Transcript
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Welcome to the Clinician Researcher podcast, where academic clinicians learn the skills
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to build their own research program, whether or not they have a mentor.
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As clinicians, we spend a decade or more as trainees learning to take care of patients.
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When we finally start our careers, we want to build research programs, but then we find
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that our years of clinical training did not adequately prepare us to lead our research
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program.
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Through no fault of our own, we struggle to find mentors, and when we can't, we quit.
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However, clinicians hold the keys to the greatest research breakthroughs.
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For this reason, the Clinician Researcher podcast exists to give academic clinicians
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the tools to build their own research program, whether or not they have a mentor.
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Now introducing your host, Toyosi Onwuemene.
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Welcome to the Clinician Researcher podcast.
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I'm your host, Toyosi Onwuemene, and it is an absolute pleasure to be talking with you.
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Thank you for listening.
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I'm talking today about whether it is time to stop being a team player, and I recognize
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that the title of this podcast episode seems a little controversial.
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What do you mean?
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I should stop being a team player.
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I'd like to point out that the title of the podcast episode is, is it time to stop being
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a team player?
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That's a question.
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It's a question you got to answer.
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I did toy with calling it, you should stop being a team player, but you know, that is
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more controversial than the question.
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So I like the question because it's, you know, it's tentative.
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You get to decide.
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Perhaps the answer at the end of the podcast episode is, oh, definitely no, or maybe it's
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yes.
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Let's see.
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Anyway, but the reason I want to bring this up is because it came up yesterday and it
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came up in the context of a conversation I was having with an external invited speaker
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who I was taking to the airport because it made sense for me to take her to the airport.
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I was going to be able to connect with her and I didn't live too far from the airport.
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So anyway, so we're conversing and the conversation turns to call.
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So she has a specific, you know, makeup of her clinical work and she doesn't participate
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in a certain call and so I asked, oh, you have this number of providers in this area.
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How do you manage call?
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It's always a question that's interesting to me because what I find is as a hematologist,
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they're not many hematologists.
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And so let's say there are three or four at one institution.
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It's like, wow, do you guys split, you know, the call three ways for the entire year?
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I'm always curious to know how people do it.
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So what she said, she was like, well, I don't participate in that call because I have my
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own call schedule that nobody else covers for me.
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And she's like, but of course I'm a team player.
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And that is the exact phrase that leads me to this podcast episode because I only hear
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that team player term in the context of taking on more work.
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And so here I am ready to talk about this episode and why I think it applies to clinicians
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who are working to lead research programs.
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What does it mean to be a team player?
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Well, I will tell you that I was a kid who did sports in elementary school.
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So I understand playing on a team.
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I also now as a parent take my kids to play games.
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I get being on the team.
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And so I'd like to just lay out for you what I see as being on a team and being a team
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player in the context of sports.
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And then I want to bring it back to academic medicine and try to correlate it because I
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think there's a challenge in the way we're defining the game in academic medicine and
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a way in which we're defining the team.
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And I'd like to just offer some suggestions as to whether it truly is a team sport and
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to clarify your role as a player on this team and whether playing on the team is right for
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you in the context of your academic career or not.
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OK.
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So let's take the game of basketball because now I am learning a lot about basketball because
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my son plays basketball.
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OK.
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There are, to my understanding, five players on each team.
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And the five players on one team know that the goal is to get the ball in the hoop as
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many times as possible over the course of the game so that at the end of the game there
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are more hoops or more points to your team compared to the other team.
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And that is how a win is defined.
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And in the context of playing the game, there are things called fouls.
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There are things you're not allowed to do.
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And clearly the real goal ultimately is to score the basket.
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And when you score a basket, you score as many as possible.
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You prevent the other team from scoring a basket and you win.
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And if you win enough games over the course of a season, you end up with a championship
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ring and a trophy.
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OK.
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That's the game of basketball.
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If I've gotten it wrong, feel free to send me a DM and school me.
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I would appreciate it.
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OK.
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Let's now come to academia.
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Hmm.
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Well, in academia, what is the game?
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What is the game?
