Transcript
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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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Well, hello, everybody.
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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 talking with you today.
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So I have shared my story before, and I'm not sure if you've heard it, but I want to
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share it again, just in case you haven't heard it.
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But I always wanted to lead research.
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I did.
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And even going through medical school, I wanted to be in an academic medical center, and leading
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research was kind of just a natural part of doing that.
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And what I didn't have was access to the research training that got me there.
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What I was instead doing was doing a clinical program, but I wanted to be a clinical researcher,
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a clinician scientist.
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And so the clinical piece was important.
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What I didn't recognize was that nowhere in the clinical training was research training.
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Well, I went through medical school, and I had the opportunity to do research.
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It was great.
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I actually led a program of research.
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It was a very small program, but I still led it.
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I did a prospective study to evaluate a new, new-at-the-time technology called cone beam
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CT in patients with breast cancer.
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And so it was looking at accelerated partial breast irradiation, which was also a new technology
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in radiation oncology at the time.
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And it was an important paper, and that paper actually had been cited over 100 times.
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So it was an important study, my first prospective study.
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And if I ever had the bug as far as being bitten by the bug of research, maybe that
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was it.
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It was awesome to develop my own protocol to recruit providers who would be part of
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that.
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And by providers, it was the radiation therapists who were administering the radiation.
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And then to recruit patients to the effort as well, it was such an amazing opportunity.
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And I think one of the things it did for me was it pulled together my love for organizing
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and collaboration and synergy.
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And I got to do that when I was a medical student.
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And that was my first, first journey to research, my first journey to leading a research program.
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While I made it through medical school, residency, as you probably experienced, was super busy.
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And yes, there was a little bit of time in there for research, but to be honest, there
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was mostly time for being a great clinician.
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And then I went to fellowship.
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And fellowship is supposed to be the time when you are able to put aside all the clinical
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stuff and really, really focus in on a research question and answer it, especially in a second
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and third year.
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Well, I didn't have that opportunity.
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And our training program in particular was very big on making sure we had all the clinical
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training that we needed.
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And so we had three half days of clinic during the week.
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And I have to tell you that three half days of clinic does not leave much room to grow
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a research program.
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And when I went around to different mentors, and especially when I went around to, well,
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potential mentors, especially the PhD mentors, they would say, oh, yeah, so when are you
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going to be in the lab?
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And I would say, well, I have three half days of clinic.
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And that would kill our potential mentor mentee experience.
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He's like, nope, you're not going to be here.
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There is no point.
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And I didn't get it at the time.
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I was so frustrated.
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I remember a time I broke down and started crying.
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And I was like, I wish I had never come to this fellowship program.
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I was so, so, so disappointed.
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Anyway, I made the most of my fellowship program.
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I ended up getting a master's in clinical investigation, which turned out to be the
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right thing to do.
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And I did get some manuscripts written.
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And I also did apply for funding.
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And at the time, I got a clinical research training investigator award, CRTI.
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I'm sure the I is not for investigator.
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I don't know.
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I come to these podcast episodes and I forget, like, key things.
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But anyway, it was the ASH CRTI.
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And I got that.
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OK.
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So that's all I had.
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Going to my faculty position.
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And then I finally got to my faculty position.
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And only to find out that, you know what?
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This research career you want to do, you're not actually qualified to do it.
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And I'm like, what?
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I'm not qualified?
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They're like, yeah, we can't really make a case for you because, well, you don't have
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much publication record to your name.
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You don't have any grant funding.
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So how are we going to make this case?
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I mean, they didn't say that at the time.
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I now can say that in retrospect because I understand what that means.
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I understand that when a faculty member comes looking for a job, people are asking, well,
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what skills do they already have?
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Not what future skills do we think they'll acquire, but what do we know they can do right
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now in terms of supporting the institution, right?
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Every institution runs based on funding.
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And as a clinician, you are able to support your institution because you bring in clinical
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revenue.
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And when you say, I want to actually work towards bringing in research revenue, then
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people start to look at your qualifications.
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And they're like, hmm, no manuscripts published.
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Hmm, no grants ever acquired.
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Hmm, yeah, no.
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So that was me.
