Avoiding distractions on the path to research impact with Dr. Peter Kurre

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Welcome to the Clinician Researcher podcast, where academic clinicians learn the skills

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to build their own research program, whether or not they have a mentor.

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As clinicians, we spend a decade or more as trainees learning to take care of patients.

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When we finally start our careers, we want to build research programs, but then we find

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that our years of clinical training did not adequately prepare us to lead our research

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program.

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Through no fault of our own, we struggle to find mentors, and when we can't, we quit.

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However, clinicians hold the keys to the greatest research breakthroughs.

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For this reason, the Clinician Researcher podcast exists to give academic clinicians

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the tools to build their own research program, whether or not they have a mentor.

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Now introducing your host, Toyosi Onwuemene.

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Welcome to the Clinician Researcher podcast.

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I'm your host Toyosi Onwuemene, and it is a pleasure to be on the show today because I

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have an extra special guest.

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Peter, please introduce yourself to our audience.

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Yeah, I'm Peter Kurre.

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So just like the spice by way of pronunciation.

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I'm currently at the Children's Hospital of Philadelphia.

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I work as a physician scientist, and I direct the Comprehensive Formular Failure Center

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here at CHOP.

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Thank you.

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Thank you for being on the show.

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Now, Dr. Kurre, you are a highly accomplished person, and you've been in the game for a

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really, really long time.

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I want to ask, at what point in your journey did you see yourself not just as a clinician,

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but as someone who's also a clinician scientist?

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And just talk to us about that transition and about your journey as well.

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Yeah, I think this goes back to, I guess, a role model.

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My first job out of German medical school for a number of quirks in the German system

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that may no longer exist, but certainly applied back then.

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I found my first job in a very highly specialized field, pediatric stem cell transplantation.

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The individual who ran that program at University of Dusseldorf was an inspiration because he

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had to manage what I didn't really understood to be possible then, which is to be a physician

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and to do great science.

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It was collaborative and I think really impactful in many ways.

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So I think that set me off.

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And I think what affirmed it was that somewhere during the pediatric training, I understood

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that the best pediatrics is not necessarily practiced by those who have a craving for

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creativity, right?

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You want someone who has deep experience and practices, what is evidence-based.

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But then again, that runs into the need for, that's certainly I felt, to do something creative

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and to explore.

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So I guess I discovered the thrill of discovery and the beauty and fun that is in science.

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I love it.

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So mentorship was kind of part of what led you to this place, but also your own love

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for discovery.

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And it sounds like there was a little bit of maybe hesitation in that transition because

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in a way it sounds like you really enjoyed the clinical care aspect of things, but there

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was this tension of needing to kind of really move towards the science of the discovery.

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I wonder if you want to speak to that.

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Yeah, I've been in this country now for 30 years.

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My initial motivation to come was to have balanced and thorough general pediatric training.

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So I had been inspired by that individual, but I wasn't sure I could do it.

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And so I was really looking for a path to good pediatric training.

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And so I think it was then being in the United States and seeing that being a physician scientist

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and working on both sides, if you will, was a reality that maybe was within reach for

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me.

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I love what you say because you crystallize a lot of the concerns I think that many younger

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physicians have where they're like, I love seeing patients.

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I love taking care of them.

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I don't want to lose my clinical skills, but research is important as well.

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What advice do you give to young faculty who are trying to balance this tension between

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clinical care and research?

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Yeah, I don't know.

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Maybe this is bad news, but I think the most important skill in the successful transition

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is to be comfortable with letting go.

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Once you become an expert in something and you really have deep knowledge, you have to

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appreciate that you can no longer have broad knowledge in everything.

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So when you are an accomplished and certified pediatrician and then want to subspecialize,

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there are many aspects of pediatrics you will have to be comfortable letting go.

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I trained as a stem cell transplant, an antihematologist at the Hutch and Seattle Children's.

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I think it was clear early on to me that I would never be a consummate GI specialist

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and that I knew very little about pulmonary medicine, for example.

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So you have to let go of something and be comfortable with that.

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And I think many young trainees early on struggle with that because it is an accomplishment

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to practice medicine and to be a gatekeeper, a pediatrician or an internal medicine doc

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who knows how to diagnose a patient and how to help them create referrals.

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But it's entirely different to be a subspecialist because there's many things you can no longer

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pursue and you will not be an expert at.

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And that's important to understand early on and to become comfortable with.

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I appreciate you saying that.

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It's almost like a fear of missing out.

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And the reality is we're doing it all the time, right?

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When we were medical students and we chose a specialty, we actually closed the door and

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all the other specialties.

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And so in a sense, what you're talking about is doing that more and more as you're moving

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forward in your expertise, you are closing doors, but you have to be comfortable with

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doing that.

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Yeah, that's very right.

