1 00:00:00,000 --> 00:00:05,860 Welcome to the Clinician Researcher podcast, where academic clinicians learn the skills 2 00:00:05,860 --> 00:00:11,260 to build their own research program, whether or not they have a mentor. 3 00:00:11,260 --> 00:00:17,340 As clinicians, we spend a decade or more as trainees learning to take care of patients. 4 00:00:17,340 --> 00:00:22,380 When we finally start our careers, we want to build research programs, but then we find 5 00:00:22,380 --> 00:00:27,780 that our years of clinical training did not adequately prepare us to lead our research 6 00:00:27,780 --> 00:00:29,200 program. 7 00:00:29,200 --> 00:00:35,480 Through no fault of our own, we struggle to find mentors, and when we can't, we quit. 8 00:00:35,480 --> 00:00:40,580 However, clinicians hold the keys to the greatest research breakthroughs. 9 00:00:40,580 --> 00:00:46,200 For this reason, the Clinician Researcher podcast exists to give academic clinicians 10 00:00:46,200 --> 00:00:51,800 the tools to build their own research program, whether or not they have a mentor. 11 00:00:51,800 --> 00:01:01,120 Now introducing your host, Toyosi Onwuemene. 12 00:01:01,120 --> 00:01:04,000 Welcome to the Clinician Researcher podcast. 13 00:01:04,000 --> 00:01:06,240 I'm Toyosi Onwuemene, your host. 14 00:01:06,240 --> 00:01:11,840 I'm super excited to be here today because I have a really great special guest, Dr. Alfred 15 00:01:11,840 --> 00:01:14,160 Lee, who's going to introduce himself in a minute. 16 00:01:14,160 --> 00:01:18,720 But I want to tell you that he is a program director of an esteemed Hemong Fellowship 17 00:01:18,720 --> 00:01:23,680 program and is just really here to give us insights that can help fellows succeed in 18 00:01:23,680 --> 00:01:25,560 the fellow to faculty transition. 19 00:01:25,560 --> 00:01:28,880 So without further ado, I'm going to ask him to introduce himself. 20 00:01:28,880 --> 00:01:30,800 Alfred, welcome to the program. 21 00:01:30,800 --> 00:01:31,880 Thank you for being here. 22 00:01:31,880 --> 00:01:33,600 Oh, thank you so much, Teyasi. 23 00:01:33,600 --> 00:01:35,640 I'm really honored to be here. 24 00:01:35,640 --> 00:01:39,760 And it's exciting what you're doing with this podcast and the conversations that you're 25 00:01:39,760 --> 00:01:40,760 having. 26 00:01:40,760 --> 00:01:42,360 So once again, my name is Alfred Lee. 27 00:01:42,360 --> 00:01:44,900 I'm a classical hematologist. 28 00:01:44,900 --> 00:01:49,080 And as you know, because we're in the same field, that is the focus of the focus of studies 29 00:01:49,080 --> 00:01:52,600 on blood diseases that are not cancer primarily. 30 00:01:52,600 --> 00:01:55,760 And I also have a big focus in medical education. 31 00:01:55,760 --> 00:02:00,640 And with it, issues of mentorship and career development come up naturally in my role as 32 00:02:00,640 --> 00:02:02,120 a fellowship program director. 33 00:02:02,120 --> 00:02:04,280 Thank you, Alfred. 34 00:02:04,280 --> 00:02:08,160 I want to thank you so much for being here because I feel like we need so much of your 35 00:02:08,160 --> 00:02:09,400 perspective. 36 00:02:09,400 --> 00:02:11,400 And I think fellows need that too. 37 00:02:11,400 --> 00:02:16,920 And without further ado, I'm going to ask you, just you've been doing this for a while. 38 00:02:16,920 --> 00:02:22,200 And I want to ask, how can fellows set themselves up for success as clinician scientists? 39 00:02:22,200 --> 00:02:28,720 We talk about this, you know, having people become clinician scientists as the Holy Grail. 40 00:02:28,720 --> 00:02:30,400 And it seems to be really hard. 41 00:02:30,400 --> 00:02:32,800 How can fellows set themselves up to win? 42 00:02:32,800 --> 00:02:33,800 Yeah. 43 00:02:33,800 --> 00:02:37,880 So this is in many ways one of many million dollar questions. 44 00:02:37,880 --> 00:02:42,040 And I think all of us, particularly, you know, those of us who do medical education primarily 45 00:02:42,040 --> 00:02:49,400 are really invested in trying to understand, first off, how we identify the fellows who 46 00:02:49,400 --> 00:02:54,640 really want academic careers and are committed to this and will do well in academic careers. 47 00:02:54,640 --> 00:02:56,400 And then secondly, how do we get them there? 48 00:02:56,400 --> 00:03:00,160 And then thirdly, how do we ensure that when they leave the nest out of fellowship, that 49 00:03:00,160 --> 00:03:04,200 they'll be positioned to continue to have success in their academic careers? 50 00:03:04,200 --> 00:03:09,240 So the thing we've always said, and I think most of the literature, certainly outside 51 00:03:09,240 --> 00:03:14,840 of hematology, but emerging within hematology says is that it's all about mentorship, right? 52 00:03:14,840 --> 00:03:18,320 Mentorship, mentorship, mentorship, mentorship is key. 53 00:03:18,320 --> 00:03:23,720 Having a good research project during fellowship is also key because that's really where trainees 54 00:03:23,720 --> 00:03:28,260 learn their chops, so to speak, and learn the methodologies that they need when they 55 00:03:28,260 --> 00:03:32,220 enter in these, you know, what we like to call career defining projects within fellowship 56 00:03:32,220 --> 00:03:37,760 that will then, you know, hopefully lead to pathways in academic medicine after they finish. 57 00:03:37,760 --> 00:03:43,440 But oftentimes, and usually the good projects come with good mentorship setups. 58 00:03:43,440 --> 00:03:47,560 And so I think as a result of that, you know, there's been a lot of discussion lately about 59 00:03:47,560 --> 00:03:51,200 what good mentorship is and what the elements are there. 60 00:03:51,200 --> 00:03:55,900 As you may know, you know, ASH, American Society of Hematology, like recently did a big mentorship 61 00:03:55,900 --> 00:04:00,600 summit in DC headquarters that a number of us were part of. 62 00:04:00,600 --> 00:04:05,840 And the roots of this came from, you know, a study that we all sort of participated in, 63 00:04:05,840 --> 00:04:10,360 which was looking at the hematology workforce in the US for over a several year period. 