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So I started my career as a faculty member doing 100% clinical.
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And they would tell me that it was 80% clinical, but I was seeing patients five days a week.
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So to be honest, I was spending all my time doing patient care.
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And it wasn't just my eight to five from Monday to Friday.
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It was my eight to five on Saturday and Sunday too.
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Oh, and the night times.
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Oh, yes, middle of the night too.
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Because at the time I had a young baby.
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Wow, it was challenging.
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But they told me that, you know, you take this clinical position, you do all this clinical
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work and we will support you the moment you start getting research manuscripts out the
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door.
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The moment you get funding, you'll get the support you need.
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And what I didn't realize is that that transformation does not happen.
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You do not become a research leader by doing clinical care.
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You don't.
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Clinical care can give you ideas to lead a research program, but clinical care and
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the whole infrastructure of clinical care is not the same infrastructure that leads
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you to leading a research program.
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Okay, I didn't know this.
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And so when I signed on, I was clearly naive.
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And I think that while my case always felt unique at the time, I realized that more and
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more clinicians are here in this boat where you want to lead a research program, but you're
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coming just with years and years of clinical training.
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No one really believes that you can.
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And honestly, no one really supports you to do it.
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So what do you do?
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How do you make that transition?
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How do you, while being a full-time clinician, make the transition to leading a research
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program?
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Well, that's the answer that I came to share with you today.
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Or actually, I didn't come to share answers with you as much as that I came to ask you
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questions.
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I'm going to talk to you today about five questions that you should ask on your journey
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to becoming a clinician scientist.
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Like, do you want to do this?
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And these are the five questions you should ask and answer.
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So you're going to answer the questions to determine whether you should take this step
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or not, whether you should do the impossible and make the transition from clinician to
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clinician scientists.
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The first question is to ask yourself, what do I care about?
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What do I care about?
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And this may be the most important question that you need to answer before you move forward.
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It's an important question because in our clinical training, actually, I can say our
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because I know this was your clinical training too.
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You did what you have to do, whether you liked it or not.
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It was just part of your training.
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You went to medical school and they told you you had six major rotations you needed to
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finish by the end of the year, right?
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By the end of your clinical year.
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For many of you, that was your third year.
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For me, that was my second year.
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And it's pediatrics, it's surgery, it's internal medicine, it's psychiatry, it's obstetrics
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and gynecology.
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These are the required rotations.
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And then maybe you have one or two electives in there, things you choose.
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For the most part, there's a very, very, very specific core curriculum that you need to
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go through as a medical student.
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And whether you love surgery or not, you wake up before AM, you do the surgery things, right?
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You don't say I care about surgery or I don't care, I'm not going to do this part of the
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curriculum.
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You just suck it up.
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You show up and you be the best surgeon that you can be.
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And that is the challenge of our training.
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I mean, it was important and I'm glad we did it.
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And we are better physicians for all the things we did that we hated to do.
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But it's just not the way we live life.
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It's the training, but it's not the way life is lived.
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All the stuff you had to do is no longer relevant when you start to move into someone who's
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shaping your own career into a faculty position.
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Now you stop doing things just because you're obligated to.
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To be honest, there are not many things you're obligated to do anymore.
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But you start doing things because you care.
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Like, no, this is what I care about.
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The electives, this is my life now.
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I do elective.
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Elective time.
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This is your elective time.
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All the elective time you didn't do in your training, this is your elective time.
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So what do you care about?
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And this is a hard question because you've been so used to doing things you have to do.
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And because you've done that for maybe 10 years of your life at least, now you're like,
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well, this is all my life.
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I only do things I have to do.
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And the reality is you don't have to do things you don't care about.
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What you should do, what you need to do.
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I mean, in reality, you live in a community that cares about certain things.
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You should know what things are required in your institution for forward motion.
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You should align the things you care about with those things.
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And you can always make it work.
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For example, if scholarship is important in your institution, well, do scholarship on
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what you care about.
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If international renown or being known nationally is important in your institution, well, be
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known nationally for things you care about.
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Do you see what I'm saying?
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So yeah, there are things you have to do, but you make your own curriculum and you do
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the things you care about and make them count for the things you have to do.
