Why Clinicians Should Lead Research

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. Hey everyone, welcome to the Clinician Researcher podcast. I'm your host, Toyosi Onwuemene, and it is a pleasure to be here talking with you today on our inaugural podcast episode. I want to share with you the story of how the Clinician Researcher podcast came to be and what to expect in the coming months of the podcast.

1:21 So first I'll tell you that about 10 years ago, I was looking for jobs as a new faculty, and I had one thing on my mind. I wanted to succeed in research. I really, really, really wanted to lead a research program, and I was shocked to find that as I went from program to program, people said, well, you know, you really want to lead research, but you're not really prepared. You're not really qualified to lead research. You don't have funding. You don't have experience getting funding, and you don't even have the publication records to show that you can do this. And so, no, but you can take a clinical job. And I went around from place to place and finally found a program that was like, well, you know, you really don't have the things that we would expect in someone who is going to succeed as a clinician scientist, but here's a clinical job and we'll support you if you can make this funding happen or if you can make the publication record better.

2:11 And I took the job, and over the course of a 10-year period, I made the transition from clinician to researcher. And in the course of that 10 years, one of the things I learned is that, wow, clinicians get 10 years or more of clinical training. Nowhere in that does anyone really prepare clinicians to lead research, yet clinicians should lead research programs. Clinicians are the right people to lead research programs, but because they get no research training, they're actually the wrong people to lead research programs. Yet many clinicians want to lead research. And so the Clinician Researcher podcast exists to help clinicians learn to lead research programs.

2:53 So why is it called Clinician Researcher? Why not Clinician Scientist or Physician Scientist or, you know, one of those names that physicians are called when they're leading research as well. That's because I'm talking to the clinician, the person who sees patients, and I'm talking to the person who's becoming a researcher. Now you can do research and the person who does research is typically called a scientist. But I'm really just talking about the two sides of the coin. One is the clinician, the other is the researcher. And my goal in this podcast is to get the clinician to become the research leader. So that's the goal of the Clinician Researcher podcast. On today's inaugural episode, I want to talk to you about three reasons why clinicians should lead research programs.

3:36 And then I want to talk to you about the skills that clinicians need to make the transition from clinicians to researchers. I'm only going to talk about seven. There are so many more. I want to paint the picture of why it's important first for clinicians to really think beyond their clinical training into acquiring the skills necessary to lead research programs. And I want to talk to you about the skills you should be thinking about developing in the course of your research experience. So the first thing I want to talk about is why clinicians should be research leaders. So the first reason is that clinicians make breakthrough observations. Now if you've been in clinic or if you've been in the hospital taking care of patients, you're probably impressed by the amount of things that we can do to help patients do better.

4:23 But you also know that there are gaps. You know that that medication that's hailed as the breakthrough medication of the year doesn't help everybody. You've seen a patient who didn't respond at all. And you know that questions remain unanswered in the care of the patient. You've also seen patients in whom all of science would say that this patient should not succeed, this patient should not make it, this patient should not live in the midst of this crazy situation. And you've seen those patients thrive. And you're asking the question, well, how? How did this patient make it and why? So clinicians are making the kinds of observations that lead to research breakthroughs.

5:05 I mean, throughout history, any major research breakthrough came because somebody made an observation. And over the years, many of these observations were made by physicians as they were taking care of their patient. And so clinicians should be leading research because they're making the kinds of observations that really can make a difference in the research questions that we have. But here's the rub, clinicians don't have the research training. And so it is very hard for clinicians to come from, oh, I've made this observation to, I've now turned this observation into an answerable question where we're going to be able to use the answer to help millions of patients down the road.

5:45 The transition is difficult. And that's why the Clinician Researcher podcast exists. Or maybe clinicians don't even have time. They're like, yeah, I made the observation. Now I got to see the next patient. I don't have time to think about that. And clinicians are so busy. There really isn't time to take those observations and make them into actionable research breakthroughs. And so part of the Clinician Researcher podcast mission is to help clinicians think about how do I create the space to be the researcher I want to be, to lead the research programs that I want to lead. And I want to encourage as many clinicians as possible to do that because clinicians make the breakthrough observations that lead to breakthrough discoveries.

6:28 The second reason why I think clinicians should lead research programs is because clinicians care about improving patients' lives. Now many people care about patients. Patient families care about patients. Patients care about patients. But in terms of sacrificing to meet the needs of a patient, I can't think of a group more amazing than physicians. I can't think of a group of people who are willing to struggle to whittle down their weeks to 80 hours. I'm trying my best to keep it under 80. And I don't know any other group that really works that much to serve the needs of people that are not family members. And so clinicians really care about patients.

7:09 They suppress the need for sleep. We suppress the need to eat. We suppress so many needs. We suppress a whole decade. Some of us invested our 20s to be able to learn to care for patients well. And so if clinicians are so dedicated to the care of patients, wow, what a group to lead research. What a group because their research breakthroughs are not motivated by financial gain alone, not motivated by fame and notoriety. It's really motivated by the care of the patient. And so if you are really looking for anybody to lead a research program that's actually going to make a difference, you should look to clinicians.

