How to achieve research productivity when you can't find a mentor

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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 Teresee Unwemona, and it is a pleasure to be talking with you right now.

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Thank you for listening.

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For today's episode, I'm bringing you a talk that I delivered at the National Medical Association

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meeting in August 2024, and I'm excited to share this talk with you.

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Well, hello, everybody.

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This is Toyosi Onwuemene.

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Thank you so much for listening to me today remotely.

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I am so sorry that I could not be at the talk, but I want to thank you so much for the opportunity

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to talk with you remotely.

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So today, I'm going to be talking about achieving research productivity when you cannot find

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a mentor.

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We're going to identify barriers to underrepresented faculty leading scholarship, and particularly

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speaking about leading research, but this is applicable to leading scholarship in general.

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I'm also going to talk about the metrics for academic success and why that's important

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for us to understand as we're pursuing mentoring.

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And I'll talk about empirical strategies for research productivity if we're not able to

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get the mentoring that we need.

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So I was a fellow about 10 years ago looking for a position, and people told me that because

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I wanted to be a non-malignant or classical hematologist, I was so lucky I was going to

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get jobs and I would have no issues.

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Well, I said I wanted to research.

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I want 75% of my time to be protected for research, but there were none of those jobs

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available.

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Instead, what was available was full-time clinical jobs, which I did not want to do.

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I was so sure that I wanted to lead a program of research.

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And so ultimately, I found a job that promised me that I would have time to do research,

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but I would first of all need to take an 80% clinical job, which by the way had me seeing

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patients five days a week.

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And so I found myself doing the work of a full-time clinician.

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And so over the course of my career though, I finally figured out that, wow, a transformation

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is really needed for a clinician who wants to succeed as a researcher and that the metrics

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for research productivity are actually kind of clear and that it's possible to achieve

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them even when you don't have the optimal mentoring that you would like to have.

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The first point that I want to make is that clinical training is not equal to research

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training.

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Clinical training is not equal to research training.

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In fact, by the time you get to your fellowship and your early faculty career, you've actually

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barely done any research so that you are truly not qualified to lead a research program.

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If anything, you are qualified to begin to learn to lead research.

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Okay.

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So most of our medical school was dedicated to learning how to understand the basic science

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so that we could actually start to take care of patients.

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And then we became interns and we mastered the art of taking care of the patient.

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And then we become residents and now we are leading other interns who are taking care

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of the patient.

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And so there's this graduated leadership journey along the pathway to becoming a clinician,

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but nowhere in the framework for clinical training is there research training.

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So what are the challenges for clinicians in leading research?

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This is an older graph, but what I want you to notice is that it is sharing with us that

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while research and teaching have stayed about flat over the course of years, patient care

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for academic clinicians continues to rise.

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And this is an ongoing trend.

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So what are some barriers to physicians and research?

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Well, the reality is that their financial and time demands of clinical practice is increasing

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complexity of patients.

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There is not a supportive infrastructure for many of us to be able to optimally deliver

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patient care.

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We also don't have the research training and I want to focus right now on inadequate research

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training.

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There is a significant difference in the training for MDs who are becoming clinicians and PhDs

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who are becoming researchers.

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Let's go through now the PhD pathway to research.

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So PhD will do maybe a pre-doc, they might do some research as they're figuring out

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whether they wanted to do research, not very much, but about maybe at the end of the day

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at most two years worth.

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When they go into their doctoral program, they are doing research, primarily leading

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research that the graduate student on the senior graduate students project, and then

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they continue until they become the senior graduate student having other graduate students

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be on their project.

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And then they finish and they go on to do a postdoc.

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And many people will do a first postdoc, some people will actually do a senior postdoc,

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and then finally they get to their early career faculty period and they say, you know what,

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I need a career development award so I can learn to lead a research program.

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PhD researchers have had a lot of investment doing research, but they still get to the

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beginning of their faculty careers realizing that more training is needed.

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Okay, well let's look at the MD pathway to research.

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Well, you know, for those of us trying to get into med school, we might do a research

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training program, perhaps a summer elective, but by the end of the time you add it all

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up, it's about no more than a year of research.