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But that's the first question you have to answer.
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What do I care about?
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Because it is time to stop doing the things you hate.
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Because you cannot sustain a 30, 40 year career doing things you hate.
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You can do it for a six week rotation.
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You can do it for a 12 week rotation.
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You can even suck it up and do it for a year.
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You cannot spend your entire career doing things you hate.
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So what do you care about?
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Answer the question.
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Number two is commitment.
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Am I committed to research leadership?
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This is a really important question.
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Am I committed?
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You know, research leadership is kind of like a marriage relationship or maybe people would
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say a strong committed like time relationship.
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It really is.
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It's like, look, I mean, it's great that you love me and all, but are you committed to
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me like, you know, for richer, for poorer, for better, for worse and sickness and in
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health rate?
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Are you committed?
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The funding comes through, it doesn't come through.
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Are you committed?
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People support you.
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They don't support you.
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Are you committed?
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The mentor shows up, the mentor doesn't show up.
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Are you committed?
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And that's an important question.
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Sometimes I hear people saying, well, I just want to try and see if I like it.
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It's like, yeah, no.
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Sometimes this journey is hard and there are real roadblocks along the way and there are
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real people who don't want you to win for whatever reason.
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And so it's not the kind of thing for the faint of heart, but it is the kind of thing
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that people who are committed can see it through because you're like, yeah, I'm not here for
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the flowers and the roses.
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I mean, I love those, but you know, I can get through because I'm committed to this
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journey.
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So are you committed?
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Because research leadership is a commitment and you only start the journey if you're committed
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to seeing it through.
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And I think this is so important because everybody doesn't have to lead a research program.
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You don't have to lead a research program.
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You can participate in research.
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You can work with a group of other investigators and just contribute as needed.
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You can do that.
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But if you say I'm leading a research program, it is a commitment because what you're doing
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is you're building an infrastructure where people come and they contribute to a program
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of research that you've conceived, that you are building, that you are funding, you are
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leading, and therefore you're making a commitment.
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And answer the question, am I committed to research leadership?
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And if the answer is no, then don't do it.
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You don't have to.
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There are other ways to succeed.
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But if you are committed, then you're ready.
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You're ready for the journey.
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Number three, I'm calling classified information, is that there is information you don't have
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access to.
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And I know this because you're a clinician and your clinical training was about being
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a great clinician.
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It was not about being a great researcher.
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I always talk about the fact that PhD scientists actually do research training.
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Research training is about getting a PhD.
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It's just part of their training, right?
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And there is a certain set of tools for success as a research scientist.
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It's a very clear set of tools.
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It's not even really a secret.
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It kind of sort of is to MDs because here you are in clinical land and you're feeling
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like this is a ripe field for research and it kind of sort of is because clinical care
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is the foundation for the work we do as researchers.
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But let's just say your clinical training doesn't really give you these research skills,
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right?
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And there are many of them.
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I've talked about them in prior episodes.
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But you don't have access to the information you need to succeed as a researcher until
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you've gone to where there are researchers who are succeeding and found out what they
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do.
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And by the classified information, what I'm saying is one of the things they do in secret
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where nobody can see them, that fuels their success.
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How much time are they actually spending writing every day?
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How many times are they submitting grants?
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What grants are they submitting?
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What research skills do they have?
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What kinds of commitments are they making to their writing?
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You know, I will tell you a couple of weeks ago, a group of collaborators and I sat down
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and we paid a boatload of money.
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I call it a boatload because it was an hour and a half.
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And actually, I'll just tell you, it was an hour and a half and it was $2,500.
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We sat down with an expert writer to go through our writing.
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And I will tell you that everybody doesn't do that.
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And I'm not necessarily here to say you should go do that.
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But I'm telling you that there is a certain kind of commitment that people are making
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to become good at what they do.
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It is not an open thing.
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It is a secret, right?
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Secret because it's hidden from you.
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That's why it's classified information.
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But what classified information do you need access to?
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What is needed to succeed in research?
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What are people doing who succeed?
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It's not common knowledge.
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But there is a clear set of tools for research success.
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And the way you find out is to ask research scientists what these tools are.
