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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today.
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Thank you so much for tuning in.
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Today I am talking about the MD and PhD partnership.
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The MD and PhD partnership.
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I think that this may be one of the most overlooked and underutilized partnerships in all of clinical
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research.
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I say that because of my perspective as a newbie clinical researcher, always looking
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around at the clinicians around me.
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That was my environment.
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I was surrounded by clinicians in my division.
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Most people are clinicians.
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We do have a few PhD scientists that are within our division, but we're mostly clinical people.
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So when we gather, we're talking about the last patient.
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We're talking about the schedule.
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We're talking about call.
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We're always talking about things that are clinical.
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And then when we think about collaboration, well, we just look to each other and we say,
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hey, let's collaborate on this project.
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But the challenge is that we all kind of think the same way.
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If we didn't think the same way before we came to our faculty positions, when we've
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spent enough time together taking a call, talking about patients, attending conferences
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together, we really start to think the same way.
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And not many new things can come out of thinking exactly the same way.
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And so one of the beauties, one of the privileges of connecting with a PhD researcher is you
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suddenly are thrust into a place of new ideas or a person who has different ideas.
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They don't spend all the time with patients.
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They don't spend all that time talking about clinical stuff.
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They have different ideas and it can absolutely energize and enhance your research.
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So I want to talk about the MD and PhD partnership.
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And I hope that at the end of this, you'll think about who are the PhDs in my life.
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And I'm assuming you're MD only, you're not a PhD researcher.
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And even if you are an MD PhD, I want to let you know that you spend a lot of time thinking
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about clinical care, assuming that you have a significant clinical component.
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Even if it's just 25%, you spend a lot of time in your brain thinking about your patients.
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And so the more partnerships you have with people who don't think like you, the more
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beneficial.
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I'm going to tell you seven reasons why.
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Number one is that when you come together with a PhD scientist who is not in the clinical
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space, you have access to more resources, the two of you combined.
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What do I mean by that?
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Clinical departments are geared to support clinical things.
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What does that mean?
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Well, when we're looking to hire, we're looking to hire medical assistants, we're looking
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to hire nurses.
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And honestly, the way things go in medicine, there's always a need.
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And so there is a lot of heavy focus spent in building the clinical infrastructure.
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Most clinical departments are funded by clinical dollars and therefore the priority will always
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go to the thing that funds it the most.
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And so if clinical dollars fund the priorities of the department, guess where the money's
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going to go?
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To building clinical resources.
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So you as an MD, when you come to the MD and PhD partnership, you end up having a lot of
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clinical resources.
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Yeah, your MA is probably not involved in research, but she lets you know when the patient
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is coming in who is eligible for your trial.
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Everybody in the clinic knows that the trial is open or accruing.
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And so you are able to support anything that has to do with the clinical domain when it
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comes to samples.
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Of course you can get samples.
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The patients will give you their blood.
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They give you their blood all the time.
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Of course with consent.
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But what I'm saying is that as the MD, you bring a wealth of clinical resources to the
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project that your PhD researcher likely doesn't have access to.
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Okay.
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How about the PhD?
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Okay.
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So they don't have all the patient access, but you know what?
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Their departments are largely funded by education dollars and research dollars.
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And so they have access to the postdocs who will work with you on the project.
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They have access to research infrastructure because you know what?
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When they're not teaching, they're able to do research.
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They have a lot more time and a lot more training dedicated to research than you do.
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And so a lot of the research resources, the people who know how to do qualitative interviews,
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the people who know exactly how to schedule patients, those kinds of things.
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They're all available.
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For example, we had a recent team meeting with one of our research projects and my collaborator
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is a measurement scientist.
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And that's what they do.
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They interview patients qualitatively.
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And so they have a team that'll be available to interview patients during the daytime.
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And they have a team member who's available to do the evening interviews.
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And so here we are in medicine saying, oh, I'm too busy.
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I'm not going to be able to do this time.
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And they have a team that's structured to facilitate qualitative interviews of people
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who have real life.
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Wow.
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I mean, that just feels actually, it's still a little bit overwhelming to me.
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I'm like, what?
