What to do with unwanted feedback

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 what an absolute pleasure it is to be talking with you today. Thank you so much for tuning in. I am talking today about how to receive feedback, especially when it feels like it's poison. Okay, that's an exceptionally long title. By the time I go to edit, I will decide on a better title.

1:22 But right now what I'm talking about is feedback that makes you feel so awful, you feel like you could just explode. And I want to share this because I do know that in academic medicine there's a lot of rejection, whether it is that you're submitting manuscripts to be accepted for publication, or you're submitting grants, or you're making proposals. You've been met with probably more nos than you've been met with yeses. And so to some extent, academic medicine is a process of getting used to getting no without wilting under the pressure, right? There's so much rejection. And many times for any of us going through rejection, there's the feeling of isolation, and sometimes the feeling of shame and discouragement.

2:04 And I just want to share that it is actually natural to experience rejection, and it is part of your journey. And very soon, actually, I will say there's no time you're ever celebrating a rejection for the most part, but over time, it ceases to have as much of a sting as it did the first time. That being said, I'd like to share a story that actually still feels a little bit stingy to me. I submitted a manuscript for acceptance. And actually, this was my first opinion piece, and I really was excited about writing it. I had so much fun writing it. I submitted this manuscript, and I was so excited to hear the feedback. Well, when the feedback came, it was horrendous.

2:48 And when I'm saying horrendous, you know, if somebody tells you that, wow, your paper is puke? Yes, that's how it felt. Now, I'm not saying that's what the reviewer said. They certainly didn't say that. But when I read the feedback, that was the sense that I got that this paper was so bad, it should never have been written, right? And I will tell you that when I first read the feedback, I thought, what is this? I tell you, I read a lot of rejections. And I'm sure that I've never had a rejection where I'm like, thank you so much. This was so awesome. But this was one especially bad rejection where it almost felt as if the reviewer was going out of their way to rub my face in how bad my piece was.

3:29 And I remember reading at the end of it and saying, okay, what do I take out of this? And I was struggling. I was struggling. Because really, what good feedback should do is move you forward. And every time you enter into a situation where feedback actually doesn't have a clear path forward, it's a sign that it's not really feedback. It's poison disguised as feedback. Why is that poison disguised as feedback? Because you know what? In life, there are so many of us that are so super successful. We have so many letters to our name, and we've got so much funding, and we've published trillions of articles and we're still hurting inside. And we're still just inadequate inside. Or we feel bad, or we don't feel like we like ourselves or the world.

4:13 And so just because externally there are markers of success does not mean that people don't walk around with poison inside them. And here's the thing about poison when it lives inside people. And when I'm talking about poison, I'm talking about bitterness and anger and just all the ugly stuff that lives inside people, unforgiveness, it comes out and it hurts other people. You know how people talk about how a hurting person hurts others? Yes, that's exactly right. Because hey, if you're reading a manuscript, your job is to say, this is how it could be made better. And even if you think it sucks so bad, you can always find ways to say, this is how it could be made better. But in a way, insulting someone who's written something is not even a sign of being a bad reviewer.

4:59 It's a sign that there's something wrong inside you that maybe you need to address. Anyway, that being said, this is not the story of this reviewer. It's a story of me. It's a story of how I received that feedback and what I do with it. What do I do with feedback, especially when it just doesn't feel like it's right? What do I do? Number one is to acknowledge that you have been wounded. Yes, acknowledge that you've been wounded. Now, no matter the feedback, if it's a rejection, it doesn't feel good. For some of us, we've had enough rejections where we're not as bothered.

5:40 Sometimes actually you submit something, you're like, if this gets in, it'll be a miracle. And then when it comes back, reject it, you're like, yeah, I knew it was a long shot. But even when you knew it was a long shot, you knew it was going to be rejected and it still comes back rejected. You knew it was a long shot and it still comes back rejected. You still feel a little bit wounded. You do. You feel hurt because you wanted them to accept it. Even if secretly, even if you openly thought they wouldn't accept it, secretly you did. And you would have felt validated by the acceptance, but instead you got a rejection. And so I think the first step is just to acknowledge your wounding and say, you know what, that sucks.

6:23 It hurts. It hurts because it does. And it's only human to feel bad at rejection. Like whoever wants to be rejected, nobody. And so if you're rejected, instead of just grinning and bearing it, acknowledge it. If you're someone who gets frustrated and nothing, the tears just come, let them fall. Give yourself time to mourn the loss of this particular experience. Give yourself time to get over the rejection. In reality, it hurts and it's okay to acknowledge the pain and to just mourn that pain or at least experience that pain for even a moment.