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To my understanding, the game of academia is about excelling in scholarship.
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The reason you excel in scholarship is because when you excel in scholarship, it brings you
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reputation.
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You are known as a scholar in X field.
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Your growing reputation grows the reputation of your institution.
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And so the more you're growing your scholarship and all of you on the team, the more you're
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all doing it, all the faculty are growing scholarship, it increases the reputation of
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the faculty on the scholarship and the institution increases its reputation, thus also continuing
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to increase the reputation of faculty.
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That's my understanding.
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And if I'm wrong, this is also an opportunity to school me.
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Now here's the challenge in academic medicine, especially for us clinicians.
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It sounds like scholarship is not the only thing that we do.
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OK.
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As clinicians, we take care of patients.
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And if we define the game of taking care of patients, our goal is to take care of patients
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safely and to help them be as healthy as possible.
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If you work in the ICU, it feels as if your game is to not let patients die, maybe.
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But anyway, our goal is patient care, right?
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The overall health and well-being of the patient.
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OK.
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So that's the part that is patient care.
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And then administration, the goal of an administrator is to make sure things run smoothly, is to
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set the direction of the organization.
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And OK, I forgot about another mission, the mission of education, which is different from
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the mission of scholarship, because scholarship is about research and it's about moving forward
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knowledge.
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So then there's the part of education.
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And the goal of education is to educate the mind, the mind of usually students in the
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institution who bring in money to the institution through their tuition that they pay.
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And that is the goal of education.
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So for us, clinical faculty or academic clinical faculty, there's a little bit of confusion
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because scholarship is part of our role.
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Though for many of us, we really have more of a clinical role than we have a scholarship
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role, yet we're still required.
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We're still held to a scholarship standard.
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However small that may be, there's still a scholarship standard.
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And then there's also a need for teaching.
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And so teaching, clinical care, and scholarship sometimes clash with each other.
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We try to do our clinical care in the context of education, but sometimes educating limits
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our ability to do the clinical work well.
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But we recognize that the benefits of educating the next generation far outweigh the drag
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that it brings to our clinical work.
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Because if you were running by yourself, it would be so much faster.
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But if you're running with a trainee, it will be much more fun, though slow.
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So we're able to integrate the concept of education within clinical care.
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Okay, when it comes to clinical care though, and scholarship, how we can overlap them,
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they don't always overlap, but how we can overlap them is to make the scholarship relevant
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to the clinical care.
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But in executing the scholarship, they really don't go well together.
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So for example, you're in clinic, it makes it hard to write the paper.
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It makes it hard to write the grant.
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You have to finish with the clinic, dispense with the activities of the clinic before you
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can go do all the other scholarship work.
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But advancing scholarship is the goal of any academic institution.
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And any academic institution that abandons its scholarly work to focus solely on all
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its other work is no longer really an academic institution.
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It's an institution, it's a hospital probably, but not an academic institution.
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Okay, so now that's part of the challenge.
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As academic physicians, academic clinicians, we've got a lot of roles, and sometimes they
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don't overlap.
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Sometimes your ability to provide what people say is excellent patient care, which usually
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is seeing as many patients as possible, and that may or may not be excellent.
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We can talk about that another day.
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Just being able to do that does not allow you to move the scholarship forward.
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And so then the question is, which do you choose?
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And that's a challenging question, but we're not really here to talk about how you prioritize
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one over the other.
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But I do think that our institutions do that for us, right?
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When we are coming into a faculty position, we're agreeing, I mean, 50% clinical and 50%
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research.
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So agreeing at the split of our hours is between clinical and research.
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Now obviously it's more complicated than that.
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It's never exact, but you know, on paper, that's what it says.
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And so, but whenever there is a need to kind of like overstep the boundary of your scholarship
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and pull you in to do more clinical, let's say for example, there are five of you esteemed
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hematologists at the institution, and two people quit, all of a sudden there are three.
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My understanding is that being a team player means leaving everything else to make up for
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the load of two more people.
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And I think the question I would ask is, is that playing the right game?
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Is it really being a team player to drop everything and pick up the load of two extra people?
