Flexibility and adaptability in research leadership with Dr. Vikram Paralkar

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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 I'm super excited to have an amazing guest on the show

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today, Dr. Vikram Paralkar.

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And Vikram, I just want to thank you.

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Welcome to the show.

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Thank you for having me.

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Okay, Vikram, let's get right down to it.

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How did you start on this journey?

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What led you from being a clinician to becoming a clinician scientist?

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How did that happen?

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My journey, I guess my journey begins with my childhood.

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So I grew up in Mumbai, and both of my late parents were doctors.

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And my dad was a surgeon, my mom was an OB-dyne, and so I grew up very familiar with medical

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lingo around the dining table.

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And at the same time, I was also very, very interested in science and scientific experiments.

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So I was always the kid who had a chemistry set or was looking at things under a blood

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cell under a microscope or dissecting algae or things like that.

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And I just loved science.

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And I also really enjoyed listening to my parents talk about medicine.

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And I grew up with the assumption that, so both of my parents were in private practice,

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they were not doing research, but I grew up with the assumption that, oh, well, every

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academic doctor must have a little lab on the side where they just do the clinical work

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and then after the day is done, they go and do some pipetting.

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And so with this idea, naive idea in mind, that I went to medical school in Mumbai, and

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I really loved learning about medicine, anatomy and physiology, biochemistry, especially in

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molecular biology.

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But I also began to realize about midway through med school that most doctors simply don't

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do research or have the bandwidth to do research.

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I think clinical medicine itself is so all consuming that most of your day goes in taking

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care of patients.

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And it was maybe about the end of my second year that I realized that I wanted to also

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have a basic science lab in addition to becoming, being a clinical scientist, in addition to

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being a clinician.

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And that's when I also realized that that kind of career track would not be possible

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in India simply because the infrastructure and funding doesn't exist over there.

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And so I began to think of coming to the United States or to the UK to pursue my studies.

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And during my medical school, I did one research rotation in the laboratory in India.

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But beyond that, I really did not have any concrete research training.

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And so when I came to the United States, I really wasn't eligible for any of the PSP

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track, the position scientist pathway tracks.

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And so I began a categorical residency.

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I also decided specifically not to do a PhD because I felt it would just stay five to

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six years out of the schedule.

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And then I had to go back and do my clinical year.

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So I came to Temple University.

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I did my residency.

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Then I was a chief resident.

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And then I came to Penn for my fellowship.

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And I pleaded with all of the people I was interviewing with that I'm absolutely sure

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I want to be a physician scientist and have a lab.

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And somehow you have to believe me despite the fact that I don't have a PhD or have spent

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no more than a few months doing electives in the lab.

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So thankfully they did believe me and I began my fellowship at Penn.

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And in my, and so my big, now in the oncology department, hematology oncology department

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here at Penn.

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And I was very drawn to leukemia and leukemia management right since the beginning.

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And in the second year of my fellowship, I joined the laboratory of Mitch Weiss, who

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was at that point at CHOP.

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He's now the head of hematology at St. Jude.

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And his lab works on transcriptional regulation and erythropoiesis.

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So I joined his lab, did my postdoctoral fellowship in his lab at the same time as developing

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my clinical skills at the acute and chronic myeloid leukemia specialist.

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And now I have my own lab and I'm a physician scientist at the University of Pennsylvania.

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Oh my goodness.

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What a phenomenal story.

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Phenomenal.

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And the part that really intrigues me and really resonates with me is just your focus

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from the very beginning.

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You knew where you wanted to go.

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So it's like, you knew exactly what your destination was going to be.

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Perhaps you didn't have the directions or you needed to kind of like take a detour or

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two to get there, but you were so focused.

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I wonder, you know, what was that?

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What helped you have that focus?

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I know your parents were physicians, but they weren't scientists.

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Like where did that come from?

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My dad was, even though my dad wasn't a scientist, he was very interested in science.

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And so we had a lot of books about science at home.

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You know, and I used to read everything from Breacher's Trip Time by Stephen Hawking to

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books by Stephen Jay Gould to other things about evolutionary biology, Richard Dawkins,

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Blind Watchmaker, Selfish Gene, et cetera.

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So I was reading all of these books as a kid.

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And I think there's just something about the unknown aspects of reality that fascinates

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me.

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There's just so much of the universe that we do not understand, so much of our own bodies

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and our own cells and their fundamental functioning that we simply do not understand.

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And I was just drawn towards those questions and I just wanted to explore them.

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It is so awesome to hear the excitement with which you speak.

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It's like you're on this amazing adventure and you're not at your destination yet.

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You're still in progress and you're having a great time.