7:07 But definitely allow yourself to experience the pain and acknowledge that the pain is present. Hey, this is disappointing. Say it to yourself. Hey, hey, this is disappointing. Okay, great. That's the first step. Acknowledge that you've been wounded in some way. Acknowledge that you've been hurt. The second thing we need to do is you need to pause. Now what am I saying? Am I saying pause and just live in that rejection for three months and say, oh my gosh, woe is me. I'll never submit another manuscript again. I'll never write another grant. In fact, I quit medicine. No, that's not what I'm talking about. Pausing is giving yourself distance between the first time you review the feedback and when you have a plan for what to do with the feedback.

7:53 Okay. Pausing is to give yourself time to come up with a plan of action. Every rejected manuscript is an accepted manuscript waiting to happen. It's literally the acceptance is sitting there waiting for you, but only if you move forward. But you can't move forward until you have a plan. And to be honest, you don't move forward well when you're wounded and still reveling in your sorrow. Now, I don't want you to revel in sorrow for too long, but you do need to have a gap between the first reading and the final decision for a plan. And here's the thing. As soon as you've read it, your mind has processed it. And already you're working through a thinking of like, what do I do now? Hopefully you're not thinking, well, I quit.

8:35 That's what. Hopefully you're thinking, okay, let me set it aside and then come up with a plan later. And the reason it's important to give yourself a gap between the first reading of it and when you finally want to come back to it is because your subconscious mind continues to work on the problem. Your subconscious mind accepts the fact that you've been rejected. And then it feels differently the next time you come to the piece of rejection or the feedback that you got. And so the third thing is to read it, go back and review it. Okay. So the first thing is that you've acknowledged that this hurt. The second thing is you've given yourself space between the first time you read it and later. And the third time is you come back to it.

9:16 So here you are. The third point is that you come back to it. So here you are. You're finally reading it again. And what you'll notice if you've given yourself enough time between the first reading and now is that you come at it with a different perspective. At first, it actually was kind of like you, the shock of being rejected was so overwhelming that you didn't even really have time to think about what were all the benefits or what are all the merits of what was brought up in, in whatever the case was against accepting your manuscript or accepting your proposal. Right. And then when you come at it a second time, you come at it with a different perspective. There's less of the hurt, less of the sting and more of an objectivity, more of a, okay, let's see what feedback is useful here that I can use to move this work forward.

10:03 And you know what, for better or for worse, there will always be feedback that you could use to move this work forward. Now in the particular rejection story I tell you, it did feel pretty scathing. It didn't really feel like there was real feedback there. You know, when you read something and you're like, you just really hate this paper, don't you? You hate it so much, you see no good in it. And that's fine. People are people. Sometimes that's the way it is. People are just like, this sucks so bad. And it, that's how they feel about it. And you can't argue how they feel about it. Now nothing sucks so bad that it cannot be salvaged, but I'm listening and I'm hearing people say, oh yeah, there are things that suck so bad, it cannot be salvaged. But one man's meat is another man's poison, which you think sucks so bad and cannot be salvaged.

10:47 Nobody else can see the kernel of goodness that can be expanded to grow. Okay. I say all that to say that no matter how tremendous the feedback was, no matter how much the person actually didn't give you feedback, but went off on a diatribe about how you suck and everybody from your institution should stop writing manuscripts. Somewhere there, there is information. Okay. That's number four. Number four is gather the information. Okay. What do I mean? Number one, the feedback, if it was good feedback should really outline steps for improvement. Here is how this manuscript could be improved.

11:27 And if you're a good reviewer and I hope you are, I'm not saying good or bad because that's never really useful, but if you're going to be a helpful reviewer, when you review, you need to point out places where improvements could be made. For example, you could say, hmm, the generic use of language reads like the use of a large language model like chat GPT. I would recommend that if such a model was used, it not be used for the revisions. Do you see? Very helpful. It's like, instead of saying, holy cow, did you use chat GPT? This is awful. You're saying, hmm, it reads like you may have used chat GPT to write this paper. Maybe you don't use it next time. Useful feedback.

12:07 If you're a reviewer, please, please, please, instead of yelling or going off in a diatribe, showing what's really inside you, give feedback that's useful. Okay. So useful feedback helps you move forward. You can gather that information. That's pretty easy. The feedback that says step one, change the way you use these terms or the feedback that says step two, do this, do that. That's helpful. You can easily gather information. What about the feedback that is the diatribe? The feedback that is the, this sucks so bad, I can't believe you're still writing or that you're still alive, right? There is that feedback. Let's just be real. There is that feedback. What do you do with that? Take the information. And you're like, what information? The information that that's not where you want to go with your paper.