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You have a team member who works the evening shift?
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Okay.
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My point is that there are resources that are different and they're different because
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we have different perspectives and we have different priorities.
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We have different things that we think are more important than others, right?
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And so we are optimized to have clinical care kind of be the driver of a lot of the resources
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we have.
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And they are optimized to have research and education be the driver of a lot of the resources
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they have.
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And when you bring that together in partnership, that's synergy because you can bring together
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a lot of clinical resources and they can bring together a lot of research resources.
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So it's really awesome.
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Okay.
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Access to a broader research pool.
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That's number one.
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Number two is complementary expertise.
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What I said at the beginning, your MD brain is thinking about patients a lot.
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You're thinking about that case that you can't crack.
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And then you gather together with your colleagues and you start talking about the case and somebody
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else has another case.
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Similarly, you get to conferences, you're mostly talking about clinical cases.
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You're always in the clinical perspective, which is excellent because hey, everything
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we do in research is with the end goal of serving patients.
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And the people who are focused on flies, who are focused on worms, at the end of all of
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these discoveries is to serve patient care, is to serve patients.
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And so your very largely patient focused perspective is so important and it's not enough.
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And so the PhD researcher comes with deep methodologic expertise.
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I don't care how much time you spent doing research in your fellowship, or maybe you
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even went and got a PhD.
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You have not spent nearly as much time as a PhD researcher has spent thinking about
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and conducting research.
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I will meet a lot of MD PhDs who said, well, I spent the same amount of time.
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And it's like, no, it's not the same.
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It's not the same when you were in your clinical space for a couple of years and then you came
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out and you went back to your PhD and you came out and went back.
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It's different.
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It is different.
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And it's not saying that you're any less qualified because I also get that too, where some of
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my MD PhDs would be like, I'm not less qualified.
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And I get that.
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But it's a pain point where sometimes you feel like you're inferior because as the MD,
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you come to the clinical space and people are like, oh, you've been in the lab for the
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last three years.
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What do you know?
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And then you go to the PhD space and then they're like, eh, you're always in the clinic.
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What do you know?
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And so there's this feeling of where do I belong?
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And I get that from my MD PhDs and I just want to honor that.
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And I also want to say that you have a different perspective that a PhD scientist doesn't have
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and an MD scientist doesn't have.
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You have a unique perspective.
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So celebrate that.
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You're not like everybody else.
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You're unique.
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But the reality is, and when we look at PhD researchers, they've had more time, more focused
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time over time invested in research in a way that MDs have not had the luxury of having.
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And so when you bring down, bring together your expertise in mostly clinical care, even
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if you have an MD PhD and you have research experience, a PhD scientist is bringing a
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totally different perspective.
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They don't have the clinical perspective, but their expertise is deep in a certain area
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of research.
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Their methodologic expertise is big.
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And they have a team that has complementary expertise as well.
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They're working with a postdoc who also has expertise in this area.
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You bring your team together and their team together and it's a powerful synergy.
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So the second benefit is complementary expertise.
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The third benefit is that you're bringing diverse perspectives.
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And I don't have to go into this for too long because that kind of speaks to the things
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I've talked about earlier.
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You are very clear on how the patient can be helped.
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You're very clear on the definition of the disease.
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You're very clear on who's an affected individual, who's not.
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You know all these things.
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You take them for granted.
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You have no idea that nobody else is thinking like you.
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For example, one of my great colleagues and friends, we write together and we have a project
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that we're doing together and we are focused on a disease called TTP, thrombotic thrombocytopenic
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perfora, for those of you who remember.
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And TTP is not ITP.
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So there's some confusion in the literature where people want to say immune TTP is ITTP,
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which is so confusing because immune thrombocytopenia is ITP.
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I mean, whose idea is this?
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Okay, I'm going to get off that box right now.
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But it's confusing to the best of us.
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And so if we're paying attention as clinicians, we're like, of course, ITTP is not ITP.
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My colleague has no idea.
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She has no idea that we're confused enough to use the same kind of three letters to describe
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two different diseases that are very similar.
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Why would I think a thrombocytopenic disease that's ITTP is different from a thrombocytopenic
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disease that's ITP?