7:49 That's why clinicians need the skills to be able to make those research breakthroughs. The third reason I think that clinicians should lead research is because they know what outcomes are meaningful to patients. Clinicians are always there with patients asking, how are you doing? How are you tolerating this medication? Are the side effects tolerable? These are the questions we're asking our patients every day. And so when we're looking to see what outcomes are meaningful to patients, we have those answers. But many times we're not there. We're not there when people are making these decisions about what outcomes are going to be studied. And that's why it's important that clinicians are there at the table when research is being done and in fact not just being at the table, but actually leading their own research programs so that they can become better contributors when they are at the table.

8:39 And so clinicians should lead research programs because they know what outcomes are important to patients. Okay, those are just three reasons why clinicians should lead research. Now what are the skills that clinicians are missing? Why aren't there more clinicians leading research breakthroughs? Well, because it takes skill. So clinicians spend 10 years or more learning to do clinical care. And that's so important because clinical care is so important and it takes a long time to learn the skills for clinical care. But guess what's not happening while clinicians are learning to do patient care and not learning the skills to do research. And it does take time and it does take effort to become skilled in doing research.

9:22 Just ask your PhD colleagues, ask them how many years they spent getting their PhD and what they were doing for most of that PhD training. They weren't taking care of patients. They were learning to do research. They were learning to acquire skills and research. And for many PhDs, they end their PhD program and then they say, hey, I want to do a postdoc. And some people even do two postdocs. Wow, some people do three or more postdocs. And what are they doing? They're honing research skills so that they can do better in research. And so you look at a PhD trajectory and people are easily spending 10 or more years just focused on research. So why do clinicians think that they're going to come from their 10 years of clinical training with two or three research electives in the midst of that training and then succeed wildly in research?

10:08 Where our PhD colleagues finish all their postdocs and then say, well, now I'm ready for a career development award. And for that reason, I just want to highlight seven research skills that clinicians should consider acquiring in their quest to lead research programs. Skill number one is asking research questions. Now, you see a patient in front of you and you're like, how can I help patients like this do better? And that's great. It's a really, really great desire. We want to help the patients do better. Perhaps the patient has diabetes and you're like, I want this patient to control their diabetes. And that's a great question. But how do you take it into a question that's small enough to answer in a way that's actionable?

10:52 So is a patient not doing better because they are not able to get access to medication? Is a patient not doing better because they have access to medication, but perhaps they can't tolerate it? Is a patient not doing better because yeah, they can tolerate the medication, but they can't absorb the medication? Or is a patient not doing better because they can absorb the medication, but somehow they have a genetic polymorphism that renders them resistant to the medication? Or is it that they are not resistant to the medication, but they're not able to break the medication down into the metabolites that allow the medication to take effect? Which question are you asking? And so part of the skill of taking something huge and complex, boiling it down into its minuscule components, and then creating a research question that you can actually answer, that takes skill.

11:45 It takes years to develop and hone that skill. And many clinicians don't have that. For that reason, this is one of the skills, asking research questions that clinicians have the opportunity to develop and to hone. The second skill is to create writing structure. Create the structure that helps you write consistently and regularly. Now if you are a research scientist, one of your primary goals is communicating your research. So if a researcher went to their lab and did a research project, and it was never communicated to anybody, was the research project ever done?

12:29 Was the research ever done if nobody got to hear about it? And the answer is no. It's as if it wasn't done because nobody heard about it. So whenever you sign up to become a research scientist, you sign up to become a science communicator because you got to communicate your science. You got to communicate your science to funders who will give you money to support your research program. You got to communicate your science to the public so that they can take action on your research findings. You got to communicate your research to your peers so that they can help you look at the blind spots that you missed in the quest to complete your research. And so communication is so important. And you know what? It's not part of our clinical training. Yes, we learn to write notes and we write a lot of notes.

13:10 Writing notes is not the same as communicating science. And having the structure that allows you to write consistently so that you consistently communicate your science, that is a skill that has to be learned. It's not just about writing. It's about the process of writing and it's about the process of writing consistently. And that's a skill that every research scientist should have so that they can communicate their science well. The third skill is writing research manuscripts. So you've done a lot of writing, a lot of writing through college. Oh, you sure did a lot of writing in medical school and in residency and in fellowship.

13:51 You've been writing all your life. But writing research manuscripts is a different beast. It's a different skill level because you're writing for a scientific audience. You're not just writing about the patient. And so yes, we get a lot of training. Many of us are mentored to do case reports. But when we talk about actually communicating a project that has been done, that does take skill. And so writing research manuscripts is a skill that clinicians have an opportunity to gain in their quest to become research scientists. So what does that entail? Well, it entails being able to communicate in a way that people who are outside your field can understand.

14:35 Have you ever read a research paper and at the end of that your head hurt because you're like, oh my gosh, that was so dense? Yes, it takes skill to write where people clearly at the end have received what you intended to communicate. And that is a skill that takes time to develop. So clinicians need skill in writing research manuscripts. The fourth skill I want to talk about is shepherding your research manuscript through the publication process. OK, the publication process is crazy. There are millions of journals available. OK, maybe not millions, thousands of journals available for you to submit your manuscript to. Which one are you going to choose? And who's your audience? And which journal actually cares about what you're writing?

