The number one shift you need to make as a clinician researcher

0:00 Welcome to the Clinician Researcher podcast, where academic clinicians learn the skills to build their own research program, whether or not they have a mentor. As clinicians, we spend a decade or more as trainees learning to take care of patients. When we finally start our careers, we want to build research programs, but then we find that our years of clinical training did not adequately prepare us to lead our research program. Through no fault of our own, we struggle to find mentors, and when we can't, we quit. However, clinicians hold the keys to the greatest research breakthroughs.

0:40 For this reason, the Clinician Researcher podcast exists to give academic clinicians the tools to build their own research program, whether or not they have a mentor. Now introducing your host, Toyosi Onwuemene. Welcome to today's episode. I am excited to be talking with you today on the Clinician Researcher podcast. And today I'm talking about the number one shift that you need to make to succeed in research that is the number one shift that you really do need to make to succeed in research. Now when I first applied for my first grant, it was actually in medical school.

1:23 And the reason I applied for this grant is because my medical school had an option to take the third year and completely make it a scholarly third year. So our second year was actually our clinical year on the wards, and our third year was just dedicated to scholarly work. And the encouragement at the time was that people would go into labs and do research projects, but you did have the opportunity to get a second degree or there were different things you could do. But really it was really about scholarly research. And it was an opportunity for me to apply to a grant that would actually pay for part of my medical school. So I was going to get a grant that allowed me to do research and actually would fund me for the duration of my third year.

2:09 And so that would be one year or less of student loan debt. So spoiler alert, I didn't get it. However, one of the things that that set up for me and I think about is how I always looked at research for me as a means to an end. I want free money, I will apply for a grant. But when I look back, it was always my MO throughout. So when I did research in undergrad, it was kind of with a view toward, okay, this will increase my chances of getting into med school. When I did research in residency and fellowship, there was always the sense of like, okay, what does this get me?

2:50 And I do think it's the perspective of many of us in medicine, especially with regard to our physician training, because we do all this stuff from undergrad to get into med school. Now we do all this stuff in med school to get into residency. And if we do fellowship, we do all the stuff in residency that gets us into fellowship. So there's always this sense that we're exchanging the research we do for something. So if I do this, I get an opportunity to do more. And in a sense, research was like a transaction. And I recognized really as I traveled through my training and finally got to fellowship, and I was like, I actually really like research.

3:30 Now there's no more transaction. Now it's not so much about, well, if you do research, you can get to the next level, because I was done. I was looking for a faculty job, and this time I wanted to do research for real. But one of the challenges of doing research as a transaction over time is that that actually became my MO. And so I had trained myself to be someone who did research so that I could get something at the end of it. And to be honest, it doesn't end as a faculty member. People are asking, well, how many manuscripts have you published, and how many grants have you submitted and earned?

4:10 And there's so much about the stuff at the end that you can become confused and think about research as something you do to get something else. Like, if I can do research, I'll get the manuscript published. If I can do research, someone will give me money to be funded. And so today I'm talking about the number one shift you need to make to succeed in research. And before I tell you the number one shift, I want to talk about three reasons why people don't succeed in research. Three reasons. There are many reasons. I want to talk about three today. And the first one I want to talk about is that many times for us physicians, our training, our experience has been in that transactional nature of research as just something we do, the price we pay to get us to the next level.

5:03 And so one of the reasons that people don't succeed is because that's the only way they see research. It's just the thing you do to get you to the next level. And the reality is that research is the vehicle that helps us answer questions. But research is an end in itself. The process of being able to answer questions that allows you to really make a difference is an end in itself. It's not a means to an end. It's not a means to promotion. It's not a means to more publications. Publications are the fruit of the research. You did work and now it's time to communicate that work. That's what a publication is.

5:45 Publication is not a reward. It's like I did this research, now give me my reward. It's not the reward. It's just the fruit of having done the research. That means just you plant seeds of research, the fruits of publication arise because it doesn't really matter what you did if nobody knows about it. And so publication is really the means by which we say, hey, we did this work and we found this thing and we want to share it with an audience. And it's the same thing as giving talks. One of the metrics for promotion is if you are invited to give talks. Well, so people chase giving talks, but really in reality, talks are the fruit of the work you've been doing.

6:28 You're talking about what you've been doing. And so I think it's important for people to stop seeing research as something they exchange for the next thing because then in a sense, you're just chasing the end result. And so the people who chase the end result will always have a different outcome from people who actually do research because there's a question that they want to answer that's really going to make a transformation in the lives of the patients they care for. And so number one reason for lack of success in research is really that many people are seeing research as something they do just to get the next thing. And you can succeed. Oh, people succeed widely.

7:10 People do. They get all the things. They get all the trimmings. But at the end of the day, research is really a means really to move forward work that is meaningful to you that you enjoy when you do it. So the fact that you enjoy the research that you do just for the sole purpose of enjoyment is a sign that you see research as an end in itself. And ultimately, research produces things if you fully enjoy what you do, it's a good sign. If you're just kind of doing it just to get to the end, not a good sign. And that's one of the reasons why people don't succeed because you know what?