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Yep.

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I love that.

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I want you now to just speak to some of the differences you see.

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You've been in your career and you've kind of done this over the last few decades.

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What are some differences you see now compared to when you were coming up as a clinician

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scientist and now as younger clinician scientists are coming up?

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I think there's a lot of good news, actually.

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I really think that there are many, many great opportunities.

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There are, I think, now more institutions that take an active role in fostering physician

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scientists.

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It's no longer limited to the major institutions, academic institutions.

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I think there are more careers that one can look at depending on how much science you

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want to do and what the context for that science should be.

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I think that there's really a golden age of science in my mind.

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The tools that the, I guess, the IT revolution and engineering have provided us have created

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an amazing set of resources to tap into.

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I think this is already great news.

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I think this is a wonderful time to become a physician scientist.

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I think the greatest risk is distraction.

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I think over the, what I still think is a short course of my career, I think there's

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so many more demands on especially young physician scientists in the transition.

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Everyone now needs to be their own PR specialist vis-a-vis social media.

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I think that there is an increased demand for how healthcare is delivered.

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I guess you catch what would be the electronic medical record that we spend a lot of time

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with.

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So I think there's a lot of distraction that has nothing to do with our patient care or

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very little.

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And on the other side, the science is accelerating in just the pace of publications.

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I think that can be a daunting set, or it may appear to be a daunting set of obstacles.

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But at the end of the day, the greatest science I know is my own, and that should be the same

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for every physician scientist.

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You should believe deeply that what you do is worthwhile, impactful, and has a future.

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And when you do, things will fall into place until you'll be able to compartmentalize and

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maybe drown out some of the distraction.

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I love how you summarize it.

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I actually really love your positive outlook as well, just that there is great opportunity.

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There's so many new technologies that can be incorporated into our research programs.

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And I appreciate what you speak about distraction.

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And there is so much now in healthcare that's required of physicians, and not all of them

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are necessarily directly beneficial to the patient.

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And so really, you speak to the need for focus, but creating structures that allow you to,

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as you say, drown out the noise so that you can really focus on your research.

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And I like what you say about your research is your own.

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You're the one leading it.

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If you don't lead it, nobody else is going to.

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All the other stuff somebody else can do at some point.

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But if you don't lead your research, the thing that drives you, the passion you have, no

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one else is going to move it forward.

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And so it's almost like there is an imperative or maybe an obligation we have, and not a

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bad obligation, but really to really move our work forward.

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And I love what you shared in that.

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And I think the...

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Yeah, I think you're hitting on a key aspect, and maybe one of the ultimate struggles in

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being a physician scientist, and especially coming from a physician side, that's very

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much outcome driven, right?

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We want to do well by patients.

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And we change many different variables of the treatment at the same time, looking for

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a top-notch outcome.

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That would be a very bad approach to science.

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And so there is an inherent tension in how we practice medicine and how we practice science.

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And I can certainly say for myself that it took a few years to understand and appreciate

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that and to take a different approach to my science than I do to my patients.

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Yeah.

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One of the things you highlight in that statement is that you come through clinical training

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and you know a lot of patient care, but you don't know much research.

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It's not part of your training.

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And there are so many nuances to addressing a research question that's completely different

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from how you care for patients.

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And I think that that's lost in our understanding as clinicians.

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And there was a sense that if we take care of patients, we must know how to do the research.

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I wonder if you can speak to that gap, and how do physicians fill that gap?

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I think I've learned a lot from the scientists I interact with and from having been in science

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for a while.

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And I think a colleague I found has a particularly nice way of asking questions that captures

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some of what I want to speak to here.

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She will typically pose a question with, well, doctor, isn't there a different way of interpreting

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your results and make a suggestion to ask a question?

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I think that's inherent in science.

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It's how we do science, right?

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Look for alternative explanations.

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And that isn't always what we do in the patient arena, but I think it would benefit us to

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do more of that.

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Isn't there a different way of looking at this situation?

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And I think that one experience that helped me with that is having worked at different

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institutions, just the diversity of experience that can really shape your outlook.

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And I think that translates into how you interact with patients.

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And it certainly has helped the science.

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I love it.

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So in growing in the science, in learning to ask better questions, in challenging your

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assumptions, you actually become a better clinician as well.

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Oh, I strongly think so.

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Yeah, I believe that.

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I love it.

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Now, you've been in the game a long time.

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What has kept you in the game?

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Yeah.

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The thrill of discovery on the science side.

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It's like climbing a mountain and being the first to see the other side of what's there

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when you reach the peak.

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And it's not always a Mount Everest.

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Sometimes they're just little molehills, but the thrill never goes away.

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On the patient side, well, it's the patients.

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My first internship was with a solo pediatrician.