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Why wouldn't we just call it a different name?
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Okay, I'm going to come back down because that does irk me.
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This is really confusing.
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I know as a hematologist, I will never be confused.
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I know ITP is ITTP, but you know, if it was just hematologists reading the literature,
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then yes, call it whatever you want.
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But anyway, I digress.
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But when my PhD scientist goes looking in the literature, she comes back with papers
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who have that and they're all talking about ITP.
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And she's like, oh my gosh, this is so exciting.
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In fact, I've seen published papers where people are talking about ITTP and they're
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actually they have a cohort of patients who have ITP.
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So they're like, oh my gosh, bleeding is increasing this population.
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I'm like, but this is the wrong population.
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Who was your partner?
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So we come with diverse perspectives.
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So in clinical things, as an MD, you know, you know the deal.
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You would never be confused that ITTP is ITP.
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You would never be confused.
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The PhD scientist doesn't think about anything clinical.
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In fact, they know methodology inside and out.
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And they would never be confused about certain assays or certain experimental methods.
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For example, yesterday I was in a meeting with two biostatisticians and they were speaking
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and I literally was doing this.
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Like, OK, if you're listening to me, I was like my head would turn to the left and then
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I would turn to the right and then I would look at the person on the left and I would
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look at the person on the right and I would be like, holy cow, I don't understand what
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you're saying because when they get together, they speak a different language.
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And they have totally different perspective from me and it's so beautiful because when
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they start flying off into biostatistical heaven, I pull them back down and I say, hey,
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the problem we're solving is here on Earth.
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It is so beautiful.
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But they have diverse perspectives that really come together and give us like a brand new
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view of the problem.
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And so here, it's kind of like two eyes coming together to see in a way that one eye can't
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see alone.
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It's like you have the peripheral vision and it just comes together and it gives you compound
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vision in a way that one eye, which is doing great by itself, can't do except when two
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eyes come together and then they're really able to give you a really great perspective.
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You can see all sides, all sorts of things.
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And so diverse perspectives are so important and you don't get more diverse than the MD-PhD
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partnership.
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Now, you think you're diverse when you jump from hematology, you'll meet a pathologist
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at some diversity, but it's still a very deep clinical orientation.
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So diversify your clinical team, yes, but especially diversify your research team with
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deep PhD methodologic expertise.
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Okay.
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Oh, one of the things, one of the ones I'm most excited about is number four.
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Can you tell I'm so excited?
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It's about peer mentoring.
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It is about peer mentoring.
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It's about the fact that the two of you come together, you start finding out that you think
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differently about things, you know different things, and now you can educate each other.
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For example, when my PhD scientist collaborator comes to me with an ITP document and she's
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so excited about what she's learned, I can educate her about the difference between ITP
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and ITTP.
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I can do that very easily and not in a judgmental way because we're colleagues.
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And when I say, oh, this is not, this instrument is not valid, she can gently correct me and
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say, well, what we say is that there is no validity evidence.
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You know, that just doesn't feel as powerful.
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It's not valid.
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It feels more powerful than there's no validity evidence.
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So I'm always, it took me a long time to move away from this.
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These instruments are not now, but it's great.
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It's great peer mentoring because I'm learning.
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I'm learning.
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I have never taken a qualitative research methods course and perhaps I should, but I
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haven't.
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I'm working with somebody who's an expert in qualitative methods.
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This person teaches qualitative methods and I learned so much just by being around her.
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I don't even have to audit her class.
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I can just be around her and learn so much.
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And she can be around me and learn so much about clinical things.
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And so it's a beautiful peer mentoring that happens as well.
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When we write grants, the way we write, I write and then she's like, well, you know,
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you couldn't, you wouldn't really say it this way because they speak a whole different language
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than I do.
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And similarly when she writes it, I say, oh, clinically we would not do this.
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When we say, oh, these are the end points we're going to measure, I would say, clinically
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these are not meaningful.
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And so we're mentoring each other and it's so powerful, so powerful because on the one
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hand when you're thinking about your mentor mentoring you, it's a hierarchical relationship.