7:53 It's hard. And rejection is like just part of the game. It's the name of the game. But if you love what you do enough so that you can overcome rejection, the chances are you're going to be doing it a long time. And the longer you do it, then you really start to see the benefits of compounding. And so people who are seeing research as a means to an end, they get to the place where it's like, you know what? This is not working. I quit. And so they're not really able to get the real benefits of the research because they quit too early. But when you enjoy what you're doing, you understand what greater purpose it serves. It really does allow you to enjoy the journey.

8:33 And that is the real gift of doing research. It's the journey. It's because of who you become in the process of learning to ask and answer good questions. All right. Number two. Number two reason for lack of success in research is because many times as physicians we see ourselves as like a peripheral bit player in the research. A peripheral bit player, not as a leader of the research. And here's the challenge. Physician training is leadership training.

9:14 Think about it. Let's think through residency. And you start out as the intern who's doing all the work and calling all the people and finding out about the patient and you're just doing. And then you move to be a resident and you're not just doing stuff. You're leading someone else to do it. You're now leading the intern or the interns. By the time you get to be a senior resident, you're really, really, really leading now. And so your whole life of training has been as a leader. And then you get to the place where you're like, OK, I want to do research. Many times I see people say, well, I just want to do a little bit of research. I just want to do a little bit. But the thing about doing a little bit of research is that, you know, are you trying to be a research technician or are you trying to be a research assistant?

10:03 Because honestly, research technicians, research assistants, they do research too. But if you are coming to research as a clinician, it's because there's a clinical question that matters. There is a problem that you've identified in the clinical space that needs to be addressed. That's why you come to research. And so if there is something that is so important that needs to be addressed, well, who's going to lead it if not you? If you're just like, OK, I'll just, you know, I'll go with whoever else is doing this work. It's not likely that they have the exact same thoughts as you in terms of the direction that the research should go.

10:45 Now, let's just, you know, OK, let's take a step back and say it's possible that, for example, I'm a hematologist and I care about TTP, thrombotic, thrombocytopenic purpura. Yes. If I gather with enough physicians, with enough hematologists who see patients with TTP, well, we probably will have similar questions that really bug us. And so we all come together and we can like figure out research questions that we want to answer. And you can be a peripheral bit player in that because there are other people who are kind of leading the same questions that you're interested in. I would argue that as a clinician who's leading research, your job is not to come together with everybody who already has the exact same interest as you and has the exact same questions they want to answer.

11:34 Your job is to have the question and then find the person who has methodological expertise, so usually a PhD in my mind, maybe a biostatistician, and connect with them. And you have the clinical question and they come with the methodology and together the synergy is super awesome. So good. But that's you as a leader. It's you saying, I lead the clinical piece of this. I know what outcomes are relevant. I understand how to interpret the findings in light of the patients that I see. And so you come to research as the leader, as someone who has clinical experience, so that your leadership is a clinical leadership within the research realm.

12:22 Because PhDs do research all the time and they're really good at it. But what they don't have is a clinical piece and that's what you have. You can interpret things in ways that they don't have the perspective to interpret it. And so they need partners in the research that they do. You need partners and they need partners. And what I see is a lot of clinicians thinking, well, you know, I'm a bit player, so why don't I just learn how to do all these assays and your job is not really to learn how to do assays. I mean, it's great that you know how to do it. Please learn it. But don't spend all your time learning all these techniques because your job is to learn it enough so you can lead other people to do it.

13:03 But when you see yourself as a peripheral bit player, then you're not thinking, I'm the leader. You are the leader. You are the leader. And if you're not, it's like, well, how do you become the leader? And you do need to be the leader because the question you have is a question you have. Other people may not have that question. And if you don't lead it, who's going to do the work? And so the problem with being a peripheral bit player is that when the head person says, oh, you know what? I can't do this anymore, and the research stops. And if it's a question you really want to answer, then it's like, well, nobody's doing it anymore. I guess I don't want to answer that question anymore.

13:44 And that can really derail you. And so if you don't see yourself as the person leading, then it's very hard to move research forward because it's dependent on the other leader. And if the other leader doesn't do it, if somebody decides to change direction, then, well, I guess the work is over. But I just want to encourage you to think about your research as a program that you lead because the questions you want to answer are questions that matter to you. If you're not leading it, then the chances are that that specific aspect of the research is not being done. OK, number three is that you see research as a part-time activity that can be done on the side.

14:30 And so I will tell you that throughout my training, really, research wasn't something that was a focus of the training. Hello, I was getting clinical training, not research training. That because of that, research was kind of the thing we did on the side. If we published a paper as a resident, we were not writing that paper during the day. During the daytime, we were seeing patients. And if we were able to get time to actually work on that paper, we were doing it kind of at night and on the weekends or in our time off. And so that experience of doing research on the side then carries over to your career. And you think that your clinical work is the most important work you do, and research is just part-time activity.