15:17 Which journal is going to reject you right away or keep your paper for three to four months and then reject you? And do you have time for three to four months of rejection as far as the science that you're trying to communicate? Those are the kinds of things that nobody teaches you, but you do need to learn. How do you shepherd a manuscript through the publication pipeline? How do you decide which manuscript to go for? Which manuscript not to go for? Is impact factor needed or do you just need to get the manuscript out there? Someone's got to teach you these skills. And it's not a skill that's easily learned. It really does take time to develop. And you may meet a lot of scientists who just easily churn out the publications and it looks so easy, but it really does take time to develop that skill.

16:01 Shepherding research manuscripts through the publication pipeline, getting it from manuscript draft to submitted and published manuscript is a skill that can be learned. And clinicians have the skills to learn it, but they do need to recognize that it's a skill that is needed. How about developing research proposals? So to take a research idea, turn it into a research proposal, find the right funder, submit it according to their specifications, take the feedback when it's rejected and turn it into another proposal. Whoa, that takes time. It takes time to figure out and guess what? Not part of your clinical training. And for that reason, there needs to be space and time to learn to develop research proposals because, you know what?

16:47 Guess who's also competing for the same funding that you are? PhDs who've been spending a lot of time learning to develop research proposals. And so I want to make sure that clinicians are aware that it really does take time and energy and investment to learn how to do it well. And if it was not part of your clinical training, or if you just spent maybe a month or two learning to do that, there is opportunity to learn to really, really grow that skill. Another skill that clinicians should consider is grant getting strategy. So you have your research proposal, oh my goodness, your idea is going to just cure humanity of all of their ills and can you get the funding to move that idea forward?

17:31 And so how do you decide how much you need to get that idea forward? How much do you need? What is the team you need to fund? To what extent do you need to fund your own time to do this work? Who is the funder who is most aligned with your interests? Do they support you in the way that's needed so they cover your time, but they don't cover the time of the person who's going to help you do the work? What is the strategy for getting you the funding that you need to move your program forward? That takes time to figure out. It's not something that's intuitive. And so many times I see clinicians who are fresh out of residency or fresh out of fellowship submitting grants and getting frustrated that they're not getting any grants.

18:14 Because it takes time to develop the skill that allows people to even look at your grant in a way that says, okay, I think this can be funded. I think this makes sense. I believe this can be done. And it's not easy. It's not straightforward. It's not part of our clinical training. So that's one of the skills that's important for clinicians to acquire. Okay. The seventh skill I want to talk about is building and leading research teams. Now, if you're going to do anything of significance, you can't do it by yourself. And if you can't do it by yourself, then you need to call other people to come alongside you to do the work. But how do you build the research teams that allow you to do the work? How do you lead the research teams that allow you to do the work?

18:56 How do you lead so that you're not so immersed in the power plays on the struggles that come from teams getting together and the research is not getting done? It takes skill to learn how to hire people. It takes skill to learn how to work with people. It takes skill to learn how to lead people in the vision that you have for your research program. And guess what? That's not part of clinical training. That being said, clinicians have the capacity to learn all of these skills, given time and investment every clinician can acquire and teach these skills. But the skills, first of all, need to be acquired. For many clinicians, you have mentors, kudos to you.

19:37 But there's at least 60 to 80% of clinicians who don't have the mentoring support to be able to lead the research program of their dreams. And that's why the Clinician Researcher podcast exists, to give clinicians the resources and the tools that they need to succeed as researchers. So what can you expect over the next several months of the podcast? I'm going to be bringing you interviews from clinicians who are succeeding as research scientists. I'm going to be bringing you interviews from collaborators who work with clinicians to bring their research programs to life. I'm going to be interviewing people who lead programs that help clinicians turn into research scientists.

20:17 I'm going to be bringing you as many resources as possible to help you succeed on this journey as a clinician researcher or really as a physician scientist. Whatever name that you want to take for yourself, I'm okay. But really it's a Clinician Researcher podcast because we want to turn clinicians into researchers who lead. At the end of this journey is leadership. And why leadership? Why not just say, hey, I'm okay to participate in research? Yes, you can participate in research. Research technicians participate in research. But if you have an idea for how to transform patient care, I'm going to submit to you that if you don't do this work, somebody else might not do it because nobody else cares about it as much as you do.

20:58 And if you care about a research question that you think will actually change patient lives, then you've got to be the person to lead it. And you need the tools to lead it. And I hope the Clinician Researcher podcast will help you acquire some of those tools. So if this podcast episode has been helpful to you, I want you to share it with just one other clinician. Just one clinician. Say, hey, you should listen to this. You should listen to this podcast. And if you want other people to find us, please subscribe. Give us a five-star rating so that we can also be found by other clinicians who need the resources to build the research programs of their dreams.

21:38 It's been a pleasure talking with you today. Thank you for listening. I'm your host, Tiesien Lumina, and I look forward to talking with you again the next time. Thanks for listening to this episode of the Clinician Researcher podcast, where academic clinicians learn the skills to build their own research program, whether or not they have a mentor. 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.