64 00:04:10,360 --> 00:04:14,840 And what we found leading up to the pandemic and then afterwards was that, you know, the 65 00:04:14,840 --> 00:04:18,860 numbers and the percentages of fellows in hematology programs who wanted to do classical 66 00:04:18,860 --> 00:04:20,920 hematology was horrifically low. 67 00:04:20,920 --> 00:04:24,560 It was like 5% and it did not change in like 20 years. 68 00:04:24,560 --> 00:04:29,280 And so ASH started doing a lot of initiatives to try to improve recruitment and retention 69 00:04:29,280 --> 00:04:30,480 in classical hematology. 70 00:04:30,480 --> 00:04:35,520 And with that came this idea of trying to get a bunch of minds together to talk about 71 00:04:35,520 --> 00:04:36,520 mentorship. 72 00:04:36,520 --> 00:04:40,960 And so there was some very interesting things that came out of that discussion recently 73 00:04:40,960 --> 00:04:44,500 that are probably relevant to some of what, you know, you and I can discuss. 74 00:04:44,500 --> 00:04:50,920 So one is that mentorship, and this is built based on the literature and also on practice, 75 00:04:50,920 --> 00:04:56,000 mentorship has both a career development function and a psychosocial function. 76 00:04:56,000 --> 00:05:00,240 And you know, I think in academic medicine, we often emphasize the former a lot, right? 77 00:05:00,240 --> 00:05:05,440 We tell people, yeah, you got to find a research mentor, get in with them, get on their projects, 78 00:05:05,440 --> 00:05:08,560 you know, start to build your projects, apply for your grants, et cetera, et cetera, et 79 00:05:08,560 --> 00:05:09,560 cetera. 80 00:05:09,560 --> 00:05:14,480 But it's important not to overlook the psychosocial support function, because one, you know, you 81 00:05:14,480 --> 00:05:20,360 can't really have a great mentorship setup unless both of these domains are being satisfied, 82 00:05:20,360 --> 00:05:24,840 because that's where I think we see fellows have the greatest success long term. 83 00:05:24,840 --> 00:05:29,240 A second thing that sort of emerged from this recent mentorship summit that Ash conducted 84 00:05:29,240 --> 00:05:33,920 was that although we still emphasize a lot the traditional diet of mentorship, so, you 85 00:05:33,920 --> 00:05:38,880 know, one mentee and one mentor, increasingly, I think a lot of fields outside of hematology 86 00:05:38,880 --> 00:05:41,280 are sort of looking at mentorship networks. 87 00:05:41,280 --> 00:05:46,040 So you bring in different faculty and different role models from the peer stage all the way 88 00:05:46,040 --> 00:05:51,140 to the faculty and beyond, who can sort of be part of your whole mentorship tree and 89 00:05:51,140 --> 00:05:53,100 help you succeed. 90 00:05:53,100 --> 00:05:57,040 And then I think just one more thing I think that's important to think about, and again, 91 00:05:57,040 --> 00:06:01,920 plays in this whole aspect of mentorship, is that, you know, we have a lot, we put a 92 00:06:01,920 --> 00:06:06,860 lot of emphasis on discussion about finding a good mentor and what the qualities are in 93 00:06:06,860 --> 00:06:09,940 a good mentor, and that's sort of its own discussion. 94 00:06:09,940 --> 00:06:14,300 But I think we also don't emphasize enough that in order for good mentorship to work, 95 00:06:14,300 --> 00:06:16,160 it has to be a two-way street. 96 00:06:16,160 --> 00:06:18,780 It's really a relationship, right? 97 00:06:18,780 --> 00:06:23,800 And in order for any relationship to succeed, both parties or all parties have to be equally 98 00:06:23,800 --> 00:06:24,800 invested. 99 00:06:24,800 --> 00:06:29,160 And so there's a certain component, I think, of success as a trainee that then carries 100 00:06:29,160 --> 00:06:35,960 over in the post-trainee realm, and that's that the mentees also need to learn how to 101 00:06:35,960 --> 00:06:38,080 be good mentees, right? 102 00:06:38,080 --> 00:06:42,240 They need to learn, you know, what are, or how, what is their role in the relationship 103 00:06:42,240 --> 00:06:45,260 and what do they need to bring to the table and what kind of work do they sort of need 104 00:06:45,260 --> 00:06:49,420 to do on their own in order to gain the skills they need to be successful during fellowship 105 00:06:49,420 --> 00:06:50,800 for their future academic career. 106 00:06:50,800 --> 00:06:55,380 So you know, I think the short answer to your question is mentorship, mentorship, mentorship. 107 00:06:55,380 --> 00:07:00,220 But how we get there, I think, has a lot of nuance, and it's very exciting, but also challenging 108 00:07:00,220 --> 00:07:04,680 to think about how we can improve that whole experience for the trainees. 109 00:07:04,680 --> 00:07:05,920 I love that. 110 00:07:05,920 --> 00:07:08,740 Thank you so much, because you talked about so many things. 111 00:07:08,740 --> 00:07:14,180 I think one of the things that really spoke to me was about the psychosocial component 112 00:07:14,180 --> 00:07:20,500 of mentoring, and you may get great academic mentoring, but that piece is missing, then 113 00:07:20,500 --> 00:07:24,260 fellows may feel like they're not even getting what they want to, even though they may be 114 00:07:24,260 --> 00:07:26,080 getting great academic development. 115 00:07:26,080 --> 00:07:27,780 And so that's so important. 116 00:07:27,780 --> 00:07:34,220 I love also what you talk about with the whole focus on the diet of the mentoring relationship, 117 00:07:34,220 --> 00:07:36,380 but really thinking about mentoring networks. 118 00:07:36,380 --> 00:07:39,540 And it's kind of, it's not traditional. 119 00:07:39,540 --> 00:07:44,100 We've thought about mentoring in the traditional way, as you talked about, of like a one-man 120 00:07:44,100 --> 00:07:45,540 mentor, one mentee. 121 00:07:45,540 --> 00:07:47,900 And so how do we get out of that? 122 00:07:47,900 --> 00:07:51,060 How do we encourage fellows to start thinking about these networks? 123 00:07:51,060 --> 00:07:53,020 Yeah, it's a great question. 124 00:07:53,020 --> 00:07:55,220 And I have to be totally candid. 