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And there are some things you're afraid to ask about because you feel like you should
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already know them.
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And sometimes you ask and your mentor looks at you saying like, you don't know that?
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And even when they're trying to be, they try to be nonjudgmental, you feel the hierarchy
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of their position.
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You feel it because medicine is so hierarchical.
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And so when you work with a collaborator, a PhD scientist who's maybe at your level,
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and even if they're not, you're learning from each other.
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It's a beautiful peer mentoring relationship.
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That's powerful.
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You're both learning.
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It's nonjudgmental.
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You're advancing.
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It makes your experience fun.
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So yes, number four is my favorite one is that peer mentoring happens because you're
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coming from different disciplines.
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And if you're going to be able to work together, you have to speak the same language and you
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both can come together to do that.
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Number five is that you also get access to interdisciplinary grant opportunities.
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So when me and my collaborator came together, I'm going to shout her out because sometimes
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she listens to this podcast.
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Hey, Theresa.
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When we come together, we have different grant opportunities.
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So my collaborator will say, hey, I have a lot of experience writing grants and being
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successful with FDA.
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I don't have as much experience in writing grants and being successful with NIH.
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And at the time, I actually didn't have experience being successful with grants with NIH, but
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we came together and we wrote a grant for NIH and we were successful.
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And we're going to come together, we're going to write a grant for FDA, and we're going
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to be successful.
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You know, we both have different opportunities and interdisciplinary opportunities come together
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when we come together to write grants.
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And so it's a really beautiful opportunity to now expand the bucket where you literally
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have the three grants in your society that everyone applies for.
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You can now really expand the pie and now you can apply for grants that only PhDs apply
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to, but you are collaborators together.
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So there's the part for you as the MD and there's the part for you as the PhD.
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And so you have access to more funding opportunities than you do if you're going it alone with
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just you and your clinical team.
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It is a beautiful thing.
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Your wealth is involved in this partnership.
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If I haven't sold you on this partnership by now, I feel like I will get you.
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I have two more things to talk about.
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Number six is that when you write grants together, there is powerful synergy.
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There is powerful synergy.
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So I will tell you that one of the most fun experiences, oh my goodness, that I've ever
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had writing grants was writing a grant with my PhD collaborator.
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It was so fun because one, we both owned the grant and we both really came at it with diverse
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perspectives and complementary expertise.
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Now when it comes to background and significance, I own the grant.
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And I say that not bragging, with humility, but just saying that I understand where this
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applies to patients because I think about patients a lot.
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I certainly think about patients a lot more compared to my PhD scientist collaborator.
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And she knows how it can help people, but not to the extent to which I know because
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I've been thinking about clinical medicine for over 20 years.
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So yeah, I can write the background and significance and really relate it to patients really well.
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And it doesn't mean she can't do that.
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It just means that it's easier for me to do.
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So I will take the background significance first and I'll write it.
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And she, oh my goodness, she's king when it comes to methodology.
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I mean, I have an idea and sometimes I've put together some nice paragraphs with methodology.
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But to be honest, she's so much better than me.
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She's faster.
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She's just, wow, she's good.
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She's really good.
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And so we divide and conquer the grant.
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I say, I'm going to write the background significance first.
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You focus on the approach and then we're going to switch.
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Because now when I go back to like revising the approach, I revise from my clinical perspective.
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And when she goes to revise the background significance, she's revising from her PhD
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methodology expertise.
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And so it is powerful synergy.
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I mean, we write great grants together.
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And so I remember the first time we wrote a grant together.
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And I mean, it was just such a powerful experience.
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And I knew, I'm like, this is a good grant.
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We both felt that way.
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Like, this is a great grant.
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And I have to tell you, I got on a plane and there was the worst kind of turbulence.
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I mean, there was someone screaming on the plane.
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That's how bad the turbulence was.
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It was turbulent.
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And I remember thinking, I was like, this plane is not going to go down because we just
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wrote a great grant.
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That's how much confidence I had in the grant.
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I mean, the confidence is not in the grant.
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But just I was like, I had such a sense of purpose about the grant.
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Like the work we were going to do felt so powerful.
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I knew there was no way I was going to die before doing that work.