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Is that fair to say?

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Well as I mentioned, as a kid during my summer vacation, I was doing experiments in my bedroom.

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And so no one was paying me to do that work then.

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Now I'm being paid to do the exact same work.

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So of course I'm excited.

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I love it.

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That's so awesome.

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Okay.

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So all along you were gunning for this destination, becoming a clinician scientist.

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At what point did you finally realize that you had transitioned?

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When was it that you finally said, wow, I'm a clinician scientist?

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I think it probably happened maybe about the second year of my postdoc or so.

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I felt that my PI Mitch during my postdoc was very, very willing to give me independence

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to pursue my own ideas.

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And so there was no fixed agenda in the lab.

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I wasn't running projects, experimental projects that he wanted me to pursue.

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His philosophy is to pretty much give everyone in the lab their own freedom and let them

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come up with their own ideas.

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And so I think very early in my postdoc, about maybe after the first six months or so I'd

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gone by, I realized that really I was just pursuing my own ideas.

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I was reading the literature.

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I was coming up with the questions I wanted to ask.

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And that's when I think I really felt like a scientist.

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And I think the part of being a clinician scientist, I think, comes from the fact that

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if you're seeing patients with the same kinds of disorders, then there's a certain kind

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of intangible understanding of what aspects of biology are actively relevant in the clinical

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sphere, how medications or drugs or stresses in the clinical arena produce certain phenotypes

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that you can potentially try to recapitulate in the lab or that your lab experiments touch

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onto.

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So I think it really was during my fellowship and postdoctoral period that it all crystallized

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together and I felt like a physician scientist.

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Wow.

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What an amazing experience you had.

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And it's not common, Vikram.

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Many fellows, especially postdoctoral fellows, are doing projects that their mentors have

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gifted them.

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And that's not a bad thing, but they don't have the opportunity to start leadership from

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the beginning.

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So you actually, while also doing your own experiments, were actually leading your research

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direction.

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And I think that's so unique.

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I wonder, what do you say to someone who is not in that same situation as you, where they

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just have whatever is available in the lab?

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How can they also kind of grow their independence to be able to start leading early?

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What would you advise them?

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I think from a very practical point of view, I think every clinical fellow who wants to

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join the lab has to immediately cultivate a network of mentors that are outside of their

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lab mentor.

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And I think that to me is the single most important thing that you should do in order

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to get a variety of different sources of input and feedback on your ideas.

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Because once you enter a lab, it's quite possible that your initial ideas may not be very productive

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and they may not be the right ideas.

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On the other hand, it may be that you have a fantastic idea, but your mentor simply is

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unable to see it or they feel like those ideas are a little too far outside in the focus

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of where they want the lab to be.

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It was really useful for me to have a mentorship committee and all of the fellows who enter

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labs are expected to have mentorship committees here at Penn.

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And the expectation is that you would present at the mentorship committee your ideas.

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You're not necessarily presenting what your PI has coached you to present, of course.

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You are a postdoc, you have to come up with your own independent ideas and you have to

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talk about your vision and how this fits into the clinical work you're doing.

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And eventually, as time goes on, what will your faculty talk look like?

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Can you say, this is what I'm bringing to your institution as a clinician and as a scientist?

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How can you harmonize those two aspects of your work together and present a vision of

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what you're going to work on in the next five to 10-year period?

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And so I think from a very practical point of view, I would say having a wide variety

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of mentors.

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And also, I think, at some level, being honest with yourself as well, whether the physician-scientist

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pathway is right for you.

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It's not right for, I should say, based on my experience, it's not right for everyone.

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One of the reasons being that basic science research has an element of chance involved

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with it.

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I think as clinicians, as long as we are aware of the literature and we are applying the

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standard of care and we are following particular clinical guidelines, beyond a certain point,

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the outcomes that individual patients will have are beyond our control.

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There are some patients we'll be able to cure.

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There are some patients, unfortunately, who we cannot cure and some patients who will

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have very difficult outcomes under our care.

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But as long as you are doing the right thing, your career and its progress as a clinician

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does not depend on the individual outcomes of patients.

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Whereas, on the research side, there is a lot of luck involved.

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There may be two post-docs who get two different paralogs of the same gene family and one of

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them gets a profound mouse phenotype and gets a very high-impact taper and the other one

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gets an extremely subtle genotype and they spend years trying to get it published and

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it leads to a low-impact taper and then they are not as well positioned.

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I think unless you're willing to put up with that kind of aspect of luck, unless you're

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willing to pivot and unless you're willing to, as they say, know when to hold it, know

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when to fold it on the basic science side, it's going to be very difficult to be a scientist

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because I think experiments not working out or negative results are just an intrinsic

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part of how science is done.