125 00:07:55,220 --> 00:07:59,740 When I was exposed to this idea of mentorship networks, it was actually a very new concept 126 00:07:59,740 --> 00:08:00,980 to me. 127 00:08:00,980 --> 00:08:04,860 When I was a fellow, so it doesn't feel like that long ago, but it actually was kind of 128 00:08:04,860 --> 00:08:07,540 a long time ago, but it was like 15 years ago. 129 00:08:07,540 --> 00:08:10,780 I used to tell people, I have three mentors, right? 130 00:08:10,780 --> 00:08:12,460 I literally say this all the time. 131 00:08:12,460 --> 00:08:16,100 So one mentor was the person I did my research with. 132 00:08:16,100 --> 00:08:19,700 And then the second mentor was the person I wanted to be. 133 00:08:19,700 --> 00:08:23,540 And then the third mentor was the person that I would gab on the phone with for like two 134 00:08:23,540 --> 00:08:27,860 hours every week and just tell this person my deepest dark secrets and what I wanted 135 00:08:27,860 --> 00:08:32,040 to do and get their advice. 136 00:08:32,040 --> 00:08:37,900 But in the midst of that, I always knew the responsibilities that each one had. 137 00:08:37,900 --> 00:08:42,420 And I did view one of them as not more important than the other, but one of them, I really 138 00:08:42,420 --> 00:08:45,300 if I had to put my money down, I would say was my true primary mentor. 139 00:08:45,300 --> 00:08:50,380 And by that, what I meant is I had full faith that if I succeeded, this person would feel 140 00:08:50,380 --> 00:08:51,380 that they succeeded. 141 00:08:51,380 --> 00:08:54,780 And if I failed, then they would feel like they failed. 142 00:08:54,780 --> 00:08:59,500 So the reason I say that is to say that I think when we think about mentorship networks, 143 00:08:59,500 --> 00:09:01,140 a few things come to mind. 144 00:09:01,140 --> 00:09:06,780 So one is that it's important for trainees to think about all the different domains that 145 00:09:06,780 --> 00:09:08,660 they need in mentorship. 146 00:09:08,660 --> 00:09:13,620 So there is going to be someone or some people who fill that traditional research domain, 147 00:09:13,620 --> 00:09:16,620 but there are also going to be people who fill that role modeling domain. 148 00:09:16,620 --> 00:09:21,580 And then there are going to be some who fulfill sort of the life advice domain, right? 149 00:09:21,580 --> 00:09:24,940 Sort of mirroring the three different domains that were important to me. 150 00:09:24,940 --> 00:09:29,380 But a second aspect to this is that I think it's still important. 151 00:09:29,380 --> 00:09:32,020 And what I'm about to say, I think is a little bit controversial still, so not everybody 152 00:09:32,020 --> 00:09:36,920 agrees with me on this, but I still think it's important even as we expand mentorship 153 00:09:36,920 --> 00:09:41,500 networks and go away from the traditional diet, I still think it is important to identify 154 00:09:41,500 --> 00:09:45,580 at least one person who really breathes and dies by you. 155 00:09:45,580 --> 00:09:49,140 I think that's important because what people have always said, and I think there's some 156 00:09:49,140 --> 00:09:54,020 truth to this, is that if you have a group of mentors, if you have dual mentors, if you 157 00:09:54,020 --> 00:09:58,740 have triple mentors, it's great because everyone fills different functions. 158 00:09:58,740 --> 00:10:01,820 But at the end of the day, if no one feels accountable for you, then that's not a good 159 00:10:01,820 --> 00:10:03,500 setup either, right? 160 00:10:03,500 --> 00:10:07,060 And maybe that's where some of the psychosocial portion of this comes in. 161 00:10:07,060 --> 00:10:11,860 So it's a long-winded way of saying that I think part of moving away from the diet into 162 00:10:11,860 --> 00:10:17,300 a mentorship network is to identify the needs that specific mentees require. 163 00:10:17,300 --> 00:10:21,780 But I think another portion of it is to still remember though that effective mentorship 164 00:10:21,780 --> 00:10:24,900 still needs someone senior to deliver. 165 00:10:24,900 --> 00:10:30,140 And if you lose that, then you kind of lose one of the most important essences of mentorship, 166 00:10:30,140 --> 00:10:31,140 I think. 167 00:10:31,140 --> 00:10:34,580 Now, that's really awesome, and thank you for shedding light on that. 168 00:10:34,580 --> 00:10:36,500 I mean, I think it is so important. 169 00:10:36,500 --> 00:10:40,060 It's that every mentee has different aspects of their lives. 170 00:10:40,060 --> 00:10:43,980 And so to think that one person is going to be able to meet all those needs is a little 171 00:10:43,980 --> 00:10:48,260 bit unrealistic and maybe too much of an expectation for one person. 172 00:10:48,260 --> 00:10:53,140 But I want to go back to something you talked about, and that is about the mentee needing 173 00:10:53,140 --> 00:10:55,340 to be ready to be a good mentee. 174 00:10:55,340 --> 00:10:57,300 How do fellows learn to be great mentees? 175 00:10:57,300 --> 00:11:02,440 How do they get that education, and what are some insights you would give us to what does 176 00:11:02,440 --> 00:11:04,100 a great mentee look like? 177 00:11:04,100 --> 00:11:06,860 Yeah, this is a great, great question. 178 00:11:06,860 --> 00:11:13,100 And part of it is that in real world terms, as you know, as all of us in academic medicine 179 00:11:13,100 --> 00:11:18,500 and education know, there's a huge hidden curriculum that we don't teach anybody, but 180 00:11:18,500 --> 00:11:19,980 people just pick up. 181 00:11:19,980 --> 00:11:21,660 And it's the same everywhere, right? 182 00:11:21,660 --> 00:11:25,660 So how do trainees, how do fellows learn to be good mentees? 183 00:11:25,660 --> 00:11:30,620 They learn by talking to their other co-fellows and former graduates and sort of young junior 184 00:11:30,620 --> 00:11:31,700 faculty. 185 00:11:31,700 --> 00:11:36,300 And they learn sort of the skills and the life patterns, and they pick those up from 186 00:11:36,300 --> 00:11:39,620 other stories, and then they internalize them. 187 00:11:39,620 --> 00:11:44,460 And on the one hand, I think it's great that this sort of hidden curriculum evolves organically 188 00:11:44,460 --> 00:11:50,660 because then most fellows end up learning what is required to be a good mentee. 