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And then we go to med school, if we're lucky, we might get a couple of months elective doing

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research during med school.

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Some of us actually gave up a year of med school so that we could do research throughout

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that year.

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But at the end of the day, it's probably no more than a year, maybe two years of research

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during med school.

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Then you go on to residency.

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Residency is pretty busy.

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Maybe you have elective time where you're able to do a couple of weeks of research.

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And then for many of you that are in ACGME accredited fellowships, you finish your ACGME

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accredited fellowship and you're lucky if you've had a full 1.5 years of uninterrupted

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time to do research.

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And then you get to your early faculty career and you're like, well, I need a career development

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award as well.

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And the challenge is that when we compare you to the PhD faculty member, that's eight

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to 12 years in a PhD researcher's trajectory versus 1.5 to three and a half years in the

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MD's trajectory.

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Honestly, as an MD, by the time you come to your faculty position, you're like a research

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baby.

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You have no idea what you're doing.

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You totally clueless, but then you're a faculty member and you're saying, I want a career

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development award.

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But when other people are evaluating your application against PhD researchers, you really

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have no experience at all.

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All right.

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So the challenge then is how is this gap going to be bridged?

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Well, currently the way we try to bridge that gap is with mentoring.

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Mentoring is an insurmountable task.

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When you think about the fact that a physician who's not really had any research training

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doesn't only need research mentorship, they need mentorship in scientific writing.

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They do need mentoring in research methodology.

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They do need to understand leadership because when you're in research, you're not actually

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trying to do everything yourself.

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You're leading a program.

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You're leading other people to do the research.

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So you need training in leadership.

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You obviously need to know how to write grants.

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People always talk about grantsmanship.

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Well, that's something that is a skill that can be built.

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And then team management as well, right?

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Because you're building teams to move the research forward and also mentoring as well.

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As the person who is mentoring is being mentored, you're also mentoring as well.

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And so there's so many things that are needed for the physician.

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And the whole idea that a mentor is going to do all of it is actually quite challenging.

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For this reason and for many other reasons, many early career faculty actually struggle

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to find mentors.

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And when we look at prior studies, including this systematic review, unfortunately, it

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is a challenge even for medical students of whom less than 50% felt that they had a mentor,

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for faculty members of whom less than 20% felt like they had a mentor.

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And then women perceive that they had more difficulty finding mentors compared to men.

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But mentorship was so important to success, yet such a big chunk of faculty members, medical

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students and trainees feel like they're missing mentors.

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So they're not really able to advance in their career because of this huge gap.

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What are some mentoring challenges in academia?

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Well, the reality is that an excellent scientist does not equal a great mentor.

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And sometimes faculty need different things from different mentors.

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One person who's a great mentor to one may not be a great mentor to another.

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Secondarily, seniority and success, while we always applaud those who are successful

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and we say, well, you should have more people in your lab, the reality is that it does not

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always lead to a great mentor.

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If you're going to be a mentor, it is hard work.

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It is patience, it's dedication, it's pouring into the life of another person.

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It takes investment and it's usually not funded.

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It's often associated with administrative duty.

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Hey, this is your job.

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This is what you're supposed to do.

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Unfortunately, it's often uncompensated.

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And I'm not just talking about financial remuneration.

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I'm really talking about its time.

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That time is often not compensated.

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And so faculty are borrowing from the fringes of their experience to try to mentor other

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faculty, which means that it's going to be a variable experience for many faculties being

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mentored.

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Mentoring is a skill and skills can be acquired and they can be grown.

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And so it's a skill that needs to be taught.

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Many faculty are actually not trained to be mentors.

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And when mentees have poor mentoring experiences, well, they can quit early, but if they become

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mentors themselves, then they continue to perpetuate that cycle of poor mentoring.

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Underrepresented faculty also may have greater challenges in mentoring.

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When you now compare faculty and advancement of faculty by race and ethnicity, well, you

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realize that many, many underrepresented faculty stay at the instructor and assistant professor

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level and few of them go on to the associate professor and professor level.

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And in general, these numbers are very small relative to the number of trainees that are

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coming through the pipeline as well.