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Is that really playing as a team?
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And that's the context in which I keep hearing the term team player.
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It's like, hey, leave all your work so that you can help the team.
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But I think it's important to define the goal of the team.
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I think it's also important to define who is included on the team.
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Now when a championship team wins a championship, everybody celebrates the trophy together because
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the trophy belongs to the team.
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Now if you leave the team, you don't get to take the trophy because the trophy belongs
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to the team.
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But in a championship game, everybody gets a championship ring.
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And no matter where you go, the championship ring stays with you.
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So in the context of playing on a team, it's important to recognize that only the members
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of the team get to claim the reward of the team.
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If for whatever reason you are not a member of the team, when it comes to the time for
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the reward, you don't get one.
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For example, let's say you've been following this basketball team around for a while and
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you didn't know that all along you were actually just the janitor and they were giving you
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a suit to wear and you were not allowed to play and nobody told you you were not on the
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team.
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But they were doing some weird shady things that make you think, am I really on this team
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or not?
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When it came to time to collect the championship ring, it became clear who was on the team
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and who was not on the team.
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OK.
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And so that's one of the things that comes up, especially for people who are underrepresented
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in academia, is a question of who is really on the team and are you counted as an equal
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and respected member of the team?
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I think this is something that's important to clarify because it defines your role on
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the team.
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Are you actually there as a true player that is respected for their contributions to making
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the team advance?
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And so the two components, it's like, what's the game that's being played?
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How do we know we win?
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And who is a true member of the team?
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So I say all that to set the stage for the points that I'm going to raise.
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Number one is that the game of academia is confusing.
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It's confusing because, you know, in a regular game of basketball, the rule is very clear.
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You're trying to get your baskets and then your shots in the basket and you're trying
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to do it and prevent the other team from doing it so that at the end you have more shots
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in your basket than the other person.
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In academia, the game can be confusing because it's not always clear exactly what that game
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is.
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But I would argue that if we're in academic medicine, if we're in an academic institution,
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then scholarship is the win because scholarship is what makes the academic institution academic.
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And everything else really rests on the foundation of scholarship.
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And I get that patient care is the foundation of our institutions because we must care for
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the person, but we care for the person in the context of scholarship and we don't get
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to really advance patient care until we can advance scholarship.
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So really, scholarship and patient care are integral and one should not have to suffer
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at the expense of the other.
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And I believe it's possible that both can move forward together.
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But academia can be confusing because sometimes what I see people saying is that, no, no,
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no, clinical care matters more than scholarship.
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And I think the reality is that scholarship and clinical care must move forward and sometimes
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scholarship is critical to advance clinical care.
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And so the game of academia is confusing and that's why it's important to clarify, hey,
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if we're talking about being a team player, let's clarify the game we're playing and
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what the rules of the game are.
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Okay.
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Number two is that academia is about excelling in scholarship, right?
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I'm here to excel in scholarship.
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If I was here only to excel in clinical care, I wouldn't be here because I'm at an academic
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institution because there's an academic focus to my clinical care.
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So I would like to argue that academia is about excelling in scholarship within the
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context of patient care and within the context of learner education.
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Okay.
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Number three is that taking on more academic work can hurt your scholarship.
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Because in order for you to do scholarship within the context of an academic institution,
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you do need to have space created for the scholarship.
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And whenever, number one, you're not given space to do the scholarship or your time for
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scholarship is taken away in favor of another task, no matter what the task is, then it
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hurts your scholarship.
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If I take on more non-academic work, it hurts my scholarship and therefore in the grand
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scheme of things, it hurts the team and we don't win in the way we're supposed to win
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in scholarship.
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Okay.
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Number four is that when people ask you to be a team player, they're not saying, hey,
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you should be a team player.
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You need to continue to advance scholarship.
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They're saying, hey, you need to be a team player.
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You should do less scholarship so that you can take on these non-scholarship tasks because
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these non-scholarship tasks make you a team player.
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But do they really?
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If we are down two physicians in a practice that needs five physicians, then it means
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we don't have capacity as a team to take care of the patients we have and then we have to
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decrease our capacity.