189 00:11:50,660 --> 00:11:55,220 But the truth is that I think we do a big disservice to a huge portion of our fellows 190 00:11:55,220 --> 00:12:02,220 by not teaching them in a formal fashion what is mentorship and what are your expectations 191 00:12:02,220 --> 00:12:03,660 as a mentee, right? 192 00:12:03,660 --> 00:12:08,220 And again, as you were saying a little bit earlier, I think we all know the expectations 193 00:12:08,220 --> 00:12:09,340 of mentors, right? 194 00:12:09,340 --> 00:12:13,700 The mentors should be people who are seasoned in their research or at least very effective 195 00:12:13,700 --> 00:12:14,700 at their research. 196 00:12:14,700 --> 00:12:19,260 They're good at analyzing and giving advice, but there's a lot of soft skills in mentorship 197 00:12:19,260 --> 00:12:20,620 too that mentors should have, right? 198 00:12:20,620 --> 00:12:21,620 They should be accessible. 199 00:12:21,620 --> 00:12:22,900 They should be personable. 200 00:12:22,900 --> 00:12:24,220 They should care about you, right? 201 00:12:24,220 --> 00:12:27,020 They should make you feel like you're valued. 202 00:12:27,020 --> 00:12:30,860 But on the mentee end, even though we don't talk about it, I think the skills that people 203 00:12:30,860 --> 00:12:37,180 identify that come through with good mentees are, number one, good mentees need to be 204 00:12:37,180 --> 00:12:39,940 invested in the process of mentorship. 205 00:12:39,940 --> 00:12:45,300 They need to know when to take initiative, to move projects forward and to move conversations 206 00:12:45,300 --> 00:12:46,300 forward. 207 00:12:46,300 --> 00:12:47,380 They need to be responsible. 208 00:12:47,380 --> 00:12:52,260 They need to feel a sense of responsibility for both the projects they're working on and 209 00:12:52,260 --> 00:12:54,020 also the relationship. 210 00:12:54,020 --> 00:12:58,460 They also need to be committed to developing the relationship and the project. 211 00:12:58,460 --> 00:13:02,180 I think what we sometimes see, and it's not really anyone's fault, obviously, but what 212 00:13:02,180 --> 00:13:08,580 we sometimes see in unsuccessful mentee mentor pairings is that one person is just not as 213 00:13:08,580 --> 00:13:10,300 invested as the other. 214 00:13:10,300 --> 00:13:14,360 And although frequently it ends up being a mentor that's not invested, a lot of times 215 00:13:14,360 --> 00:13:17,500 it ends up being a mentee that has sort of unrealistic expectations. 216 00:13:17,500 --> 00:13:23,300 So sometimes a mentee will enter into a relationship with a very well-established and reputable 217 00:13:23,300 --> 00:13:26,780 mentor, but then walk away with sort of, quote unquote, nothing to show, right? 218 00:13:26,780 --> 00:13:31,800 No research productivity, no papers, no grants, nothing, and no real life advice. 219 00:13:31,800 --> 00:13:36,140 But sometimes it's because the mentee sort of thought that everything would be handed 220 00:13:36,140 --> 00:13:40,840 on a platter because this mentor is so well-seasoned and well-regarded. 221 00:13:40,840 --> 00:13:44,940 But instead, in order to make that relationship work, maybe the mentee had to sit down with 222 00:13:44,940 --> 00:13:49,980 the mentor and learn what's expected of me, what's my role, what part do I need to sort 223 00:13:49,980 --> 00:13:52,660 of do in order to build this relationship and the project. 224 00:13:52,660 --> 00:13:54,240 So I think you're right. 225 00:13:54,240 --> 00:13:59,120 As much as we talk about mentors having expectations, mentees also need to have the same expectations 226 00:13:59,120 --> 00:14:02,580 of themselves, even though they differ. 227 00:14:02,580 --> 00:14:04,540 Thank you for talking about the hidden curriculum. 228 00:14:04,540 --> 00:14:06,460 I mean, that's a big thing. 229 00:14:06,460 --> 00:14:08,900 And you know what's interesting? 230 00:14:08,900 --> 00:14:14,780 For many people who are self-aware, they're able to master the hidden curriculum in short 231 00:14:14,780 --> 00:14:17,660 order, but people do struggle with the hidden curriculum. 232 00:14:17,660 --> 00:14:22,100 I wonder, and this is kind of like really asking for your opinion, how do we make the 233 00:14:22,100 --> 00:14:24,020 hidden curriculum more explicit? 234 00:14:24,020 --> 00:14:25,020 Yeah. 235 00:14:25,020 --> 00:14:30,820 And you know, this is such a fun question to ask because if we look at what comes out 236 00:14:30,820 --> 00:14:32,460 of the hidden curriculum, right? 237 00:14:32,460 --> 00:14:34,580 First off, what is the hidden curriculum? 238 00:14:34,580 --> 00:14:39,100 It's the stuff we don't teach that everyone sees and knows and internalizes. 239 00:14:39,100 --> 00:14:42,520 And some of the hidden curriculum is very, very bad, right? 240 00:14:42,520 --> 00:14:44,540 That's where we all learn bias. 241 00:14:44,540 --> 00:14:46,780 That's unconscious bias, right? 242 00:14:46,780 --> 00:14:50,700 That's contributed to so many things that we're trying to now combat actively. 243 00:14:50,700 --> 00:14:53,520 But some of the hidden curriculum is really good, you know? 244 00:14:53,520 --> 00:14:57,580 And as an example, I would say near peer mentorship is one of these concepts, right? 245 00:14:57,580 --> 00:15:02,860 That's emerging now where anyone at any point in the training pathway and beyond can identify 246 00:15:02,860 --> 00:15:08,780 someone who's just a little bit senior, who is reliable and who's doing things that the 247 00:15:08,780 --> 00:15:13,900 mentee wants to do and can impart those same sort of life skills. 248 00:15:13,900 --> 00:15:19,500 So I think the hidden curriculum includes some good aspects like near peer mentorship. 249 00:15:19,500 --> 00:15:25,260 And so in terms of how do we optimize the hidden curriculum and make it a formal curriculum, 250 00:15:25,260 --> 00:15:29,660 part of it is, of course, introducing mentees early on to these sorts of concepts. 