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I was like, nope, I'm not crashing in this plane.
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I know that for a fact.
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And it came from the powerful synergy we had of writing the grant.
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I would tell you, even if I got on the plane that day, I was the last person on the plane
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because I was putting some finishing touches to like one of the pages of the grant.
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And I was like, I'm going to finish this page before I get on the plane.
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It was such a synergistic grant writing experience.
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It absolutely was.
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And I do want to pause and say that you have to find the right person.
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This is not like, oh, every PhD scientist I write with is going to be a powerful, you
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know, powerful experience.
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I've written with other PhD scientists where they literally were like, you're on your own.
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Good luck.
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Show me the grant and I'll help you edit it.
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This was really two of us coming together to really write something that was synergistic.
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And so it has to be mutual commitment.
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You don't just find someone off the street and say, well, write with me.
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There's relationship building.
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There's chemistry.
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That is important.
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But it really is a powerful synergy when two people who are like-minded, but from different
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perspectives come together to create something.
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It's really a powerful synergy.
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Finally, increased productivity.
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Increased productivity.
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You know, this one probably doesn't need too much explanation.
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You both have different perspectives.
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You can submit to different journals.
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For example, we have manuscript and we're like, should we submit to a qualitative research
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focused journal, health services focused journal?
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Or should we submit to a hematology focused journal?
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We have options.
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And so, yeah, we can do that.
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And for example, we're thinking about a project that we're working on together and we're like,
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okay, well, why don't we lay out what the landscape should look like?
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How about we just write a paper that describes why it's important for us to do the work we're
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doing?
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Let's lay the foundation for why our work is important.
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I mean, we did that in the grant anyway, so why not just write the paper out of it?
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And then as we're starting to work, we're like, wait a minute, why don't we publish
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our protocol?
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Wow, there's another manuscript, right?
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And I'm working on some manuscripts, she's working on other manuscripts.
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It really allows us to be super productive.
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And then we have different avenues that we can send our work to.
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And so it's a really powerful, powerful, powerful experience.
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Okay, so I shared seven things.
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I shared seven things.
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I want to summarize them.
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Access to border resource pool.
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You get access to a broader resource pool.
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You have complementary expertise, diverse perspectives.
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You can mentor each other, so peer mentoring.
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You have interdisciplinary grant writing opportunities.
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You have synergistic grant writing, and you have increased productivity.
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So if you are an MD researcher, even if you're MD PhD, and you're like, oh, I don't really
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have any PhD scientists in my collaboration pool.
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I want you to think about who is like you, similarly looking for opportunities.
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Many times we're looking for the senior mentors just to give us the light of day.
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And in reality, they're so full, they don't care about us, right?
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They're not hungry.
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But there are people who are on the same level as you.
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They are early career, and they are hungry for collaborators.
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And you are an expert person that they can partner with.
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Yes, you don't have all the resources.
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Yes, you don't have all the opportunities.
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But wow, when two of you come together, you can really create something amazing.
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So who might you partner with?
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I want to invite you to think about your PhD friends, or at least somebody who can link
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you to a PhD colleague who has complementary expertise.
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And see if you reach out to them and set up a meeting, just this week.
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Set up a meeting and talk, see what's possible.
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And I'd love to hear about how the conversation went.
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And it may be that it goes well, and you start thinking about a collaboration, or it may
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be that it doesn't go well.
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But at least you are working to expand your networks and to create the kind of synergy
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that allows you to really go far.
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All right.
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It's been a pleasure talking with you today.
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As always, if you're looking for a coach, I'm happy to support you in that process.
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And I want you to succeed, because we need more clinicians winning in research.
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And it's so hard, because we're not set up to do it.
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Our clinical departments, even though they tell us they want to do research, they don't
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really support us to do it.
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And so it takes time, it takes effort, it takes energy.
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And I would love to see you win.
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All right.
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Until next time, I look forward to talking with you again on the Clinician Researcher
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podcast.
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Have a great day.
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Thanks for listening to this episode of the Clinician Researcher podcast.
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Where academic clinicians learn the skills to build their own research program, whether
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or not they 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.