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And that is evidence that there is not adequate mentoring for underrepresented minority faculty

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compared to majority faculty.

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What are some barriers to effective mentoring of URM faculty benign neglect, faculty reported

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feeling uninformed and unsupported.

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Many faculty are having to patch their mentoring experiences together.

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There is a perception that so the work that underrepresented faculty want to do is not

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necessarily widely accepted.

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Why is mentoring needed?

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Mentoring is needed because for academic faculty to advance, there are some very clear metrics

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for success.

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Let's talk about some of those metrics.

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So this is from the National Center for Faculty Development and Diversity, which I think is

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a little bit more geared towards PhD faculty.

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So I want to say that where you see teaching, I want to substitute clinical medicine for

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those of us who are MD faculty.

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I mean, you look at the criteria for tenure and promotion.

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In general, research scholarship drives promotion and tenure, research and scholarship.

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Everything else is a little bit smaller, right?

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But the average faculty member is spending so much time doing teaching the service work

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for clinicians, you can just translate that into patient care.

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There is very little time for scholarship, the thing that actually allows academic faculty

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to be promoted.

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Let's look at a different set of metrics.

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Now this actually comes from the University of Maryland School of Medicine, and they're

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very clear about, okay, so there's a tenure track and there's a non-tenure track.

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And I want you to pay attention, even when you look at the non-tenure track, publications

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are still relevant in advancement, right?

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Contributions to knowledge.

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That means seeing patients in advancement at any academic medical center is usually

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not enough.

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There is an element of contribution to scholarly work that's required, right?

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It's very important.

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And so here's the challenge.

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If you don't even have time to do any scholarship because you're so busy, how can you contribute

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to the scholarship that actually facilitates your promotion?

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It's challenging.

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And many faculty, many early career faculty, found themselves in this space, and so do

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many underrepresented faculty as well.

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And so then what are faculty members to do?

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Especially if they have no mentor.

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Okay, so it's important to recognize that faculty have many needs.

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We talked about the need for research skills, there's also career development is needed,

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intellectual development as a scholar, professional development as a professional, needed a role

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model, someone who can give them substantive feedback on manuscripts and grants, faculty

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need accountability so that they can meet their goals.

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They also need safe spaces as well.

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You need sponsorship, they need emotional support.

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So the current model of mentorship is a myth of a guru type mentor.

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And again, this comes from the National Center for Faculty Development and Diversity.

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But the idea that there is one mentor that can meet a faculty member's needs in every

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way.

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Now it sounds a little bit ridiculous to you, doesn't it?

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That, oh yeah, one person can't meet all these needs.

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And so what ultimately happens is that as the guru mentor is struggling, the mentees

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become abandoned.

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And there are many abandoned mentees out there whose careers have been affected because they

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can't find the adequate mentoring.

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And so I think it's important for us to think about how do we reimagine the paradigm?

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How do we support faculty to succeed when they cannot find a mentor, when they cannot

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find the one and be all guru mentor that can support all of their needs?

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Well, first of all, consider the faculty have many needs.

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And there's this idea that there's one person who's going to be able to solve all these

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problems.

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But if we take away the guru mentor from the center and we put the faculty member at the

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center and recognize that, well, the faculty member is the one who has all these needs.

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So where can the faculty member go to get these needs met?

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Well, so if we take away the idea of the guru mentor, what we really have is that faculty

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members need mentoring networks.

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If there's an issue of elderly care as my parents are aging, I need a mentoring network

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that's separate from my research mentor at work.

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Or if I'm dealing with issues of family planning, pregnancy, I want to talk to somebody who's

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not a primary mentor.

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And so faculty actually need mentoring networks so they can advance their career.

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And so empowering faculty members can occur through coaching.

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So faculty members are taking ownership of their own careers as they move forward, rather

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than being totally dependent on one person.

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It's great when you have a great mentor, but if you don't, you still need to be able to

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move forward.

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You still want to succeed in scholarship.

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And so empowering faculty through coaching is helpful so that faculty members can really

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take ownership of their careers and use their mentors in their networks to their advantage.