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And I think that's shaped how I look at healthcare and pediatrics in many ways.

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I just love being in the room with the kids and with the parents.

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And then not to underestimate the fact that being around young people who ask questions

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and who want to do their own thing is just as exciting.

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Those three things really.

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That's really awesome.

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I'm excited just listening to you talking about that.

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It's like, wow, this is really cool.

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Now, I will tell you, in an age where there's so much physician burnout and people are quitting,

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how does being a research scientist change your experience relative to the global experience?

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Yeah.

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I mean, I've only done one thing, so I can't really speak to what it looks like when one

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is a full-time physician or a full-time scientist.

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But I can say that balancing the two is part of the answer here.

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I go to the clinic on my ambulatory clinic days and it just is invigorating to be with

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the patients.

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And by the same token, some of the noise that we deal with in patient care falls away when

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I come back to the lab and think about experiments when I design.

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Those experiments I write the grants.

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So I think it's the ability to go from one to the other and have them reinforce each

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other.

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I like the reinforcing of each other.

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And it's true.

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I mean, we came to this.

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For those of us who started as clinicians, we came because of patients.

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And the work we do is our goal is to advance patient care.

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Yeah.

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Now, it's almost like you make it sound so easy, but I bet there have been challenges

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along the way.

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What are some of the greatest challenges you faced along the way?

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Rejection, right.

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And I mean, I don't mean that to be in a personal way, but our clinical training, there's plenty

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of ways in which we are taught that I'm terribly conducive, that maybe I reject.

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Certainly science is that way, right?

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So there is a strong inclination for scientists to criticize, to look for alternative explanations.

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But I think that the answer here is you have to be comfortable with the process.

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So it's not the immediate outcome, right?

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My first grant, probably my first few grants were rejected, not funded, but it's a process.

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And so it's not about the immediate success.

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It's about being persistent and it just makes the joy that greater.

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And I think that can be a challenge because the clinic, you know, you go into the exam

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room and it's a great experience.

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Invariably the patients, their kids, they're positive.

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So I think that's a positive experience.

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When things go well, then, you know, the parents are great.

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It's a wonderful situation.

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It's like a candy jar.

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Why wouldn't you go back?

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Right.

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And I think it's important to understand that science is not like that.

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And of course, clinical care isn't all like that.

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But I think to be comfortable with the fact that it's not all immediate gratification

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that you're in it for the long game and takes a little while to understand that there is

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beauty in that.

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Now rejection really is a pretty prominent feature of science and the whole scientific

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enterprise.

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Now that you've been doing it a long time and you've probably had a lot of rejections,

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does it get easier?

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How do you handle rejection today compared to when you first started?

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Yeah, it does definitely get easier.

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Some of it is built into the process.

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So initially you have, you know, one project, a few experiments, someone doesn't like them,

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you don't get funded.

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Ultimately, when you grow into your career, you have different projects, many trainees,

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different types of grants.

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And so you balance one with the other success here, maybe lack of success and a bit of rejection

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on the other side.

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So I think that's a big part of it.

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But the other part is that I have learned an incredible amount of ultimately actually

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science from my reviewers of papers and grants.

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Some of the projects in my lab, I've been investigating the biology of vesicles in the

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hematopoietic context, extracellular vesicles and what their cargo protein, microRNA, what

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role they play in regulating hematopoiesis.

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That first came to us because the reviewer asked us about an observation that was sort

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of a sideshow in an early paper and said, have you ever considered this?

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And so that led to now well over a decade of research funding papers.

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And so I think what I've come to understand is that the criticism, even the harsh criticism

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can sometimes hold incredible value.

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You just have to go back and be willing to digest it.

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Wow.

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I love those insights.

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It's, I mean, it's true.

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I mean, I think about my experience too.

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You're always annoyed at the reviewer.

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When you go back and you think about it, you realize that if you're willing to be open,

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there's some insight and gems that you can take and make into something.

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And that at the end, I feel like my manuscripts are definitely enhanced by the reviewers and

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certainly grants as well.

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And so, but there's also in your talking, there's also an openness though to feedback.

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And I wonder how people can encourage that in their journey.

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Because I think that the initial response is to be close-minded, but how do you take

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that rejection and make it a gift?

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You made it a gift.

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It's been a gift to your research lab for the last 10 years.

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How do you do that?

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How do other people do that?

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Yeah.

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I just go back.

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So when I get, I guess they used to be called pink sheets from NIH grants, right?

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So I go back to my critiques and I read them, I reread them, I, you know, I like them.

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So I think you really have to be willing to read carefully, to read between the lines

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and to digest.

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I don't think it's a, no, it's a single read and immediate realization.

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I think that the openness and the acceptance and the opportunity that comes with some of

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the critique isn't always immediately apparent.