251 00:15:29,660 --> 00:15:33,900 But I think part of it is also adopting some of these organic structures and seeing if 252 00:15:33,900 --> 00:15:38,180 they can benefit from sort of an institutional or systemic structure. 253 00:15:38,180 --> 00:15:42,100 So as an example, right, in our fellowship program and I think many other fellowship 254 00:15:42,100 --> 00:15:46,900 programs as well, you know, we sort of recognize that the fellows when they come in are going 255 00:15:46,900 --> 00:15:50,500 to latch on to the second year fellows and the third year fellows. 256 00:15:50,500 --> 00:15:54,620 So you know, every fellow in our program and many others too will get like a buddy system, 257 00:15:54,620 --> 00:15:55,620 right? 258 00:15:55,620 --> 00:15:58,920 And the buddy is initially supposed to just help the first year fellows get acquainted 259 00:15:58,920 --> 00:16:01,720 with fellowship and sort of go through the nuts and bolts. 260 00:16:01,720 --> 00:16:06,900 But a lot of times the buddy system ends up delving into issues of real life and also 261 00:16:06,900 --> 00:16:09,180 research, you know, mentorship and so forth. 262 00:16:09,180 --> 00:16:12,620 You know, some of the fellows have reached out to their buddy to talk about starting 263 00:16:12,620 --> 00:16:15,860 a new family, you know, where do they get support for this? 264 00:16:15,860 --> 00:16:16,860 Where do they get childcare? 265 00:16:16,860 --> 00:16:18,220 You know, how do they find a mentor? 266 00:16:18,220 --> 00:16:19,640 You know, who's a good mentor? 267 00:16:19,640 --> 00:16:23,780 And so I think, you know, we were doing this sort of buddy system for a long time without 268 00:16:23,780 --> 00:16:26,580 even realizing that it actually is near peer mentoring. 269 00:16:26,580 --> 00:16:30,620 And I think things like that, it's worth asking the question, do we want to take something 270 00:16:30,620 --> 00:16:32,980 like that and actually make it a formal thing? 271 00:16:32,980 --> 00:16:38,580 Or do we value the organic nature of it that we have to find the right balance where that 272 00:16:38,580 --> 00:16:43,300 we as a program, we don't overstep and make something that's organic and wonderful into 273 00:16:43,300 --> 00:16:44,700 something that's very bureaucratic. 274 00:16:44,700 --> 00:16:49,020 I think that that's sort of the trick here to try to make these bits of the informal 275 00:16:49,020 --> 00:16:50,300 curriculum better. 276 00:16:50,300 --> 00:16:56,460 No, that's a really great point because the organic nature of it kind of helps it to be 277 00:16:56,460 --> 00:17:01,900 a safe environment where people feel like they can ask these personal questions and 278 00:17:01,900 --> 00:17:03,780 turn it into a bureaucratic thing, mate. 279 00:17:03,780 --> 00:17:06,900 They change the nature of it and maybe it won't be as helpful. 280 00:17:06,900 --> 00:17:09,240 So there's definitely a fine balance. 281 00:17:09,240 --> 00:17:12,540 But really, I think one of the points that I feel like is so important that you make 282 00:17:12,540 --> 00:17:17,340 that I want to just reiterate is just peer mentoring is important and that people, as 283 00:17:17,340 --> 00:17:21,940 they're thinking about mentoring or mentorship networks, they should be thinking about peers 284 00:17:21,940 --> 00:17:23,660 as part of that network as well. 285 00:17:23,660 --> 00:17:24,660 Yeah, absolutely. 286 00:17:24,660 --> 00:17:25,660 Oh, sorry, go ahead. 287 00:17:25,660 --> 00:17:28,820 No, I was going to say, do you want to speak more about that? 288 00:17:28,820 --> 00:17:29,820 Yeah. 289 00:17:29,820 --> 00:17:35,800 And I think what you were saying, Toci, is so important nowadays because along these 290 00:17:35,800 --> 00:17:40,520 same lines, we're actually just having discussions about this at our institution. 291 00:17:40,520 --> 00:17:46,420 Along the same lines, we're starting to have discussions that senior fellows and faculty 292 00:17:46,420 --> 00:17:50,980 need to be lumped together and viewed the same. 293 00:17:50,980 --> 00:17:54,420 And I know this is a little bit of a controversial concept and not everyone at our medical center 294 00:17:54,420 --> 00:17:57,420 necessarily agrees, but this is literally fresh in our minds. 295 00:17:57,420 --> 00:18:01,620 And I've heard a lot of senior leadership talk about this idea. 296 00:18:01,620 --> 00:18:05,100 And the more I think about it, the more I feel like it actually makes sense because, 297 00:18:05,100 --> 00:18:10,180 again, for academic fellowship programs that are training largely academic physicians, 298 00:18:10,180 --> 00:18:15,100 even though we have this true barrier and crossover between being a trainee versus being 299 00:18:15,100 --> 00:18:19,180 an attending physician, the career development arc starts early. 300 00:18:19,180 --> 00:18:21,100 It starts in fellowship. 301 00:18:21,100 --> 00:18:26,160 And the elements of success within fellowship end up laying the groundwork for later success 302 00:18:26,160 --> 00:18:28,240 as a young faculty member. 303 00:18:28,240 --> 00:18:35,120 And so I do feel that senior fellows and junior faculty probably do represent the same continuum 304 00:18:35,120 --> 00:18:38,920 and need to be thought of similarly with the same sort of support structures. 305 00:18:38,920 --> 00:18:42,820 And I think part of that, then, is this concept of near peer mentoring. 306 00:18:42,820 --> 00:18:48,460 Because when you're a fellow, in your first year or second year or so forth, you look 307 00:18:48,460 --> 00:18:50,380 to the senior fellows. 308 00:18:50,380 --> 00:18:54,500 And then when you transition to faculty, you start to look to your peer faculty and some 309 00:18:54,500 --> 00:18:56,340 of the younger faculty. 310 00:18:56,340 --> 00:18:59,380 Most of us, when we're junior faculty, we're not going to immediately go to our chair with 311 00:18:59,380 --> 00:19:02,460 every single problem we have and talk to them for advice. 312 00:19:02,460 --> 00:19:05,900 We're going to go to our colleagues, the ones who have been at our institution for just 313 00:19:05,900 --> 00:19:09,640 a little bit longer, and sort of reach out to them and get their insight. 