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So answer the question, what classified information do I need access to?
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Question number four is creating structures.
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What structures do you need to create to guarantee your success?
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Ask that again.
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What structures do you need to create to guarantee your success?
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And the reason this happens, this is an important question, is because success does not happen
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in a vacuum.
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Success does not happen because you kind of woke up and you got lucky and you're like,
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oh, look at you, you got successful.
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Yay, yay, yay.
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It was like when people told me when I started, they were like, yeah, well, go be a full-time
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clinician, and whenever you can make the manuscripts happen and the grants get funded,
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then of course we'll support you.
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Like, it's not the kind of thing where you roll over in bed one day and you're like,
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oh my gosh, I made it happen, everybody, I'm so lucky.
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You create the structure that is necessary to guarantee your success.
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So what structures do you need to create?
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What structures are you missing?
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You now know, right?
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Because if you answer the information about the classified information thing, you go create
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a structure, right?
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What's the structure you have, number one, for consistent writing?
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I've talked about the skills that you need to build as a research scientist.
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What structure do you have for consistent writing?
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What structures do you have to improve your writing?
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Yeah, your writing's good.
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And what structures do you have in place to take it to the next level?
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What structures do you have in place for accountability?
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Because no one's going to come knocking at your door saying, oh my gosh, did you submit
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that grant?
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Yeah, most of the time they don't do that.
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But they'll come knocking at your door if you don't show up to clinic.
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So what structures do you need to create for accountability?
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What structures do you need to create to get access to information you need so your mentor
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doesn't show up to your mentoring meetings or your mentor doesn't give you information
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that you feel like you need?
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Who else can you go to to get the information you need?
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What structures do you need to create that guarantee your success?
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That's the next question to answer.
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Question number five is your clinical expertise.
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If you're going to be a clinician that's going to succeed as a scientist, then you've
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got to make sure that your clinical expertise and your research overlap.
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They just have to.
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Sometimes I see people say, well, my mentor is a breast cancer radiologist.
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I guess that's what I do now.
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And no, it's not what you do.
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Because remember, we started with care.
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What do you care about?
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If you don't care about it, please do not.
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Oh my goodness.
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Oh my gosh.
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I've got to stop because this is about to get in a soap box now.
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Many other people who build their careers around mentors' lives.
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They're like, well, I don't care about this, but my mentor is super successful.
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And if I want to be super successful, I want to do what they do.
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And please do not do that.
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Because your mentor's career birthed probably 20, 30 years ago is a different career from
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your career.
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And they've been successful.
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And congratulations to your mentor.
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You are building something new.
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And the thing you're building is for this generation.
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It's for now.
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It's starting 20, 30 years later.
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And you've got to care about what you're doing.
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And it's got to really be the area in which you have strong expertise and you care about.
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So you want to make sure they overlap.
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Don't go changing what you're doing just because it makes sense.
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It makes sense this moment.
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It's short term gain.
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But long term, that probably doesn't get you to where you need to be.
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So those are the five questions.
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I'll tell you that I actually have seven.
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But I think it's good to stop at five.
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If you want to hear the other two, you should come to our upcoming webinar where I talk
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about how clinicians can transition to research leadership.
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And I'm doing that on November 20th, Monday, November 20th at 6 p.m. Eastern time.
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You are invited.
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For more information, you should visit our podcast website, ClinicianResearcherPodcast.com.
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But I'm excited because this is my dream.
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It's my vision is to see more clinicians lead research programs.
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And I think it's challenging.
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It's difficult.
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But I absolutely know it can be done because I'm doing it and I'm helping other clients
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do it as well.
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And I know that if it is your dream, you can do it too.
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So to summarize, five questions you need to ask yourself on the journey to becoming a
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clinician scientist.
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Number one, what do I care about?
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Number two, am I committed to research leadership?
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Number three, what classified information do I need access to?
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Number four, what structures do I need to create to guarantee my success?
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Number five, what is my overlapping area of clinical expertise?
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Those are the five questions today.
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I want to thank you so much for taking the time to listen.
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And I look forward to talking with you again the next time.
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Take care.
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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 health
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care.