How to do research and still excel at patient care

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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 another episode of the Clinician Researcher podcast.

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I am Toyosi Onwuemene, and excited to talk to you today about how to do research and still

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excel at patient care.

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So I was recently at a national conference and moderating a table talking about tips

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for grant writing, and one of the trainees at the table asked, well, what do you do when

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you really love patient care, but you still want to do research?

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I don't want my patient care to suffer because I'm doing research.

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And you know, that question really resonated with me because we're clinicians.

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We love to care for patients.

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At least most of us do.

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We used to, until burnout and disappointment set in.

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Many of us really, really love to care for patients, and I actually argue that most of

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us still do.

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And we usually come to a career as a clinician because we enjoy caring for patients and we

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enjoy taking care of them and meeting their needs.

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And over the course of our training, we get to do it really, really well.

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What we don't get as part of our training is research training.

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And even if you did a PhD, you didn't get as much research training as, say, your PhD

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colleagues.

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And every time you have a patient care role, in general, you're not able to have as much

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time spent doing the research that's needed.

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And so I do think it's important to think about this.

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Medicine's what seems like a dichotomy between research and clinical care, but it's really

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a false dichotomy.

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The reality is that both support the other.

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The state of medicine as it is today is much improved because of research that has happened

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over the years.

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And the state of medicine is what it is because there's more opportunity for research.

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And so research and clinical care really do go together.

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Clearly, they don't always reside in the same person, but I do want to speak to five reasons

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today why doing research makes you actually a better clinician.

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Now one thing I want to go back to, and I say often to you clinician researchers who

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are listening, is that it really does take time to do research well.

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It takes time to learn to do research well.

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This is the reason why, or for this reason.

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People are professional researchers.

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I talk about PhD colleagues all the time.

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Their whole training revolves around learning how to do research well.

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And it takes them a minimum of five to seven years to get that PhD that says, I now know

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how to ask a question and answer it and move projects through whatever their area of specialty

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is.

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And then people go on to do post-docs, and post-docs can last as long as five to seven

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years.

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More research training.

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And so when a PhD is done with all of their research training, you tally that together.

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That's about 10 and sometimes up to 13 years of training just to do research well.

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And so it takes time to do research well.

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And as clinician researchers, or as clinicians who aspire to research careers, you need to

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understand that investment is needed to do this work well.

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Clinical training is different from research training.

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And clinical questions are different from research questions.

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And so, yes, if you are going to really take this seriously and move your career forward

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as a clinician researcher and be someone who leads a research program, you do need to make

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the investment of learning how to do it well.

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Over time, you're going to have a team that's going to support you in doing this well.

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But you, as the fearless leader, need to have the resources that you need to do this well.

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And so don't think of it as my clinical care will suffer while I'm investing all this time

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and energy into learning to lead a research program.

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Think of it as enhancing your clinical care.

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And you enhance your clinical care in five ways.

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The first way is you learn to ask better questions.

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So leading a research program is about figuring out a way to take something that's huge and

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complex, a real big problem, and boiling it down into very, very, very small pieces, so

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into one of its small components, and then figuring out a way to answer, to test a hypothesis.

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So it's like, if I do this, what happens?

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If I do this, will I get this result?

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And it's a yes or it's a no.

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And so you're able to set up experiments that help you answer the question.

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And that's why it takes so long, many, many years, to really make a significant impact

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because you're answering small questions each time.

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What it does is it trains you to really ask and test hypotheses.

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And in clinical care, sometimes that is what we're doing.

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I mean, we're never doing research on the patient.

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But we are asking questions.

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This patient's blood pressure is high.

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If I give this medication, which is the first line recommended medication, will this lower

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the blood pressure by 10 points or the systolic blood pressure by 10 points?

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You're asking questions better when you can really narrow down a very clear outcome that

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you're going to measure to tell you that you have success or you don't have success.

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And to some extent, we already do this as clinicians, but we are able to do it so much

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better as researchers.

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And it really helps us to say, well, these are the outcomes that I'm going to measure.

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This is the timeframe in which I'm going to measure the outcome.

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And based on the results of the outcome, this is how I'm going to respond.