314 00:19:09,640 --> 00:19:15,460 So I think the near peer mentoring approach, which is so important and begins in fellowship, 315 00:19:15,460 --> 00:19:19,620 is the same thing that transitions when one goes into a junior faculty role. 316 00:19:19,620 --> 00:19:22,740 And we should probably be thinking about these as one continuum. 317 00:19:22,740 --> 00:19:24,860 It's definitely an important one to have. 318 00:19:24,860 --> 00:19:27,220 I love what you were talking about. 319 00:19:27,220 --> 00:19:31,860 And I actually want to take a step back and just talk about who succeeds in this clinician 320 00:19:31,860 --> 00:19:32,920 scientist thing, right? 321 00:19:32,920 --> 00:19:34,500 We bring so many people through. 322 00:19:34,500 --> 00:19:37,300 And we talked about earlier, it's 50-50. 323 00:19:37,300 --> 00:19:41,660 But if you could go back and look at your fellows at the beginning or even at any time 324 00:19:41,660 --> 00:19:44,100 during the program, who succeeds? 325 00:19:44,100 --> 00:19:45,180 Yeah. 326 00:19:45,180 --> 00:19:47,820 So this is a loaded question. 327 00:19:47,820 --> 00:19:50,280 Everything you're asking is loaded and so important. 328 00:19:50,280 --> 00:19:55,120 And I'm glad that we're dissecting this because I feel, and I'm assuming that you do too, 329 00:19:55,120 --> 00:19:59,780 and others in active medicine, that the definition of this is dramatically changing as it needs 330 00:19:59,780 --> 00:20:00,980 to, right? 331 00:20:00,980 --> 00:20:05,940 So I mean, as you know, because we all sort of went through this together, historically, 332 00:20:05,940 --> 00:20:09,740 the idea was that if you're in a fellow in an academic program, then you're going to 333 00:20:09,740 --> 00:20:10,820 go for an academic job. 334 00:20:10,820 --> 00:20:12,020 And what is an academic job? 335 00:20:12,020 --> 00:20:16,260 It's basically emerging as a clinician investigator or as an investigator sometimes. 336 00:20:16,260 --> 00:20:18,420 Clinician investigator or lab investigator, right? 337 00:20:18,420 --> 00:20:21,420 And it used to be that everyone was both a clinician and a lab investigator. 338 00:20:21,420 --> 00:20:25,320 Then they sort of diverged and both became sort of equally valid. 339 00:20:25,320 --> 00:20:31,500 But with the complexity of medicine now, with real issues in the pipeline of recruitment 340 00:20:31,500 --> 00:20:37,940 and retention, with real issues of not having actually a pitifully low number of underrepresented 341 00:20:37,940 --> 00:20:43,420 minorities in throughout academic medicine, especially in hematology, with real issues 342 00:20:43,420 --> 00:20:50,220 of access to care, so many patients not having access to a physician, much less one who specializes 343 00:20:50,220 --> 00:20:51,820 in the treatments that we do. 344 00:20:51,820 --> 00:20:56,240 I think the old paradigms have to completely come tumbling down. 345 00:20:56,240 --> 00:21:02,960 And as a result, it makes it both really difficult but also really exciting to try to redefine 346 00:21:02,960 --> 00:21:05,560 what it means to be successful, right? 347 00:21:05,560 --> 00:21:10,900 So as an example, in the olden days, if a fellow tried to go into a lab, maybe when 348 00:21:10,900 --> 00:21:14,580 you and I were in fellowship, a fellow tried to go into a lab and didn't publish their 349 00:21:14,580 --> 00:21:19,360 nature paper or their cell paper, then that's a failure, right? 350 00:21:19,360 --> 00:21:22,220 But nowadays, that might not be, right? 351 00:21:22,220 --> 00:21:27,540 Because we have fellows who come into our program like extremely well-versed and experienced 352 00:21:27,540 --> 00:21:29,660 in basic science research. 353 00:21:29,660 --> 00:21:34,580 And then when they go through fellowship, either they fall in love with something else 354 00:21:34,580 --> 00:21:39,020 or they fall in love with patient care or their project just doesn't work out, but they 355 00:21:39,020 --> 00:21:43,700 realize that all the skills they learned in the lab are actually really useful and can 356 00:21:43,700 --> 00:21:50,020 be morphed into, say, phase one trials or clinical trials, right, or explaining these 357 00:21:50,020 --> 00:21:54,220 sorts of very complex therapies to patients who ordinarily wouldn't have access to a 358 00:21:54,220 --> 00:21:59,500 trial, but the fellow and the trainee then becomes a facilitator to help promote health 359 00:21:59,500 --> 00:22:01,460 equity and access, right? 360 00:22:01,460 --> 00:22:07,380 So I think now the definition doesn't really exist the way that it did before. 361 00:22:07,380 --> 00:22:11,580 And it gets back to sort of the domains of mentorship. 362 00:22:11,580 --> 00:22:14,860 There's a career development portion, but there's also a psychosocial portion. 363 00:22:14,860 --> 00:22:19,500 And I would say the same thing about our overall career development in general, right? 364 00:22:19,500 --> 00:22:24,140 There are certain benchmarks that we all set for ourselves, and we try to achieve them, 365 00:22:24,140 --> 00:22:26,180 and sometimes we do, and sometimes they don't. 366 00:22:26,180 --> 00:22:32,580 But there's also a personal sense of satisfaction and destiny even and fulfillment. 367 00:22:32,580 --> 00:22:38,660 And I think those are things that although we expect fellows, even while they're interviewing 368 00:22:38,660 --> 00:22:42,580 for our program to know, in reality, they don't know, and many times they don't know 369 00:22:42,580 --> 00:22:45,780 until very late in their training and sometimes beyond. 370 00:22:45,780 --> 00:22:50,180 And so it's a long way of saying that I don't know what the right definition is, but I think 371 00:22:50,180 --> 00:22:55,120 we have to take into account overall life experiences and constantly ask our fellows 372 00:22:55,120 --> 00:22:57,700 and encourage them to ask themselves, are you happy? 373 00:22:57,700 --> 00:22:58,700 Are you doing what you want? 374 00:22:58,700 --> 00:23:01,100 Do you feel like your purpose is being served? 