12:51 You're like, what do you mean? There's the New England Journal of Medicine. I've always wanted to publish here. I am so glad that that's your childhood dream, but it's not the dream from this paper, clearly because this paper is not going to be looked at favorably by this particular community. And I know in academia, there's a lot of what's a high impact journal, what's the low impact journal and where should you try to get your work into and what should you not try to get your work into. That's a whole conversation for a different podcast. But at the bottom of your writing for peer review is that you do excellent work. You want feedback so that your excellent work can be presented in the best possible light and go out into the world and do good.

13:36 That's at the bottom of all of it. For every manuscript, there is a home. Some homes look a little bit more appealing than others, but there is a home for every manuscript. And sometimes the information you take is that, wow, this manuscript could not scale the security of or could not get past the security of this particular journal. And you decide, do I take it to a journal with a less stringent security team or do I say, what will it take to scale the wall of this particular impregnable fortress of a journal? And it may be that that's what you want to do, but take the information and use it.

14:19 If it's a scathing review, it may be that you say, well, I guess this journal is not for me. Or you might be like, okay, well, let's go knock on the door again and say, can you help me know how I can make this better? And sometimes you do that and you succeed. For example, I had a manuscript that I once submitted and it was a really interesting article idea to me, but I was also writing in an era that was outside of my expertise. And I think I recognized that and I thought, oh, I can write in this area. So I was writing kind of in hematology, but I was also writing in a genre that, oh gosh, what was it? It may have been medical decision-making, which it's hematology and I make medical decisions all the time, but people are very specific about their specific kind of expertise, a specific kind of language they used.

15:05 Anyway, I got rejected. But what was interesting is that the journal said, you know what? We can't accept this manuscript in its current format. If you significantly revised it, maybe we could reconsider it. So they kind of opened a little bit of door and I was like, okay, well, let's go at it again. And we revised it, revised it, revised it. We sent it back. And they sent it back again. And I was like, you know what? Wow, this is a great case, but oh my gosh, your attempts are just, they're just, they're awful. Like, I mean, they didn't say it in that way. They were actually very, very helpful in just saying, this is how, if you were going to revise the paper, you would need to do this, but holy cow, that's a great undertaking. I'm not sure you're going to be able to do this. And so what we finally did was we went and we found somebody who had very specific expertise in this kind of writing.

15:49 I know I'm calling it medical decision-making. I'm now blanking on what it actually was, but it's, anyway, the point I'm making is I got someone who was an expert in writing these kinds of papers and that I asked the editor. I said, Hey, we really think this is a great case and we think that people are going to learn from it, but we are not well versed in writing in this way. Who do you know who might work with us? I asked the editor that. And to be honest, the first time I sent a letter to the editor, I got no response. And then I went and looked at other people who had been associate editors or other people who had in some way, shape or form been associated with a journal. You could say I was stalking the journal. Maybe I was because I was like, no, this journal, this article is getting in here.

16:32 And finally, finally they turn around and say, okay, I have nothing to do with this, but you should reach out to this person who frequently writes these kinds of articles. Great. And then they made the introduction. It was so awesome because now we had an expert in our field, in our, in our, in our court, right? In 2019. And that expert really helped us. It really, he really helped us shape the article. And when we finally submitted, we got another revision, but this time it was that this is a great article. Here's how you make it better. And so sometimes the information you receive is that, oh, wow, it sucks so bad. Well, how can I make it not suck so bad? And you go after that information and you don't stop until you get it.

17:12 Or sometimes you say, you know what? I don't have time to be chasing or trying to knock down this wall. How about I just take it somewhere else that doesn't have a security system that's so, so intense, right? Information. You can use the information to your advantage. What you don't want to do is to be overwhelmed, but you do want to use the information to your advantage. And even when it's a scathing review, it is helpful information. And you have to ask yourself, what do you want to do about it? And that is the next thing. I think it's number five now. I'm not counting now, but not the number five is, is what is your plan? Like formulate a plan. Now, to be honest, formulate a plan should have been at the very beginning when you first submitted your manuscript.

17:53 You should have had a list of three journals that you were going to submit to tier one, tier two, tier three. And as soon as you knew that tier one was rejecting your work, you would be like, oops, sucks for you tier one. You'll go to tier two. And then tier two is like, yeah, we hate this work too. You're like, sucks for you tier two. And then you go to tier three, right? That's kind of the pre-planning you do at the beginning of any, every manuscript. We don't always do that. And to be honest, in this particular manuscript I'm referencing, did not do that. So now I'm like, oh, I don't know where else I want to send it. I haven't really done this work. Well, whatever, no matter when you decide to have a plan, just have a plan and it's okay. And what is your plan?