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So I do think that that has to be an important reckoning that every potential scientist has

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to do for themselves.

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They have to, first of all, be really interested and excited by a scientific question, but

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they have to be willing to deal with lots of failed experiments and lots of investigational

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directions that don't go anywhere.

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And if, despite that, you are still enthusiastic about the questions that you're asking, then

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that's when you are a scientist.

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I love it.

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I love it.

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You said many things.

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So one thing you said that I want to highlight is the importance of having a network of mentors.

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I think many times, and I'm not sure where this comes from in medicine, where it's like

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there's just one mentor for me, but there's one mentor.

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And if things don't work, it may not be the mentor's fault, it may not be you, it just

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doesn't work.

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And I love what you're talking about, this need to have a mentoring network so that you

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know what, you have options.

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And in saying that, you're also talking about the importance of leading your own career.

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Like nobody's in charge of your career, you are.

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And if an experiment fails terribly, like you don't get to blame your mentor.

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You don't, I mean, nobody knows that it was going to happen that way.

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And so, but your ability to say, I'm in charge allows you to pick yourself up and say, where's

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the next opportunity?

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So it's interesting, you talk about luck and I agree that there's an element of luck.

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There's also an element of flexibility, also an element of recognizing when it's time to,

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as you said, fold the cards and move on.

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And an element of accepting the successes when they come.

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As like, you know, I, preparation meant opportunity, right?

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It's not all luck, but it's like working hard and then seizing opportunities when they come,

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but also when the opportunities don't work out, finding a different direction as well.

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Absolutely.

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No, I completely agree with this.

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And I think one of the wrong impressions about science that students and postdocs sometimes

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get from reading papers is when you read a paper, the findings in the paper are presented

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in this extremely logical progression, as if they did the first experiment, they got

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an amazing result.

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Then they did the second experiment, got an amazing result.

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Right, section number one, almost onto the next section.

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Then they did an RNA-seq and they picked one of those genes and they manipulated it and

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lo and behold, it rescued the phenotype.

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So what you don't see in any of these papers is how many different avenues that came perceived

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that did not go anywhere and how many negative results they had.

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And I think that is something you really actually don't understand until you have done it yourself

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and your results have given you negative results.

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And so I absolutely agree, the willingness to be flexible, the willingness to, again,

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at some point, take a step back and say, is this project working?

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Is this project within the big picture plans of what I want to do?

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Is this a time to pivot?

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Can I take this to my mentors and get guidance from them on what they would do if they were

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in this situation?

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And also, why did I choose to be a scientist in the first place?

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What are the big picture questions that I'm interested in?

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And how can I move forward keeping those questions in mind?

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I really, really, really appreciate that.

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And I feel like it can't be said enough.

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I think sometimes, and this is part of our training, where our training is not very flexible

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as clinicians, right?

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You do med school, you end med school.

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You go to residency, you end residency, you do fellowship.

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I mean, it's very prescribed.

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And so when you start doing a research project and things are not quite working out, there

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is that sense of like, no, I'm committed to this.

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Let's see it through to the end.

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And as you say, there are times where you stop and say, is it worth continuing this

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project?

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And you alluded to not just making the decision on your own, but bringing in a team of mentors

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or a team of advisors to help you make that decision.

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I wonder if you want to speak to where do you get that flexibility from?

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Because we don't all have it.

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Oh, well, and are you asking me as a person or in general, how does one get flexibility?

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Well, I think I'm asking to be honest, I feel like you, you've had to be flexible in your

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journey as you've pivoted so much.

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So in a sense, you've been practicing flexibility for a while, but I'm assuming that.

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So if you want to speak to how you got your flexibility, that would be great.

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And if, you know, I don't have the flexibility, what do I do?

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Where do I go to get it?

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Well, I suppose the one thing for myself that I could say is that there's one interesting

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feature sometimes we see in Tremies where if their experiment is critiqued, they take

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that as critique of themselves.

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And I think one of the things that you have to realize as a scientist is the biggest skeptic

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for your data has to be you yourself.

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Right?

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If you're getting an interesting result, you have to ask yourself, how could I be fooling

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myself?

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Do I have all of the right controls?

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Is it possible I'm leading myself down the garden path?

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And I think for me, I just think I'm intrinsically, if I get an interesting result, I am the one

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who constantly thinks about the ways in which it could be wrong.

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And I find myself asking, how can I push this in a different way?

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How can I approach it in a different way?

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What else can I do to ensure that what I'm getting is truly a real result as opposed

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to some kind of spurious artifact?