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Coaching is helpful for helping faculty play at a higher level.

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So what are some strategies to enhance research leadership?

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Now, we measure success in different ways, retention, publications, funding, reputation,

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promotion.

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And so mentors need support.

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And so we need mentoring support systems.

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We also need resources for mentors in terms of time and funding.

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And then for the baby, too, the mentee, if they had other sources of nourishment and

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were not fully dependent on the mentor, perhaps they could do well, even if they ultimately

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were abandoned.

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And so is it possible that mentees can have their own networks so they can be successful

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as well, rather than being dependent on a stressed out faculty member?

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And finally, can faculty also benefit from peer mentoring networks?

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And I think the answer is definitely yes.

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How can we also encourage skills development in mentees?

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Because being a good mentee is actually a skill that can be developed.

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And then acquiring all the skills of a successful researcher also can be developed as well.

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So how do we help faculty create their vision for their research?

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All right.

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So I want to go back to my story, the case study.

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So I started out with no resources for research.

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Honestly, I didn't even have resources for clinical care.

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So I had a double whammy there.

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But one of the things that I really needed was research training.

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I actually didn't have much research training.

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Now by the time I came to my faculty position, I had a master's in clinical investigation.

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But I certainly needed a lot more training than that.

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Again, compared to my PhD colleagues who were doing research training or doing post-docs,

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I had barely really had much by way of research training.

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That's one thing I needed.

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The other thing I needed was protected time.

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I needed to be able to do research during my work hours rather than trying to stuff

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research training and the research into my off hours, which means that there's so much

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less that's going to get done if I'm trying to do it by burning the candle and not sleeping

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at night.

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Now, the other thing that's needed is salary support.

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So well, if you're a clinician, make a lot of money generating RVUs and now you're not

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generating RVUs because you're doing research, who's supporting your salary?

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And that's an important question that faculty have to think about even when they don't want

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to as they're trying to lead research, as they're trying to do more scholarship.

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It's like, well, who is paying your salary?

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And that becomes a really important question.

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So I will tell you that throughout my process, I was very stressed trying to keep up with

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my full-time clinical load, seeing patients five days a week, also writing grants at nights

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and on weekends, also taking care of at the time, two children under three.

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It was a really stressful time.

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I found myself spending a lot of time sleeping in my office.

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And I finally got to a point where I was like, I cannot do this.

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It is impossible.

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I will quit.

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And I was fortunate because actually I found a way out.

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And so my first step towards growing my scholarship was that I was awarded a diversity supplement

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to one of my mentors, R01 Grants.

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Following the diversity supplement, I was selected to be part of an institutional K-12

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award and I started moving projects forward.

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I ended up getting an HTRS Mentored Research Award.

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I also got the Harold Amos AMFDP Career Development Award, supported by the American Society of

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Hematology.

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And currently I have a number of funding sources as well and continue to move my research forward,

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continue to collaborate to answer questions in classical hematology.

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Now I just want to share a little bit about what I think about when I advise faculty who

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feel like they don't have adequate mentoring.

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And so the most important thing is to recognize that there does need to be a shift in identity.

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There are two shifts that I think are important to recognize.

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Number one is a shift from trainee to faculty member.

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And you may be in that transition period or you may have already transitioned, but it's

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important to recognize that you're no longer looking for people to tell you who you are,

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to tell you what to do, but now you're the person who's driving your own career.

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In the same way as you're the one who the buck now stops with when it comes to patient

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care, that is your career as well.

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And so I know we look to mentors to drive our careers and I'm so glad that mentors are

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so helpful, but at the end of the day, if the mentor doesn't take care of you, you are

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still responsible for moving your career forward.

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And so no matter what stage you are in, even if you're a trainee right now, it's important

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to say, wait, I'm the one driving my career.

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What do I want my career to look like?

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And it's not too early to start to ask that question, to shift from, okay, everybody tell

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me what to do, tell me how to advance to say, well, what do I need so I can have the kind

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of career success I actually want?

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And so first of all, a shift of identity is needed.

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The second thing is that you know what?

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Protected time is essential.

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You cannot succeed in research without protected time.