15:14 But in reality, research is a full-time job, and you can have more than one full-time job. Absolutely, you can. And in reality, when you think about even the big-time PIs, as we like to call them, who have multiple grants, they're kind of part-time actually on each grant. And what they do is they raise enough money, enough capital, called grant funding, to have other people do work for them. So in reality, part of what research funding does for you is it helps you leverage the time of other people. And so you can be a full-time researcher because you fund other full-time people to do it, right? But research is not a true part-time activity, especially not when you get started.

15:59 And it's not really a thing that can be done on the side. People do it on the side. They totally do. However, if you're going to lead a research program, you're not just answering a question. You're raising and funding other people to do the work. I'm going to say that again. You're raising and funding other people to do the work. Any research you're doing by yourself that doesn't require anybody else to come alongside you is just not work that's going to be impactful. It's not. If you can do it by yourself with nobody else supporting you, it's not going to have impact. But the more you have people who are kind of part of the program doing the work, leading the work, the more you are able to bring in collaborators that add synergy to the work, the greater the impact that you can have.

16:52 That doesn't happen if really you only do it on the side when you have time. And so research is not a part-time activity, and people who see it as something that's part-time don't tend to succeed because not much can come out of part-time activity where there's not significant investment. Now over time of years of part-time work maybe, but in general, if you're really going to make the transformation in research that you want to make, if you really want to see the impact of your work on the lives of patients, then research is something that's really done full-time.

17:32 And whether it's your full-time or somebody's full-time that you're leveraging because you're funding them to do it, research is really full-time. So I talked about three things, three reasons for a lack of success in research. That's if you see research as a means to an end and not an end in itself, if you see yourself as a peripheral bit player in research and not as a leader of it, and three, if you see your research as a part-time activity that can be done on the side. Okay, so what is the number one thing that you need to succeed as a researcher? And I would say that the number one shift that we need to make from our clinical mindset is that we see ourselves as leaders of a research program that will solve an important problem.

18:22 So the mindset shift you're making is that I am a leader of a research program, and this research program is working to solve an important clinical problem. And why is that shift important? Because many clinicians don't see themselves as leaders of research. Maybe they see their mentors as leaders, or they see their chairs as leaders, but they don't see themselves as leaders, and until you see yourself as the de facto leader, then it makes it very, very difficult to succeed. So there's the part of seeing yourself as a leader of a program of research, but then there's also the piece where you see yourself as solving an important problem.

19:09 Research is what we do because there are problems that need to be solved, and we don't understand. We have questions we ask that help us to solve problems. We don't do research to get manuscripts. We don't do research to give talks. We don't do research to get promoted. Research leads to talks. It leads to manuscripts. It leads to getting promoted. But research is really about problems that need solving. And so when you see yourself as doing work to solve problems, you see yourself as the leader of a program that does work to solve problems.

19:50 That's the critical shift you make that allows you to start to lead. And then you're not asking people, well, how do I live as a researcher? Tell me what to do. You really are like, well, if I'm leading this research program and this is the problem I want to solve, then these are the tools I need. These are the people I need access to. And it allows you to move from someone who's just a recipient of whatever people give them to someone who's like the director of their resource need. So it's like, thank you for all this wonderful stuff you want to give me to succeed in research, and here is what I need. Thank you for this wonderful package that allows me to have a biostatistician in my program, and I need grant writing help.

20:37 And I need a program that teaches me to write proposals well. And I need support for X. Because once you're the leader, then you're not turfing responsibility to someone else. You are clear about what you need to achieve. Because of that, you can now argue or negotiate for the resources that you need. So that is the number one shift you need to make to see yourself as a leader of a program that will solve an important problem. And this shift doesn't come easily. I told you that if you had an experience like mine, research was just something you did, transactional. But many people actually maybe came to research, and they're like, wait, this is not about a transaction for me.

21:20 This is about what I want to do. But in reality, our clinical programs don't support us doing that. Like it's a clinical training program. It's not a research training program. And many clinical programs actually have research built into it. But even then, it's not the component of the program. Not typically. It's a side thing. It's like, oh, you get three months of elective time. What to do? And so making this shift, once you come out from your training mindset to, I lead a research program, I'm going to solve an important problem, changes the way you see yourself, and it changes the way you act and you show up in the world. So this shift takes work. It does take work. And this is why we are hosting a master class on August 21st at 6 p.m. to help people negotiate their careers, to help people make the shifts that are necessary to lead as clinician researchers.

22:11 And if you want more information, you can check out our podcast website, ClinicianResearcherPodcast.com, because it does take work to figure out exactly how you make the shift. It takes time. It takes intention. It takes effort. And so definitely reach out and be part of our upcoming cohort of clients who are learning to negotiate their careers so that they can succeed as clinician researchers. If this podcast episode has been helpful to you, please share it with someone else. Somebody else needs to hear this. Somebody else needs to be encouraged and to learn that, the things that you've learned today.

22:51 So if this has been helpful to you, definitely share. All right. It's been a pleasure talking with you today. Definitely let us know how this episode was helpful to you. I'll see 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.

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