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And as a result, I think if an experiment doesn't work out, if a result doesn't hold

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up, well, the process worked.

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As in I investigated it and I got a high confidence negative result.

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And so I think for me, the success of an experiment is really not about whether you get what you

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want to see.

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It's about whether you can get a clear result.

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So given that, I think if that is your approach, then in general, it will probably help you

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in science long-term.

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Because the question isn't if the experiment going to validate the result conclusions you

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already had in mind from the very beginning.

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But can you find the truth of the system?

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And the truth may be a negative result.

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And you have to be prepared for that.

297
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Those are really good points.

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I think that clinical training is not the same as research training.

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And many times I think a lot of clinically trained people come at it with that.

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It's like, well, I mean, there's a lot of subjective judgment in the clinical arena.

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And so there's sometimes the sense of this judgment on my experiment is a judgment on

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me.

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But what you talk about, the need for skepticism is so important because you know what, if

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you're not skeptical, other people will be.

305
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And as soon as your paper leads your lab and goes out to the reviewers, then you find out

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just how strong the skepticism is.

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So you're talking about the opportunity for people to question your work so you can question

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your work and do what is needed to really make it rigorous.

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Because it's an opportunity to see what else are you missing.

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Absolutely.

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Absolutely.

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And I think in some ways, sometimes there's an aspect of this that also bleeds over to

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the clinical side in the sense of when our patients have unfortunate outcomes, we do

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as doctors sometimes blame ourselves.

315
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Why did I not act on that one particular slightly high calcium a day earlier that I could have?

316
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Why did I not give a higher rate of fluids on the surgeon as compared to others?

317
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And these are things that we always think about.

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And I think one of the things in clinical medicine that we learn about is you can, at

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the end of the day, you can only do your best, right?

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And you can only try to apply the standard of care and you can only try to be diligent

321
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and a conscientious doctor, but you cannot control the outcomes that you get.

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You have to accept the outcomes that arise from any disease.

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And I think at some level, that's what science is like.

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You can try to do your best and you have to be willing to accept the outcomes.

325
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It's always good to have multiple different projects going so that if one particular one

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doesn't work, how does it always be others that you can carry forward?

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But that may be one way in which there are some similarities, but clearly there are many

328
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differences as well.

329
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Thank you for those points.

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I also see this, you know, there's a love for what you do, but there's a healthy, my

331
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eyes are open.

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I'm not walking in the clouds.

333
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I'm like doing this wonderful experiment and I have these other three potentially if this

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one doesn't work.

335
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So that's really good.

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And I do think that more people need to understand that, you know what, you just don't know what's

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going to succeed.

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And so don't focus on just one area.

339
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So that's really awesome.

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You know, it leads me to my other question, and this is around the fact that, goodness,

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you're so optimistic.

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You like pursued things and you succeeded and you're just having a great adventure.

343
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Has this been like just a walk in the park for you?

344
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If there have been any challenges, what have they been?

345
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Well, it hasn't been a walk in the park.

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So there have certainly been places where I have had to, so like actually let me walk

347
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you through my process of coming to the United States.

348
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So I applied for a residency from India and I applied to 120 residency programs and I

349
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got interviews at eight of which only one was a university program and that was Temple

350
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University Hospital.

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And it's my good fortune that I got into that program because as you know, if you are in

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the community program, for instance, it is really difficult to transition from that into

353
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an academic environment and end up with a research career.

354
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So that was definitely not an easy transition, but things ended up working out there.

355
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And then during my postdoc, actually the first project that I was working on ended up not

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going in the direction that I wanted.

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And I ended up getting actually a high impact negative publications because it went against

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something that was considered to be more of a accepted dogma in the field.

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But it did lead me to a point where I had to pivot my scientific direction.

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And so midway through my postdoc, I had to find a different project and I had to develop

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the resources to be able to get it to a point where I could get other people out if I could

362
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and have the applying for faculty positions come up with sort of a vision of how this

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project would help me set up my lab.

364
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And as a result, my postdoc was perhaps a little longer than some of my colleagues,

365
00:21:50,940 --> 00:21:56,500
but that was fine because at the end of the day, it helped me get what I wanted to get.

366
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I love it.

367
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I'm a master of the pivot.

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And so what I'm hearing you say is that, yes, you have challenges and for every challenge,

369
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you kind of got up and found a different way.

370
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You've kind of been the person who's always getting up again and saying, what other direction

371
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can I go in?

372
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Is that fair to say?

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Right.

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00:22:15,100 --> 00:22:19,980
I mean, I guess another way to think about it would be I am extremely privileged that

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I am genuinely doing the work that I love doing.