375 00:23:01,100 --> 00:23:06,060 Because I think if we include those elements into traditional benchmarks of success, then 376 00:23:06,060 --> 00:23:10,900 we'll find that, number one, we're actually doing a good job overall, all of our programs 377 00:23:10,900 --> 00:23:12,580 are and all of our fellows are. 378 00:23:12,580 --> 00:23:17,160 And then number two, I think we'll also find that that's improving the overall experience 379 00:23:17,160 --> 00:23:21,940 of healthcare for everyone. 380 00:23:21,940 --> 00:23:22,940 I love it. 381 00:23:22,940 --> 00:23:25,380 So it's expanding the definition of success. 382 00:23:25,380 --> 00:23:29,700 And the truth is that the definition of success was always expanded, but as long as we were 383 00:23:29,700 --> 00:23:34,060 defining it narrowly, we could find the fellows who succeeded and those who didn't. 384 00:23:34,060 --> 00:23:38,720 And so I do love what you talk about because fulfillment is important in the psychosocial 385 00:23:38,720 --> 00:23:39,720 aspects as well. 386 00:23:39,720 --> 00:23:44,460 And then at the end, the program thinks the fellow is successful, but the fellow thinks 387 00:23:44,460 --> 00:23:47,140 that fellow is successful as well. 388 00:23:47,140 --> 00:23:48,140 Absolutely. 389 00:23:48,140 --> 00:23:54,900 And even like operationally at the institutional level, again, even though we have historically 390 00:23:54,900 --> 00:24:00,420 had this idea that there are academic physicians and then there are our clinician, and the 391 00:24:00,420 --> 00:24:04,500 academic physicians are the ones who do some type of research and the clinicians see patients. 392 00:24:04,500 --> 00:24:09,460 I mean, as we all know in oncology and also in hematology, a huge part of what we do is 393 00:24:09,460 --> 00:24:12,140 ambulatory care in the community. 394 00:24:12,140 --> 00:24:15,220 And within oncology and malignant hematology and even to a certain extent in classical 395 00:24:15,220 --> 00:24:18,860 hematology, a lot of the clinical trials enrollments are happening in the community with community 396 00:24:18,860 --> 00:24:19,860 physicians. 397 00:24:19,860 --> 00:24:24,500 And then even at academic centers, we're all recognizing that there's a tremendous need 398 00:24:24,500 --> 00:24:29,540 for pure clinicians within academic centers, especially in classical hematology. 399 00:24:29,540 --> 00:24:33,500 I'm sure Duke is the same way in many other places, but anyway, at Yale, all across our 400 00:24:33,500 --> 00:24:38,820 cancer center network, 50% of the volume of patients that are seen by attending physicians 401 00:24:38,820 --> 00:24:40,580 is classical inpatients. 402 00:24:40,580 --> 00:24:41,940 And every center has that. 403 00:24:41,940 --> 00:24:46,820 And so we have a real need for not just researchers in classical hematology, but also clinicians. 404 00:24:46,820 --> 00:24:50,900 We're super excited because we actually just hired one of our senior fellows to be a pure 405 00:24:50,900 --> 00:24:56,740 classical hematology clinician, but with an academic appointment on our academic clinician 406 00:24:56,740 --> 00:24:57,740 track. 407 00:24:57,740 --> 00:25:03,180 So, and basically I just say that to say that I think that these definitions of fellow success 408 00:25:03,180 --> 00:25:07,500 are going hand in hand, these redefinitions of fellow success are going hand in hand with 409 00:25:07,500 --> 00:25:15,180 redefining what it means to be an academic clinician and even an academic investigator. 410 00:25:15,180 --> 00:25:16,740 I appreciate that perspective. 411 00:25:16,740 --> 00:25:17,740 Thank you. 412 00:25:17,740 --> 00:25:20,060 It's that so much is changing. 413 00:25:20,060 --> 00:25:25,220 And I think in medicine, sometimes we're slow to change, but ultimately the reality is that 414 00:25:25,220 --> 00:25:28,620 we're preparing the fellows for the new world that they're entering and the new world they're 415 00:25:28,620 --> 00:25:33,300 entering is a different one that we entered 12, 13, 14 years ago. 416 00:25:33,300 --> 00:25:37,220 I love how you said that because that's exactly what it is. 417 00:25:37,220 --> 00:25:41,380 And I think we have to keep reminding ourselves that this sort of redefinition and reassessment 418 00:25:41,380 --> 00:25:45,340 and change is good because we need it, because that's what our patients need. 419 00:25:45,340 --> 00:25:47,940 That's what the field of science needs, right? 420 00:25:47,940 --> 00:25:48,940 Absolutely. 421 00:25:48,940 --> 00:25:49,940 Absolutely. 422 00:25:49,940 --> 00:25:50,940 I love it. 423 00:25:50,940 --> 00:25:52,060 You shared so many great gems. 424 00:25:52,060 --> 00:25:57,540 I would say that as we're wrapping up, what is one thing you want to leave with Earth 425 00:25:57,540 --> 00:25:58,540 listeners? 426 00:25:58,540 --> 00:26:04,300 What do you want to say that perhaps needs to be emphasized or hasn't been said yet? 427 00:26:04,300 --> 00:26:06,780 Let's see, what should we emphasize? 428 00:26:06,780 --> 00:26:13,080 So mentorship still to me remains the most important aspect, even though the definitions 429 00:26:13,080 --> 00:26:15,320 of mentorship are changing. 430 00:26:15,320 --> 00:26:22,660 I think we need to think about ways to formalize a lot of the organic nature of mentorship, 431 00:26:22,660 --> 00:26:27,460 kind of like you and I talked about, while still preserving some of the serendipity that 432 00:26:27,460 --> 00:26:30,340 can happen with a good mentorship pairing. 433 00:26:30,340 --> 00:26:33,780 And I think we're all sort of struggling with how to do that. 434 00:26:33,780 --> 00:26:37,360 A lot of programs, including our own, create mentorship committees, right? 435 00:26:37,360 --> 00:26:40,860 When fellows come in, they get paired to faculty for career development advice. 436 00:26:40,860 --> 00:26:43,900 And sometimes those pairings work, sometimes they don't. 437 00:26:43,900 --> 00:26:47,620 But we also know that when we remove that from the equation, then suddenly the fellows 438 00:26:47,620 --> 00:26:48,620 want it. 439 00:26:48,620 --> 00:26:50,280 And it's the same for the junior faculty. 