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So it does help you ask better questions.

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And it's important to ask great questions because amazing discoveries come from asking

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questions.

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And sometimes as clinicians, we get so busy.

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We're just trying to work through the schedule.

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And it doesn't feel like there's time to really sit and think about the patient.

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But the more you are involved in research, the more gaps you're aware of and the better

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questions you ask about the patient.

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Huh, of the last 10 patients I saw, this is the one patient whose blood pressure was not

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lowered by this medication.

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Hmm, what is different about this patient?

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And then you start to ask questions, like to what extent is this patient different in

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terms of perhaps body mass index or dietary exposure, different things.

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So you get to ask better questions in your work as a clinician researcher.

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Number two thing is that it trains you to pay close attention.

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It trains you to pay close attention.

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So you are always making observations, whether you're a researcher or not, you're always

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making observations.

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But the more you spend time honing and refining and answering research questions, the more

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you pay attention when patients come your way that don't fit the norm.

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And so in general in medicine, there's always the patient who didn't read the textbook.

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We joke about that.

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But the patient who doesn't read the textbook, it brings you so much more information than

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the patients who do read the textbook, who do present as you expect, as the textbook

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would suggest that they would show up.

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And when they present in a way that's different, then it's an opportunity to ask what is different

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about this patient.

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And so you pay closer attention to anybody who passes through and doesn't fit the norm.

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And it trains you to pay attention more to the nuances about the patient that might be

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different.

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And one of the gifts of being a clinician researcher is that really you do have the

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opportunity for what people call the bench to bedside translation.

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Now it sounds actually more glamorous than it really is.

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But what it really does do is allow you to think about how do I answer questions that

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might help me help a patient like this, this patient who is unusual, who was outside of

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the norm?

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How might I structure my research questions to answer and to help this patient or help

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a patient like this 10 years down the road?

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And so you're always paying close attention to opportunities that come from your patient

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population to really enhance your research program.

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So doing research makes you a better clinician because you pay attention in a different kind

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of way.

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Number three is that you tend to find diagnoses that no one else can.

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And that happens because your patient becomes your teacher.

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Now in medicine we recognize, we recognize that there is so much that's unknown.

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We recognize that there's so much more that healthcare could be.

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There's so much more that we could do for our patients.

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But we don't always have time as clinicians to really do more, be more, we're just so

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busy.

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We're so busy.

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But when you are a researcher, number one, you create space for your research.

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And over time the space for your research can grow.

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But what you also do is you create space for thinking.

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And I would argue that the highest value of a clinician is not what they can do, but how

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they think.

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What you do can be put into protocols and you can hire people that will do that.

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And if that's all they do, if that's all they did for a 10-year period, they get really

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good at doing.

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But your power, one of your superpowers as a clinician is your ability to think.

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And so when you create space for thinking, as you need to, as you're growing a research

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program, what you also create space for is thinking more critically about the patient

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that shows up before you.

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Ideally, you're not so swamped with clinical care that you can't even think about the last

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patient you saw, let alone going back three patients earlier to ask, why is this patient

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different from the others?

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And so because you have an inquiring mindset, because you're asking better questions, because

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you're paying closer attention, you tend to find diagnoses that no one else can.

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And that's why people travel all over the world to meet the one expert in the one field,

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because it's a thing you study.

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It's a thing you understand.

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And you can find things that no one else can.

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And so you tend to prioritize the patient as your learning laboratory.

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And so the patient is your teacher.

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Number four reason why doing research makes you a better clinician.

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And when I say better clinician, I'm not saying that it makes you better than clinicians.

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Being a researcher doesn't make you better than somebody else.

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What it does is it makes you better in yourself.

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So you're a clinician.

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It enhances your ability to be a clinician.

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I know there's this narrative of comparing.

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And many times in academic institutions, there's sometimes a sense that, oh, the researchers

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are more valued.

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Or sometimes it's like, oh, the clinicians are more valued.

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And that argument will always go on for generations, I'm sure.

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But when I'm asking you to think about it, I'm asking you to think about how can you

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be better tomorrow than you are today?

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Not how can you be better than the other person?