376
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Right?

377
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And I think that making changes, changing a scientific direction, changing a project,

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accepting that, oh, this project didn't work out or perhaps I need to spend another year

379
00:22:32,900 --> 00:22:38,180
doing X, Y, and Z, those are small prices to pay if at the end of the day, I get to

380
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do what I love doing.

381
00:22:40,780 --> 00:22:46,100
I appreciate you saying that because I think that's so important for really all clinicians

382
00:22:46,100 --> 00:22:48,460
and really all clinician researchers.

383
00:22:48,460 --> 00:22:55,340
And I wonder how did we get to be able to tolerate misery, not doing the things we actually

384
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enjoy doing.

385
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And I really do think that's important.

386
00:22:58,380 --> 00:22:59,900
And I wonder if you want to speak to it.

387
00:22:59,900 --> 00:23:04,980
So as young people are coming in, people are trying to get publications because it helps

388
00:23:04,980 --> 00:23:07,580
them get into residency or fellowship.

389
00:23:07,580 --> 00:23:12,140
And they want to say they had a lab experience.

390
00:23:12,140 --> 00:23:17,220
How do you advise people who are coming through now as trainees who are trying to do all

391
00:23:17,220 --> 00:23:22,380
the things, get all the checkboxes, but also hopefully eventually end up where they love?

392
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What do they do?

393
00:23:26,900 --> 00:23:32,580
That's a difficult question because I don't think there's a single right answer to it.

394
00:23:32,580 --> 00:23:41,380
I do find that often when I'm talking to fellows or residents, I ask them if, and let's say

395
00:23:41,380 --> 00:23:44,780
they approach me or someone else for a rotation project or they want my guidance on which

396
00:23:44,780 --> 00:23:46,420
kind of lab we should pick.

397
00:23:46,420 --> 00:23:52,340
I ask them, do you genuinely want to do the lab because you enjoy answering questions

398
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or is it just because you want to have that as a line on your CV so it can help you in

399
00:23:55,980 --> 00:23:57,820
the next phase of your career?

400
00:23:57,820 --> 00:24:03,580
And it's really important, I think, for trainees to be honest about this because sometimes

401
00:24:03,580 --> 00:24:09,180
an example in oncology is, in general, you can think of two big career paths if you're

402
00:24:09,180 --> 00:24:10,460
doing research in oncology.

403
00:24:10,460 --> 00:24:14,140
It's the basic science lab based or you can think of clinical trials.

404
00:24:14,140 --> 00:24:19,660
And there are trainees sometimes enter a lab, but in their heart of hearts, they are not

405
00:24:19,660 --> 00:24:21,660
absolutely sure that that's what they want to do.

406
00:24:21,660 --> 00:24:25,900
And so they spend the two years of fellowship, two years of research time of fellowship,

407
00:24:25,900 --> 00:24:27,880
pursuing a project somewhat half-heartedly.

408
00:24:27,880 --> 00:24:29,340
It doesn't work out.

409
00:24:29,340 --> 00:24:33,900
But then at the same time, they might have spent the time better in getting a clinical

410
00:24:33,900 --> 00:24:35,260
trial up and running.

411
00:24:35,260 --> 00:24:38,500
And so what happens is they reach the end of the fellowship and they don't have a basic

412
00:24:38,500 --> 00:24:42,780
science project that's really working out and they don't have a clinical trial that's

413
00:24:42,780 --> 00:24:43,980
well established.

414
00:24:43,980 --> 00:24:47,420
And so now they're in a real fix in terms of when they apply for an academic position,

415
00:24:47,420 --> 00:24:50,340
exactly what are they going to sell their career as?

416
00:24:50,340 --> 00:24:54,860
And so sometimes it happens that they will then purely do a clinical research career.

417
00:24:54,860 --> 00:24:55,860
And that's fine.

418
00:24:55,860 --> 00:24:59,520
There's absolutely nothing wrong in being 100% or 80% clinical.

419
00:24:59,520 --> 00:25:04,340
But if that wasn't your original goal, then in some ways you have to reflect on whether

420
00:25:04,340 --> 00:25:10,460
you have used this trainee time optimally to advance your career.

421
00:25:10,460 --> 00:25:15,260
And so I would say the first goal is to identify this is really, really, really what you want

422
00:25:15,260 --> 00:25:16,260
to do.

423
00:25:16,260 --> 00:25:20,540
One way to do this is to talk to others who have pursued this track before you and learn

424
00:25:20,540 --> 00:25:24,320
the positives as well as the pitfalls of this career track.

425
00:25:24,320 --> 00:25:30,180
And then, yes, if you're sure, then dive into it and give you everything to that track.