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Right?
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So if we are working in a factory and one of the machines breaks down, then it means,
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okay, well, we're not able to fulfill our quota today.
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But if we say, well, the machine is down, therefore I'm going to try to work like a
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machine, I might break in the process and that's a problem as well.
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Now, as institutions, we are responsible for making sure that the people who are working
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with us do not break in the process.
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Let's go back to the sports analogy.
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A player is playing and gets hit on the head, has a concussion, the game stops.
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The game stops long enough for the player to be carried out, usually on a stretcher,
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to be attended to because a hurt player in the game is no benefit to himself or herself
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and is not a benefit to the team.
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Why is it in academic medicine that we allow people who are hurt to continue to play, they're
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getting more hurt while the game is going on and the institution of the team is suffering?
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That's not being a team player.
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So somebody is saying, hey, I'm not going to give you any extra support or any extra
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effort or any extra time for taking on additional work, which I know is actually stressful to
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you and your life outside of academia, then they're not really playing a game that is
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a good game and that game doesn't lead anybody to win.
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Playing with a team full of players who are hurt does not lead the team to a win.
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Playing with players who are overstretched beyond their capacity does not lead to a win
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for anybody.
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So this concept of asking people to become team players by taking on more tasks that
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do not enhance their scholarship or the scholarship of the institution is suspect.
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Point number five is that when women and people who are underrepresented in medicine are asked
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to be team players, they're usually being guilted into taking on projects that may not
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advance them.
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Hey, be a team player.
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Will you take on this task?
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It's a guilt strategy.
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I've noticed it.
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I've noticed it.
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It's a guilt strategy.
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Or I should say it's a strategy of inducing guilt.
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Oh, be a team player.
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Take on this project.
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But that project may not advance you.
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And if it doesn't advance the player, that means it doesn't advance the team.
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Any strategy that doesn't advance the player doesn't advance the team.
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OK, let me go back to the basketball analogy.
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So this last game I went to play, I went to see my son didn't play in the game the whole
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time.
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So he didn't get play time, but that's fine.
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Play time is not the only time that you get to play.
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You get to play also when you're practicing.
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You get to enhance your skills.
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Your skills are enhanced the more you play.
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But I could see that it was a tough game.
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And I could see that in that game, they only wanted to field their very, very best players.
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So literally the same five kids played the entire time.
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I got it.
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It was a really tough game.
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I was a little worried.
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I was like, wow, never seen elementary school.
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Actually, they were not elementary age.
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They're middle school.
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They really played.
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It was one of those really important fights.
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Or I should say it was a game.
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It was a really important game.
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But anyway, so he didn't play on the game, but that's fine.
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As part of the team, we expect that throughout the season, there are games that he's going
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to be able to play.
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And there might be games where he may not play as much.
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But at the end of the day, there is development of the player that comes every time the player
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is asked to play.
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If a player is not asked to play throughout the season, then they're not being developed.
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And that means the team is not being developed.
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And if any of those five players have major injury and none of the other players have
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been developed, then that means that the team doesn't really get to move forward in the
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same way.
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So I think I'm saying all of this to say that any game that does not benefit players and
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benefit players by helping them advance and grow is not a good game for either the team
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or the players, as long as these team members are actually part of the team.
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So any game that says some people don't get support to advance doesn't actually advance
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the whole team.
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Any game that says some people are the only ones responsible for X, Y, Z, whatever that
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may be, is not really a game that's good for the team or for the player.
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So what I want to say with my point number six is that when people ask you to be a team
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player, I'd like to ask you to pause.
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Ask them to define the game, ask them to define the win, and help clarify that you're actually
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a member of the team.
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And this is important because I think what we're seeing in academia is that there are
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a couple of games being played at the same time.
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It's not all a cohesive game that clearly leads to a win.
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And that's okay.
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You know, you think about a basketball season, there are several games being played all on
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the way to the championship game.
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And so it's fine.
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But you want to be clear.
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When someone says, hey, be a team player, say, hey, what's this game?
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And how do we know that we win?
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And am I a member of the team?