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Because that's kind of like just a false comparison.

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Because if you feel like you're better than the other person, well, there's always someone

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who in that metric is better than you.

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And so you're either sometimes feeling inferior or sometimes feeling superior.

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And none of them is good for you.

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But how can you be better?

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How are you enhancing yourself?

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That's what I'm talking about.

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So number four is you make discoveries that apply to thousands of patients.

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And so you can help the patient in front of you.

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Or you can help thousands of patients that you may never see.

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And that's a beauty of creating a body of work that other people can use and that patients

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beyond you will be able to have access to through their health care providers.

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What's so beautiful is that you may never see another patient again.

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But any work that you have done, that you have put out in the public space, you've communicated

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in some way, hopefully through manuscripts and also through presentations, you are able

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to really impact the care of people that you may never know.

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And that's so awesome because I think we come into medicine for impact.

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We want to know that the work we do matters.

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We want to know that the work we do will impact someone else.

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And so it's such an opportunity for us to be able to do that.

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And so you want to make sure that you enhance your skills as a researcher because you're

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really going to be able to make so much impact.

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And that is important.

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Number five is that after you're gone, your work is going to continue to live on after

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you and care for more patients.

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So you're going to be able to care for patients beyond the grave.

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And I think it's super important because we really are about impact.

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We really are about making a difference.

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And if we can make a difference for so many more patients, if our work is going to live

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on to continue to make a difference for patients, how awesome is that?

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How awesome is that?

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And so yeah, these are the things we do need to think about as we're really thinking about

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big picture.

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You love to care for patients.

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You're in medicine because you love to care for patients.

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And patient care will always be kind of the foundation of all we do.

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But then the question is, how can you care for your patients better?

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And research allows you to do that.

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But also, how can you care for more patients?

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How can you really expand knowledge?

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How can you contribute to knowledge in such a way that so many more people beyond you

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will be able to benefit?

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And I think that's what being a clinician researcher does for you.

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Now one of the challenges, going back to the beginning, is that research takes time to

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learn and being able to lead a research program is not something you just jump into when you

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have finished all your clinical training.

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You really do need to make that investment.

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And it is worth making that investment while keeping the clinical care that you do minimal

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so that you can really enhance the part of you that's a researcher.

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And people get worried.

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They're like, I'm going to lose my clinical skills.

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You never lose your clinical skills.

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What you do need to do is keep up with the literature.

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And actually, maybe some people will say, well, I'm a surgeon.

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I'm a proceduralist.

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If I don't do this often enough, I deteriorate in my skills.

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And I would give you that.

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The question is, which part of you do you really want to develop?

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And what does it take to develop that part of you?

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If you want to lead a research program, what does it take to do that?

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And it may be that you don't lead a research program.

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It may be that you're a partner to somebody else who leads a research program.

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And that's OK.

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But it is important to clarify what you want to do in the space of being a clinician and

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in the space of being a researcher and recognize that honestly, both are two different jobs.

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Both are two full-time jobs.

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And if you're going to do it well, then you are going to prioritize getting training and

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research as you have prioritized getting training in clinical care.

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And these are the things that we do really as we negotiate our lives in the academy.

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So if you are interested in coaching and really navigating this tricky dichotomies that exist,

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I would invite you to sign up for one of our coaching programs, reach out to us on our

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website, clinicianresearcherpodcast.com for more information.

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We're enrolling the next cohort of faculty in the Academic Negotiation Academy.

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And these are the things that we help coach around.

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How do you navigate your career as a clinician and as a scientist, as a researcher?

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How do you do it in a way that feels true to you?

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Because each of us as faculty members have a different journey.

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There is not a one size fits all.

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And if that be the case, then you want to make sure that you really have career satisfaction

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by making decisions that align with your values.

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So I invite you to check out our website and sign up for more information.

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All right.

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It's been a pleasure talking with you today.

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If this episode has been helpful to you, please share it with someone else.

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Don't keep the information to yourself.

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I'll see you on the next episode.

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

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

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have a mentor.

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

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Someone else needs to hear it.

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So take a minute right now and share it.

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

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

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care.