426
00:25:30,180 --> 00:25:32,980
Yeah, that's really, really, really great advice.

427
00:25:32,980 --> 00:25:34,860
And I do wish that more people heard that.

428
00:25:34,860 --> 00:25:39,420
I think sometimes, and perhaps again, it goes back to the training of medical school that

429
00:25:39,420 --> 00:25:40,420
is just the path.

430
00:25:40,420 --> 00:25:43,460
And after four years or five or six, you're done.

431
00:25:43,460 --> 00:25:45,500
And then residency, it's like, this is the track.

432
00:25:45,500 --> 00:25:48,060
And then people feel like fellowship, it's the same thing.

433
00:25:48,060 --> 00:25:51,700
The fellowship is unique because it's a transition point.

434
00:25:51,700 --> 00:25:56,040
And so if ever you are not doing anything you didn't care about, fellowship is not the

435
00:25:56,040 --> 00:25:58,900
time to just dabble in things you're not interested in.

436
00:25:58,900 --> 00:26:02,980
Because at the end, as you mentioned, you can lose both ways.

437
00:26:02,980 --> 00:26:04,940
Absolutely, absolutely.

438
00:26:04,940 --> 00:26:07,620
I really think fellowship is not a dabbling time.

439
00:26:07,620 --> 00:26:12,180
I think by fellowship, you really have to have a pretty clear idea.

440
00:26:12,180 --> 00:26:16,180
For instance, in oncology, when you're coming in for fellowship, you don't need to know

441
00:26:16,180 --> 00:26:20,380
if you want to become a breast cancer or a lung cancer or GI cancer specialist.

442
00:26:20,380 --> 00:26:21,880
That you can figure out.

443
00:26:21,880 --> 00:26:25,200
What is important to know is, do you see yourself long term as someone who's going to run their

444
00:26:25,200 --> 00:26:26,200
own lab?

445
00:26:26,200 --> 00:26:29,340
Do you see yourself as someone who's doing mostly clinical work but is connected with

446
00:26:29,340 --> 00:26:30,340
the lab person?

447
00:26:30,340 --> 00:26:33,180
Do you see yourself interested in epidemiology, you know, and statistics?

448
00:26:33,180 --> 00:26:35,140
That's like another direction you can go in.

449
00:26:35,140 --> 00:26:37,820
Or do you see yourself as someone running clinical trials?

450
00:26:37,820 --> 00:26:42,460
I do think it's important either by the beginning of fellowship or at least six months within

451
00:26:42,460 --> 00:26:45,220
the first start of your fellowship to figure this out.

452
00:26:45,220 --> 00:26:50,380
So you can position yourself well for the remaining two to three precious years of your

453
00:26:50,380 --> 00:26:51,380
fellowship.

454
00:26:51,380 --> 00:26:52,380
Absolutely.

455
00:26:52,380 --> 00:26:55,840
I wonder though, Vikram, how do people get that certainty?

456
00:26:55,840 --> 00:27:00,820
Because I feel like there's so much, in a sense, chameleoning and shape shifting throughout

457
00:27:00,820 --> 00:27:01,860
training.

458
00:27:01,860 --> 00:27:06,380
And so how do you now suddenly get to fellowship and be clear on your direction?

459
00:27:06,380 --> 00:27:08,980
How do people get that?

460
00:27:08,980 --> 00:27:14,700
I think one of the ways in which this is changing is I think we have a decent amount of contact

461
00:27:14,700 --> 00:27:19,060
with residents these days talking about our career pathways and the career tracks.

462
00:27:19,060 --> 00:27:22,940
And so I sometimes am invited to talk to the internal medicine residency program about

463
00:27:22,940 --> 00:27:25,580
a physician scientist track and what it's like.

464
00:27:25,580 --> 00:27:31,840
And I'm constantly urging residents that residency is really busy and most of the time is spent

465
00:27:31,840 --> 00:27:35,220
in catching up with the sleep that you've lost after being on overnight call.

466
00:27:35,220 --> 00:27:39,700
But please keep thinking from your intern year itself about what the shape of your career

467
00:27:39,700 --> 00:27:41,060
is going to look like.

468
00:27:41,060 --> 00:27:44,720
Don't fixate on specialties and subspecialties.

469
00:27:44,720 --> 00:27:50,860
That is less important than the contours of your career and exactly what kind of work

470
00:27:50,860 --> 00:27:54,860
you want to be, what kind of doctor you want to be, what kind of clinician or clinician

471
00:27:54,860 --> 00:27:59,720
researcher or clinician epidemiologist or basic scientist you want to be.