440 00:26:50,280 --> 00:26:55,140 So how do you create these structures, but then allow for the flexibility for that organic 441 00:26:55,140 --> 00:26:57,900 nature to happen, I think is important. 442 00:26:57,900 --> 00:27:01,700 I think another thing that we need to think about, and again, this ultimately goes back 443 00:27:01,700 --> 00:27:08,100 to, again, success of a fellow as an academic clinician afterwards, is how do we and should 444 00:27:08,100 --> 00:27:13,700 we, and I think the answer is yes, but how do we and should we be incentivizing faculty 445 00:27:13,700 --> 00:27:15,540 to mentor, right? 446 00:27:15,540 --> 00:27:20,300 Because a lot of faculty take on mentorship just out of goodwill, and also because we 447 00:27:20,300 --> 00:27:23,500 got good mentors and we want to pay that back. 448 00:27:23,500 --> 00:27:29,000 But as medicine becomes more complex, as financial reimbursement models become increasingly a 449 00:27:29,000 --> 00:27:36,660 big driver in academic hiring even, how do we start to systemically and institutionally 450 00:27:36,660 --> 00:27:42,740 incentivize mentorship so that all of us will want to be mentors and realize that when we 451 00:27:42,740 --> 00:27:46,980 invest in people the way they invested in us, then that's how we continue the field 452 00:27:46,980 --> 00:27:48,860 and we all benefit. 453 00:27:48,860 --> 00:27:53,060 So I think those are two concepts, of course, they're beyond our own discussion, but I think 454 00:27:53,060 --> 00:28:00,100 they tie back to what we can do to increase the likelihood that our fellows will be successful, 455 00:28:00,100 --> 00:28:04,140 because I think we have to not just invest in mentorship, but also invest in the future 456 00:28:04,140 --> 00:28:06,460 of mentorship, whatever that means. 457 00:28:06,460 --> 00:28:13,820 I love it, when you talk about the serendipity, it's almost like someone needs to come up 458 00:28:13,820 --> 00:28:20,300 with a mentoring matchmaking service, kind of like dating services exist right now. 459 00:28:20,300 --> 00:28:23,060 Create the structure and then watch for the chemistry. 460 00:28:23,060 --> 00:28:25,940 Absolutely, yes, yes. 461 00:28:25,940 --> 00:28:28,680 Some of us have talked about apps, right? 462 00:28:28,680 --> 00:28:31,180 Can we create an app that does this? 463 00:28:31,180 --> 00:28:36,140 I mean, the traditional thing of asking around who's got research projects and then meeting 464 00:28:36,140 --> 00:28:42,580 with them and then creating databases and notebooks and websites of which faculty have 465 00:28:42,580 --> 00:28:43,940 research projects going on. 466 00:28:43,940 --> 00:28:47,460 I mean, it's basically evolving into a dating app. 467 00:28:47,460 --> 00:28:57,060 So yeah, I think we should just call it what it is and do it. 468 00:28:57,060 --> 00:28:59,380 I agree, and thank you for your patience. 469 00:28:59,380 --> 00:29:03,860 I have been having connection difficulties for everyone who's listening and wondering 470 00:29:03,860 --> 00:29:05,540 what all the positives are. 471 00:29:05,540 --> 00:29:06,740 And Alfred, thank you so much. 472 00:29:06,740 --> 00:29:10,060 You have been such a pleasure to talk to you. 473 00:29:10,060 --> 00:29:11,300 You have such great insight. 474 00:29:11,300 --> 00:29:14,620 I feel like at some point I'm going to need to invite you back again so that we can talk 475 00:29:14,620 --> 00:29:19,900 about some more of the nuances of the mentoring and defining success, because there's so much 476 00:29:19,900 --> 00:29:21,860 really to unpack. 477 00:29:21,860 --> 00:29:22,860 And I just want to thank you. 478 00:29:22,860 --> 00:29:25,860 You shared so much wisdom, so much insight. 479 00:29:25,860 --> 00:29:29,460 And I know our listeners will learn so much from it. 480 00:29:29,460 --> 00:29:30,620 Thank you so much, Dorothy. 481 00:29:30,620 --> 00:29:33,900 And thank you for everything you've done in our field and also with this podcast and all 482 00:29:33,900 --> 00:29:38,100 the things you're doing now to sort of propel trainees and our whole field forward. 483 00:29:38,100 --> 00:29:39,100 Thank you. 484 00:29:39,100 --> 00:29:40,740 I think we have a shared goal. 485 00:29:40,740 --> 00:29:45,180 And so I'm glad to have you as a partner globally in this effort. 486 00:29:45,180 --> 00:29:46,620 Thank you for being here. 487 00:29:46,620 --> 00:29:47,620 Thank you. 488 00:29:47,620 --> 00:29:49,220 All right, everyone. 489 00:29:49,220 --> 00:29:50,940 You've heard Dr. Lee. 490 00:29:50,940 --> 00:29:55,900 He's talked a lot about things that fellows need to think about in terms of being successful. 491 00:29:55,900 --> 00:29:59,760 If you've enjoyed this podcast episode, please share it with somebody else. 492 00:29:59,760 --> 00:30:04,020 If you're a mentor who's listening, please share it with your mentees and ask them to 493 00:30:04,020 --> 00:30:09,220 share it with their peer mentors or their peers so that more people can kind of learn 494 00:30:09,220 --> 00:30:14,140 a lot about the hidden curriculum and then continue to work towards their own success. 495 00:30:14,140 --> 00:30:28,100 All right, until next time, take care. 496 00:30:28,100 --> 00:30:33,460 Thanks for listening to this episode of the Clinician Researcher Podcast, where academic 497 00:30:33,460 --> 00:30:38,900 clinicians learn the skills to build their own research program, whether or not they 498 00:30:38,900 --> 00:30:40,260 have a mentor. 499 00:30:40,260 --> 00:30:46,360 If you found the information in this episode to be helpful, don't keep it all to yourself. 500 00:30:46,360 --> 00:30:48,100 Someone else needs to hear it. 501 00:30:48,100 --> 00:30:52,140 So take a minute right now and share it. 502 00:30:52,140 --> 00:30:57,620 As you share this episode, you become part of our mission to help launch a new generation 503 00:30:57,620 --> 00:31:02,980 of clinician researchers who make transformative discoveries that change the way we do healthcare.