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I am afraid I don't have a sort of a magic bullet or a go-to strategy for what you're

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asking.

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But I think allowing the process to take hold and a critique just to percolate through your

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mind is one way that's worked for me.

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Sure.

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I also hear you talking about the resilience because you keep going back, right?

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You don't first read the, I mean, I think I'm also kind of hearing that, I mean, you're

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going back to resubmit or you're going back to readdress the issues.

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And so because you keep going back to it, you have the opportunity each time you go

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back to take something different from the first time.

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And the, I guess the other aspect of that is of course, the interaction with peers,

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right?

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So I'm a big believer in working with, so in terms of, in the case of NIH grants, working

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with the institutes, what is it they want?

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What are they, what are their critiques?

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What's their interpretation of the critiques you've received?

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So, and it's just one example, the theme here is talk to other people, see how they interpret

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what comes back and bounce ideas or rebuttal of others.

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And I think those interactions can be incredibly insightful.

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Sometimes the discussion with maybe where you get insight where you least expect it.

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So you know, there's, whether I talk to the program officer or a medical student in the

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elevator, the insight is everywhere.

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You just have to look for it.

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Yeah.

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You need to mine it.

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I also hear you speaking to the collaboration.

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There's just collaboration happening on many levels, collaboration happening in your lab,

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collaboration is happening with other investigators, collaboration kind of with the reviewers too,

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because their insights now are part of your program.

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And you're also talking about with the institutes as well.

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What are they looking for?

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How are they interpreting the reviews?

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And so it's almost this sense of, I mean, we talk about team science, but it really

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is kind of the greater team science.

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Yeah.

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And I think that the sciences reach such a complexity that you really need to, you need

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to consider the environment.

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I mean, not just the physical environment, but also the intellectual environment as part

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of your resource, a necessary resource.

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And I strongly encourage reaching out to others beyond your own institution.

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Because, you know, we all have a tendency to sit in our own little ivory tower and other

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people's towers at different altars.

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I love it.

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I love it.

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I, yes, I totally, totally resonate with that.

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There's just so much diverse perspectives when you step outside of the institution.

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That's a relief.

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And people love to be tapped for advice and guidance, right?

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I mean, I've had some of the strongest support and greatest insights in my career from folks

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who I emailed out of the blue with a specific question or who I approached during a meeting.

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These can be great interactions.

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That's really insightful.

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And thank you for sharing that.

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All right.

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So we are coming to the end of the episode.

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And I wanted to ask if there is a young junior faculty person really just starting out right

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now distracted by so many things and they don't feel like they can succeed, what advice

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do you have for them?

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Believe in yourself and persist.

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If you want it, it will happen.

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And don't be distracted by people like myself who present their career in sort of a linear

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fashion.

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It's not like that.

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The linearity of the existing hindsight and the back and forth, the curves in how things

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proceed for you, part of how curbs are shaped.

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I like that.

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I like that.

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We look to our mentors, those who have gone ahead and we're like, their life is so good.

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And what we've missed are the challenges that they have, the challenges and the obstacles

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they've overcome to get there.

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And so earlier on, you're in that phase of overcoming obstacles.

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So sometimes it can feel insurmountable.

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But that is the path.

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That is the journey everybody is on.

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I love it.

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I love it.

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Thank you.

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Thank you for sharing your insights.

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I wonder if you have any closing statements, something that we haven't touched on that

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you feel like it's important to share with our audience.

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It's all doable.

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Put your mind to it.

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And again, I think that nothing's beyond reach.

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And I think don't be intimidated when people tell you that you have an MD behind your name

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and you're not made to be a scientist.

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It's not like that.

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I love it.

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So much positivity, so much encouragement, so much inspiration.

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Thank you so much, Peter, for just your insights and just for being on the show.

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Thank you.

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I really appreciate the opportunity to ask.

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I think this is great.

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I really enjoyed my time.

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Thank you.

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All right, everybody.

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You've heard Dr. Peter Kurre.

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This is doable.

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You can do it.

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Don't, don't be discouraged.

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This is a hard journey, but you can do it.

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There is somebody else who needs to hear this episode.

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It's been really insightful.

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Please share it with them if you're a mentor and mentee needs to hear this.

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If you're a mentee, you have a network that you can share it with as well.

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And I invite you to do that.

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All right.

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Thank you for joining us.

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We look forward to talking with you again on the next episode.

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Thanks for listening to this episode of the Clinician Researcher Podcast, where academic

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clinicians learn the skills to build their own research program, whether or not they

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have a mentor.

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If you found the information in this episode to be helpful, don't keep it all to yourself.

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Someone else needs to hear it.

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So take a minute right now and share it.

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As you share this episode, you become part of our mission to help launch a new generation

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of clinician researchers who make transformative discoveries that change the way we do healthcare.