472
00:27:59,720 --> 00:28:05,900
And I think perhaps more emphasis in residency to figuring that out, perhaps in some kind

473
00:28:05,900 --> 00:28:06,900
of formalized way.

474
00:28:06,900 --> 00:28:10,900
I don't know, perhaps residency programs could implement questionnaires or something like

475
00:28:10,900 --> 00:28:15,400
that to help people score what are the different things they want to get out of the career

476
00:28:15,400 --> 00:28:17,980
and then trying to come up with some kind of career counseling.

477
00:28:17,980 --> 00:28:22,460
I'm thinking off the top of my head that I can imagine one way in which residents could

478
00:28:22,460 --> 00:28:29,460
be formally exposed to and trained early to pick between one of these different approaches

479
00:28:29,460 --> 00:28:33,540
so that they can then get everything lined up for when they begin fellowship.

480
00:28:33,540 --> 00:28:34,540
I love it.

481
00:28:34,540 --> 00:28:37,020
I love how you talk about the shape of your career.

482
00:28:37,020 --> 00:28:40,260
It's not, you're not, you're not, you're not like locking yourself in.

483
00:28:40,260 --> 00:28:42,940
You're just figuring out what are the contours.

484
00:28:42,940 --> 00:28:44,220
I really love that term.

485
00:28:44,220 --> 00:28:45,860
It's just, it's just, what does it look like?

486
00:28:45,860 --> 00:28:48,700
It's a big blob or it's like a big piece of stone.

487
00:28:48,700 --> 00:28:51,620
You're chiseling out the statue, but what, what does it look like?

488
00:28:51,620 --> 00:28:52,620
What's the shape?

489
00:28:52,620 --> 00:28:53,700
I really appreciate you saying that.

490
00:28:53,700 --> 00:28:54,860
Thank you.

491
00:28:54,860 --> 00:28:58,980
So we are coming towards the end of the show and I will say that, gosh, we've, we've learned

492
00:28:58,980 --> 00:28:59,980
so much from you.

493
00:28:59,980 --> 00:29:05,220
I feel like it's just been just, there's been so much packed in and there's still so much,

494
00:29:05,220 --> 00:29:07,540
I think, that we could yet talk about.

495
00:29:07,540 --> 00:29:11,980
But I want to ask you, when you think about this whole pathway, this whole journey as

496
00:29:11,980 --> 00:29:16,900
a clinician scientist, what haven't we talked about that's important for younger people

497
00:29:16,900 --> 00:29:19,660
to know?

498
00:29:19,660 --> 00:29:20,660
That's a good question.

499
00:29:20,660 --> 00:29:25,100
Actually, I think we talked about so much that I wondered if anything specific I have

500
00:29:25,100 --> 00:29:26,100
left to say.

501
00:29:26,100 --> 00:29:31,460
But I guess the one thing I would say in response to this question is, and it doesn't apply

502
00:29:31,460 --> 00:29:37,060
to me, but I think in the past, especially for women in science, having children and

503
00:29:37,060 --> 00:29:41,780
taking maternity leave was considered to be a real detriment to your scientific career.

504
00:29:41,780 --> 00:29:43,680
And that is definitely changing.

505
00:29:43,680 --> 00:29:48,580
And so I think there's a lot of recognition that, you know, maternity time, paternity

506
00:29:48,580 --> 00:29:54,760
time is going to be part of your scientific career and definitely allows you to add extra

507
00:29:54,760 --> 00:29:58,500
years to your tenure clock, for example, as a faculty member if you have kids.

508
00:29:58,500 --> 00:30:06,700
And so I think that is something that I hope that women in science don't shy away from

509
00:30:06,700 --> 00:30:11,420
the position scientists track, thinking that maternity leave or maternity is anyway going

510
00:30:11,420 --> 00:30:12,820
to compromise their success.

511
00:30:12,820 --> 00:30:14,900
Because I think there's a lot more recognition of this.

512
00:30:14,900 --> 00:30:17,140
There are lots of resources for this.

513
00:30:17,140 --> 00:30:21,820
And I think as we are increasingly seeing more women in leadership positions as chairs

514
00:30:21,820 --> 00:30:25,620
of divisions, including basic science divisions, which necessarily might not have been the

515
00:30:25,620 --> 00:30:31,780
case maybe like 10, 15 years ago, I do think that this is an important aspect of science

516
00:30:31,780 --> 00:30:33,060
that is shifting.

517
00:30:33,060 --> 00:30:38,400
And so I suppose that's the one thing I would say, that I hope scientists don't choose

518
00:30:38,400 --> 00:30:45,140
or not choose position scientists tracks for reasons about the logistics, about family

519
00:30:45,140 --> 00:30:50,340
life and concerns that that may not allow them to achieve what they really should be

520
00:30:50,340 --> 00:30:52,020
able to achieve.