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Am I?
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Am I a member of the team such that when the win happens, I am also part of the win?
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And this is the point at which I want to stop and recognize this concept of Simone's Maxims.
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I don't know if you've heard of them.
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Dr. Simone is a guy who wrote an article.
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Actually, he did a lot more than write that article.
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But that article anyway was introduced to me by a colleague.
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And he would always bring up the article whenever we got upset with the institution.
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Like I can't believe this happened to me.
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It's like the institution doesn't love you back in Simone's Maxims.
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So I think there are like maybe seven to 10 Maxims.
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And it just reminds you of how you and the institution are different.
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For example, it talks about how the institution has a long time horizon.
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And so you can't be comparing yourself to the institution.
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The institution will be here long after you get back and long after you're done.
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And so you want to be clear that your time horizon is different from the institution's
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horizons.
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One of the favorite things, one of the favorite pieces of advice from that article my colleague
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would bring up each time is that the institution doesn't love you back.
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This is important because sometimes there's this sense that as clinicians, our job is
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to sacrifice ourselves on behalf or on the platform of the institution, which is not
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appropriate.
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Because if we burn ourselves in the process of trying to bring light to the world, then
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at the end, there is no light and we're still gone.
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And so when people ask you to be a team player, you want to be clear, what is this game that
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we're playing?
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Because not every game is a good game.
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Not every game leaves everyone in the team with a win at the end.
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Not every game is considering all team members to be equivalent, equal, respected members
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of the team.
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So especially if you are underrepresented in the academy, you want to be clear when
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people ask you to be a team player that you understand the game, understand the win, and
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to clarify that you are a respected team player who's going to be part of the win when the
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win is announced.
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So my very final point to you is that you should ask these questions so that you can
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decide for yourself if it is in fact a game you want to play.
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You should decide for yourself if it is in fact a game that you want to play.
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I will say that every game is not a game to be played.
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It's like the Hunger Games.
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It's like, oh, these are games.
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But at the end of the game, some people die.
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Is this the game you want to play?
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You got to decide that.
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And so my call to action this week is to ask yourself if the game you're playing is the
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one you want to play.
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And I'm going to ask you, if you're not clear what game it is you're playing to go clarify,
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please don't play a game where at the end you burn up as part of the games being played.
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Don't play it.
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But if you're going to play it, you want to play it intentionally.
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You want to know that, oh, OK, this is the game I play where at the end I'm sacrificed
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at the end of the game.
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You want to know.
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Because if you want to do that, you should do that.
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That's called being in the military.
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It's like I am serving on behalf of my nation.
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And if I die in the process, this is the price I choose to pay.
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It's serving the military, but it's not playing a basketball game.
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Playing a game is not the same as serving the military.
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But what I want you to do is to clarify what you're doing, what game you're playing when
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people ask you to be a team player so that you can decide, is it time?
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Is it time to stop being a team player?
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All right.
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I am glad to have brought you that episode.
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Clearly, I have a lot of thoughts in my mind surrounding that episode.
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I'd like to hear your thoughts.
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And I also want to invite you to consider coaching, because I think it transforms your
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life as a clinician, especially a clinician who's trying to build a research program,
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when you might not actually have the support to do that.
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So let's talk about how I can help you shape the career that you actually want to have.
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For everyone else, I invite you to please share this episode with somebody else who
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needs to hear it, because it's important that we are playing games that we want to play,
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and that at the end of our sacrifice, at the end of our really pulling, we know that the
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award that's coming to the team is also coming to us.
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And I invite you to please share it with someone else who needs to hear it today.
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All right.
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Thank you for listening.
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I look forward to talking with you again the next time.
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Thanks for listening to this episode of the Clinician Researcher Podcast, where academic
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clinicians learn the skills to build their own research program, whether or not they
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have a mentor.
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If you found the information in this episode to be helpful, don't keep it all to yourself.
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Someone else needs to hear it.
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So take a minute right now and share it.
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As you share this episode, you become part of our mission to help launch a new generation
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of clinician researchers who make transformative discoveries that change the way we do healthcare.