18:34 Your plan is, well, what am I going to do with this paper? Where do I want to send it to? How do I want to revise it? So it's meets that other audience's criteria. What do I want to do with this paper? Have a plan. And then of course, the last thing is execute on that plan. Execute on that plan. You know, and it seems a little bit obvious, but in reality, many of us stop at like number one, where we're just so wounded. We're like, you know what? Academia sucks. I am no good at it. I'm really horrible at writing. I don't know how to write grants. I just am not going to do this anymore. And I just want to say, please don't let that be you. Don't be the person who allows obstacles to throw them off course.

19:18 Now here's the thing about obstacles. Obstacles are actually kind of clarifying because when an obstacle comes in front of you, you have to decide to do something about it, right? You're on your way. You're in motion. All of a sudden this big boulder drops out of the sky, narrowly misses you, lands in front of you, blocks the path. Okay. You have to do something about it. The question is, are you going to find a way through the boulder? Like are you going to try to blast it out of your way? Are you going to try to find a way over the boulder? Are you going to see if you can dig a tunnel and go under the boulder or are you going to walk away from the boulder? Are you going to say, you know what, this boulder? I know, but it's clarifying, but don't let an obstacle stop you because the question is should you be on this path?

20:06 And it's really a question you ask before the obstacle comes because obstacles don't define you. They don't define where you're going. They don't define who you are. They clarify for you. Is this the path you actually want to be on? And if it is the path, then don't let the obstacle stop you. Let the obstacle be your jumping off point. So it's like, okay, well, here you are, big bad boulder in the middle of my path. How about I build a bridge or a ramp and ride a really fast motorcycle and use you to catapult to the next level? Absolutely could do that. But that's only if you have clarity that the path you're on is the path you want to be.

20:48 Don't let obstacles make decisions for you. Don't let negative feedback make decisions for you. Make decisions for yourself. Make decisions regarding your purpose and why you want to do what you're doing. And if this is the field for you, one horrible feedback from one or two reviewers should not make you change off that path. So in summary, please don't quit. Don't quit because you got a horrible review. You know, unfortunately, there are many more where those came from and it's okay. The important thing is, are you doing work that matters to you? Are you doing work that resonates with you? Are you doing work that makes you proud of the work you do?

21:31 And if the answer is no, then why are you doing this work? If you're like, well, I'm just looking because, you know, at my institution, they say we're supposed to submit manuscripts and I just want to, I just want to check the boxes. I want to say, please stop checking boxes. Life is just not, it's about so much more than just checking boxes. And I know you succeeded getting through med school and residency and fellowship by checking boxes. I know because I checked those boxes too. But there comes a point in life when we decide that checking boxes is not the way to live. And I'm thinking that's now. This is the moment. Like if you're listening to me, it's now.

22:12 Because checking boxes, when there's a big obstacle that comes or a really huge rejection or a huge disappointment, then you find out that checking boxes doesn't satisfy and it's not enough to move you forward. So I want to encourage you that if for whatever reason you are a box checking person and there's no shame, I love box checking. I still think a good box checking gets me through my day. But I want you to think about how do you do your career differently? How do you do it differently? How do you stop doing what everybody else says you should do? How do you stop living like everybody else says you should live and begin to really live for your purpose, for something that resonates with the deepest core of who you are and that moves you to where you're supposed to be?

22:58 If you don't know that, I invite you to come work with me as your coach. So you'll see on Wemina, I am available on Instagram, most especially LinkedIn, also on Facebook. Reach out to me and let's set up a 30 minute conversation just to talk about what you need and how you're going to move forward in your academic career. But if you're miserable in any way, if you are overwhelmed or tired or burned out, I want to say it doesn't have to be that way. Don't accept it. Okay, so I'm going to summarize. First of all, you got it when you get bad feedback, something that's so horrible. Number one, you just got to acknowledge the hurt. You've got to acknowledge that you've been wounded.

23:39 Number two, you've got to separate yourself. Just give yourself a gap between your first reading and your next reading. Number three, you do have to come back to it and give it another look and you'll find that you're seeing it with a new perspective. Number four, you want to draw out the information of this particular piece of feedback, no matter how bad it's giving you. Number five, you want to come up with a plan. Number six, you actually want to act on that plan. Number seven, you want to make sure that you know what to do with this obstacle and that it doesn't derail you or keep you from having the career that you were meant to have. All right, it's been a pleasure talking with you today. Thank you so much for paying attention. Please, please, please, please share this episode with somebody else who's just been rejected and needs this encouragement.

24:24 Thanks for listening. I look forward to seeing you again next time on the Clinician Researcher Podcast. 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 are 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.