521
00:30:52,020 --> 00:30:53,500
I really appreciate you saying that.

522
00:30:53,500 --> 00:30:58,640
I think really even speaking more broadly, it's like don't think that there are barriers

523
00:30:58,640 --> 00:31:00,760
that are insurmountable.

524
00:31:00,760 --> 00:31:07,520
Don't make the choice based on those barriers because you see the obstacles and for whatever

525
00:31:07,520 --> 00:31:10,420
case you have ideas about what those obstacles are.

526
00:31:10,420 --> 00:31:13,780
So don't make the decision based on obstacles you perceive.

527
00:31:13,780 --> 00:31:16,940
There is opportunity to push past those obstacles.

528
00:31:16,940 --> 00:31:20,320
I think all of science is about pushing past obstacles.

529
00:31:20,320 --> 00:31:25,380
So that's really, really important that you raise that and thank you for doing that.

530
00:31:25,380 --> 00:31:26,380
All right.

531
00:31:26,380 --> 00:31:29,820
Well, I want to say thank you for being on the show.

532
00:31:29,820 --> 00:31:32,200
I really do appreciate your insights.

533
00:31:32,200 --> 00:31:37,280
I will tell you that I appreciate and enjoy your enthusiasm for your work.

534
00:31:37,280 --> 00:31:40,060
You clearly are on a great adventure.

535
00:31:40,060 --> 00:31:41,640
That's not without its challenges.

536
00:31:41,640 --> 00:31:45,280
You just choose to see them as opportunities to move in different directions.

537
00:31:45,280 --> 00:31:53,060
I think that optimism, that enthusiasm, and that just flexibility and practicality is

538
00:31:53,060 --> 00:31:59,040
key and that people really should be looking to engage those skills to be able to really

539
00:31:59,040 --> 00:32:01,640
succeed in this career.

540
00:32:01,640 --> 00:32:02,640
Thank you so much.

541
00:32:02,640 --> 00:32:05,020
It's been such a pleasure to talk to you.

542
00:32:05,020 --> 00:32:09,060
I appreciate your insight and everything you bring to this conversation as well.

543
00:32:09,060 --> 00:32:10,060
Thank you.

544
00:32:10,060 --> 00:32:11,060
Thank you.

545
00:32:11,060 --> 00:32:12,060
It's been fun.

546
00:32:12,060 --> 00:32:13,060
All right, everybody.

547
00:32:13,060 --> 00:32:14,680
That was an amazing conversation.

548
00:32:14,680 --> 00:32:16,960
I think so many people need to hear it.

549
00:32:16,960 --> 00:32:21,420
This path can be challenging, but really, how do we choose to see it?

550
00:32:21,420 --> 00:32:22,420
How do we choose to move forward?

551
00:32:22,420 --> 00:32:24,860
How do we choose to address pitfalls?

552
00:32:24,860 --> 00:32:29,500
These are things that Dr. Parulkar really elaborated on for us.

553
00:32:29,500 --> 00:32:33,660
So please, if there's someone you know who would benefit from hearing this podcast episode,

554
00:32:33,660 --> 00:32:34,940
please share it with them.

555
00:32:34,940 --> 00:32:37,900
If you're a mentor, your mentees probably need to hear it.

556
00:32:37,900 --> 00:32:40,620
If you're a mentee, your network needs to hear this.

557
00:32:40,620 --> 00:32:42,260
So definitely share this episode.

558
00:32:42,260 --> 00:32:43,260
All right.

559
00:32:43,260 --> 00:32:53,860
Thank you so much, and we'll see you next time on the Clinician Researcher Podcast.

560
00:32:53,860 --> 00:32:59,220
Thanks for listening to this episode of the Clinician Researcher Podcast, where academic

561
00:32:59,220 --> 00:33:04,500
clinicians learn the skills to build their own research program, whether or not they

562
00:33:04,500 --> 00:33:06,020
have a mentor.

563
00:33:06,020 --> 00:33:12,120
If you found the information in this episode to be helpful, don't keep it all to yourself.

564
00:33:12,120 --> 00:33:13,860
Someone else needs to hear it.

565
00:33:13,860 --> 00:33:17,900
So take a minute right now and share it.

566
00:33:17,900 --> 00:33:23,380
As you share this episode, you become part of our mission to help launch a new generation

567
00:33:23,380 --> 00:33:43,420
of clinician researchers who make transformative discoveries that change the way we do healthcare.