oh my, where do I begin? So I'll say probably the biggest one is coming to Tromsvith and just accepting the fact that the journey is long and that there are ups and downs and then living the keys to live in the moment. So it's not about the destination. It's not that you're sort of going somewhere. So yes, sure, finishing medical school and MD, PhD program and residency and fellowship.

20:56 But the key is you're a scientist, a clinician, a physician, a professional from the beginning. And this is something that I think framing it in this way has made the journey, the long journey seem fulfilling for me. So other, I guess, challenges is sort of just sustaining or even recognizing just how disjointed our physician-scientist training can be. And I'm talking specifically about people who did, for example, like myself first. And nowadays it's more common. People take gap years.

21:36 I didn't do a gap year. But essentially you have something that you do, then you're switching to medical school, then you're switching to research, switching back to medical school, now doing residency and then going back into the lab. And you always think about, so why do we do certain things? So in my mind and what sustained me was just both the curiosity, the ability to be creative and to feel that I'm making a difference as corny as this may sound. But also when you think of it, so you just gain your mastery, you're on top of the world, you're this scientist, just finished with your PhD and then you're an intern again.

22:25 And you're wondering where, how to navigate across the hospital and how you do this procedure and patients and trying to now stay on top of clinical medicine and you finish residency, you're on top of the world, you're the best clinician probably, you're over and you join fellowship and you're proceeding, then you're back in the lab and wait a second, the genome project is out and everything has changed. And what is this CRISPR and what questions do I want to ask and how do you start again? And so if you remember in Batman, there's that question, like why do we fall, Bruce, I think that's the line from the movie about how he sort of falls in this well, right, with the bats and he's very scared and that the butler comes about and tells him why do we fall so we can get up again or maybe this, I sort of made up the story now.

23:22 I can't watch this movie in so long, but essentially you just have to have this resilience to pick yourself up and be willing to be humble, right, and start again and sort of sustain yourself. And meanwhile, you're also thinking about, so what are your colleagues doing, you know, if it's important to you to sort of to think that someone is, you know, you're still doing this and finishing and somebody is probably running a big hospital or doing something else in pharma, like what's your opportunity cost and what would you rather do, right, and just recognizing like it's a choice and I'm doing it because I love it and I'm very passionate about it and there's nothing else that I would rather do.

24:13 But you know, this again, like this may change and your mind can also play tricks with you, right? So there was stretch and the stretch is difficult and things may not be working so smoothly, you know, your postdoc mentor may leave, like what's happened to me and you're sort of okay, so I'm a fellow and my postdoctoral mentor retired and what do, like how do you navigate this and I was very fortunate in my, so right, so this was towards this period that in, you know, it's very, it's very well recognized and physician scientists were sort of wanting to do basic research and they're looking for a position, place that will be willing to bet a lot of money and resources and commitment on them to start their own lab and think of it like you're basically coming in and you're going to start your own business, right?

25:12 So a lab were coming, you know, for me to get hired on what is called a 10-year track position with the lab requires a lot of commitment and investment from the institution, so they really have to look at me and say, you know what, like I'm going to give her a lot of money and I'm going to give her this precious space that you think, what are they doing, you know, they're building it up, but in fact, it's very little space. So now they're going to invest in you and for that to happen, you have to have many things that, you know, you have to demonstrate that you can get a chance and you published and have a body of work and they have to sort of believe in you.

25:55 So for me, as I was finishing, I was sort of not really that close at the time my mentor retired, but she sort of, you know, she was wonderful and I always think of mentors who empowered me and she was one of them, you know, her quirky saying was move in like a truck. So anytime when I have self doubt or, you know, wonder how am I going to do it, she goes, well, you just move in like a truck. So anyway, so I was okay, well, I'm going to move in like a truck. So I sort of squatted in the lab space that she had, she had sort of a grant that was still running out.

26:35 So I had a little bit of funding after she left because otherwise you sort of, you don't have a mentor and you don't have funding and the institution supported me. So that was probably the most typical time was just navigating that transition from the time when I'm, you know, sink or swim, right? You were swimming and wondering like, is anyone going to believe in me to, you know, to sort of be willing to hire me for a 10 year truck position? Thank you.

27:18 Thank you so much for sharing that. And you know, you shared many challenges that now make me feel like, wow, this is a hard journey. So for the clinician at the beginning, let's say they're done with their fellowship, they haven't, they haven't, they haven't done all these amazing things that you've had. They don't even have a great mentor like you had. And they're like, wait a minute, is this research thing for me? Does it make sense to move forward in this direction? What advice do you have for them? Well, I would say just stay passionate and try to remember and sort of stay true to what really, you know, what excites you, right?

27:59 And what you think will sustain you for your career. If, for example, you know, if you're interested in, let's say I want to do early clinical trials, I've never done it, but I would like to pursue that. I think seeking out a project or identifying a question and identifying a mentor would be really important. And then I think just finding a project and running with it and accepting that you're going to learn from it and you know, there's always going to be mistakes as you're starting, but having somebody to mentor you and you, I guess the other key part that I would like to tell the, uh, share with the audience is how important it is to find a mentor, but recognizing that they are human, they have little time, they didn't have mentorship training.

28:54 It's not like somebody runs these classes and degrees for mentors. So they themselves just came to where they came to be. So you have to be very active yourself and you have to know, and you essentially also have to probably give something of yourself and your time and your effort to the mentor for your relation, for this relationship to work. So as you're finding, you know, deciding to start on the research project, I think you just have to believe in yourself, stay passionate about what, what is it that you're, what you're doing starts small. So pick something that's manageable and then, you know, success begets success.

29:38 So you just, you start in something, you have a mentor who you schedule meetings with, you come prepared, right? You, you use and come through on your board. So if you decide that, okay, we're going to meet in a week or in two weeks. And by that point, I'm going to do this, then do it, or pick something smaller to do, but just try to come through on your commitment. And then, and then essentially, once you learn the ropes, then you can expand. And then once you expand, you know, I wouldn't shy away from opportunities to that come along, right? And that would be something that you don't think is in your wheelhouse, but I would still, if it's interesting to you, I would absolutely jump on that with the right team and the right collaborators and the right mentors.

30:30 That's super awesome. Thank you. I hear you talking about how you can't do this by yourself. You need community and that community includes mentors and, but there's still a lot that you have to do. So you have to be able to bet on yourself and then you need to take the bull by the horns. I love it. Move in like a truck. I know, it's a little bit sign. It's my motto, you know, in the days when I'm still doubt myself, I, it just, it comes back to me. It's a good one. It's a good one. It's, it's taking advantage of every opportunity, trusting yourself that you can, you can take it to the end. That's really awesome. Well, Dasha, you've just shared some amazingly incredible insights with our audience and you have a great story.

31:13 I appreciate you sharing it with us. I'm inspired just listening to your story and, and, and so, yeah, thank you. Thank you so much for having me. It was fun. Thank you for inviting me. Yeah. And so our audience, thank you for listening. This has been great. If you can think of someone else who needs to hear Dasha's story, Dr. Babashok's story, please share it with them. This is really important, I think for, for, for everybody at every level to recognize how, how much investment is needed to really lead a research program as a PI, how much community support is needed as well. And I think those are all the things that Dr. Babashok highlighted. So please share this with someone. If you're a mentor and your mentee needs to hear it, please share it with them as well.

31:55 But thank you all for listening and I look forward to talking with you again 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.