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Any thought that doing research at nights and on weekends is going to help you advance

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and make up for that gap between a PhD researcher's training and yours is not realistic.

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Protected time is needed because there's a gap, there's a skills gap.

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Research and leading research is a skill that is built over time.

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And if you focused all your training on clinical training, that's good.

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But if you're going to lead scholarship, if you're going to lead research, you do need

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to go back, walk back the steps and get the training that you need.

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And you got to do that as part of your work day, not as something you do overnight.

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And so for those of you who are exploring new positions, you really got to think about how

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do you get the protected time you need so that you can be successful?

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For those of you who are already in positions where you don't have the protected time, how

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can you partner with your division chief, division director, your dean to figure out

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how you get the protected time to move research forward?

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And then if you are going to be given the protected time, if you receive the protected

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time, how do you actually get accountability so you're not just wasting time?

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So you're not just saying, well, I have all this protected time and now I have all this

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free time, how about I just try to finish all my notes during this protected time?

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It's creating structures for accountability so that you can be productive.

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And there are very specific metrics and strategies to be productive that don't necessarily have

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to come from a mentor, but can help you really succeed.

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So one of the things that's important is that if you are a scientist, if you are a researcher,

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if you are a scholar, it means you are a writer.

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It means that writing is part of your daily job.

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And so one of the things that you think about for productivity is how do you create space

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for continued daily writing so that you can move research and writing forward?

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Now writing is so critical because as a researcher, you're a communicator.

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You communicate with funding agencies so you can get money to move your work forward.

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You communicate with the scientific community by putting out manuscripts and abstracts or

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giving talks.

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You communicate with the lay community or with the public as your projects are funded

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and you're disseminating your work.

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And so communication is such a critical part of what you do.

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You've got to create the structure and accountability to write consistently.

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Another thing you want to do is to be clear about where you're going with your research.

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And part of that work is to make sure that you have a clear strategic plan and a weekly

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plan that helps you get there.

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These are things again that mentors are able to provide you, but you can get on your own

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in many programs that support you doing that so that you can be productive even as you

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continue to pursue the skills in research training as you need.

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And so creating structures for productivity is so important if you're going to succeed

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in scholarship, if you're going to advance in the academy.

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So I want you to think about your own career and I want you to think about what do you

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wish for your career?

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What do you see ahead of you?

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And I want to encourage you to think about how can you create what you want?

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What do you need?

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Who are the mentors?

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Remember I noticed I said mentor with an S. You don't need one mentor.

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You need multiple mentors for your career, for your research, for your academic advancement.

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You need sponsors.

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There are many people you need.

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You need help with your writing.

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You're a great writer, but scientific writing is different from what you've done.

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And even more important is grant writing.

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Grant writing is a different skill.

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Who are the people who can support you, especially early on, give you the intense mentoring that

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you need?

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And it may not be the people that you think because they're so far ahead.

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They don't really have enough time to invest in you, but there may be peers that wouldn't

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mind doing that.

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There may be instructors in writing programs that may be able to help us do that.

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So reimagine your career.

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Where is it you want to go?

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And who is it that already is around you that can help you get there?

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And as you begin to be more, think more critically and take the driver's seat of your career,

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you're able to create fireworks literally in your career because now you're not waiting

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for someone to show you where to go.

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And then if you have no mentor, you're stuck.

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But now you're saying, well, who do I need and how can I go get them?

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And then you realize that you don't have to be focused on just the faculty within your

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academic institution.

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Who are the connections you already have outside your academic institution that can help you

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create the vision you have for your own career?

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I want to thank you so much for listening.

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It's been a pleasure talking with you.

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Again, I wish I could have been there with you in person, but I want to thank you for

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listening.

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And I hope that any questions that you have can be directed at me.

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I'm at tonyasidardonwemina.edu.

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I would love to hear from you.

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And I want to thank you so much for listening.

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Have a great rest of your sessions.

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Thank you for listening.

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I look forward to talking with you again next time on the Clean Ocean Researcher podcast.

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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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00:27:43,040 --> 00:27:49,000
of clinician researchers who make transformative discoveries that change the way we do healthcare.