Welcome to the Clinician Researcher podcast, where academic clinicians learn the skills
to build their own research program, whether or not they have a mentor.
As clinicians, we spend a decade or more as trainees learning to take care of patients.
When we finally start our careers, we want to build research programs, but then we find
that our years of clinical training did not adequately prepare us to lead our research
program.
Through no fault of our own, we struggle to find mentors, and when we can't, we quit.
However, clinicians hold the keys to the greatest research breakthroughs.
For this reason, the Clinician Researcher podcast exists to give academic clinicians
the tools to build their own research program, whether or not they have a mentor.
Now introducing your host, Toyosi Onwuemene.
Welcome to the Clinician Researcher podcast.
I'm Toyosi Onwuemene, your host.
I'm super excited to be here today because I have a really great special guest, Dr. Alfred
Lee, who's going to introduce himself in a minute.
But I want to tell you that he is a program director of an esteemed Hemong Fellowship
program and is just really here to give us insights that can help fellows succeed in
the fellow to faculty transition.
So without further ado, I'm going to ask him to introduce himself.
Alfred, welcome to the program.
Thank you for being here.
Oh, thank you so much, Teyasi.
I'm really honored to be here.
And it's exciting what you're doing with this podcast and the conversations that you're
having.
So once again, my name is Alfred Lee.
I'm a classical hematologist.
And as you know, because we're in the same field, that is the focus of the focus of studies
on blood diseases that are not cancer primarily.
And I also have a big focus in medical education.
And with it, issues of mentorship and career development come up naturally in my role as
a fellowship program director.
Thank you, Alfred.
I want to thank you so much for being here because I feel like we need so much of your
perspective.
And I think fellows need that too.
And without further ado, I'm going to ask you, just you've been doing this for a while.
And I want to ask, how can fellows set themselves up for success as clinician scientists?
We talk about this, you know, having people become clinician scientists as the Holy Grail.
And it seems to be really hard.
How can fellows set themselves up to win?
Yeah.
So this is in many ways one of many million dollar questions.
And I think all of us, particularly, you know, those of us who do medical education primarily
are really invested in trying to understand, first off, how we identify the fellows who
really want academic careers and are committed to this and will do well in academic careers.
And then secondly, how do we get them there?
And then thirdly, how do we ensure that when they leave the nest out of fellowship, that
they'll be positioned to continue to have success in their academic careers?
So the thing we've always said, and I think most of the literature, certainly outside
of hematology, but emerging within hematology says is that it's all about mentorship, right?
Mentorship, mentorship, mentorship, mentorship is key.
Having a good research project during fellowship is also key because that's really where trainees
learn their chops, so to speak, and learn the methodologies that they need when they
enter in these, you know, what we like to call career defining projects within fellowship
that will then, you know, hopefully lead to pathways in academic medicine after they finish.
But oftentimes, and usually the good projects come with good mentorship setups.
And so I think as a result of that, you know, there's been a lot of discussion lately about
what good mentorship is and what the elements are there.
As you may know, you know, ASH, American Society of Hematology, like recently did a big mentorship
summit in DC headquarters that a number of us were part of.
And the roots of this came from, you know, a study that we all sort of participated in,
which was looking at the hematology workforce in the US for over a several year period.
And what we found leading up to the pandemic and then afterwards was that, you know, the
numbers and the percentages of fellows in hematology programs who wanted to do classical
hematology was horrifically low.
It was like 5% and it did not change in like 20 years.
And so ASH started doing a lot of initiatives to try to improve recruitment and retention
in classical hematology.
And with that came this idea of trying to get a bunch of minds together to talk about
mentorship.
And so there was some very interesting things that came out of that discussion recently
that are probably relevant to some of what, you know, you and I can discuss.
So one is that mentorship, and this is built based on the literature and also on practice,
mentorship has both a career development function and a psychosocial function.
And you know, I think in academic medicine, we often emphasize the former a lot, right?
We tell people, yeah, you got to find a research mentor, get in with them, get on their projects,
you know, start to build your projects, apply for your grants, et cetera, et cetera, et
cetera.
But it's important not to overlook the psychosocial support function, because one, you know, you
can't really have a great mentorship setup unless both of these domains are being satisfied,
because that's where I think we see fellows have the greatest success long term.
A second thing that sort of emerged from this recent mentorship summit that Ash conducted
was that although we still emphasize a lot the traditional diet of mentorship, so, you
know, one mentee and one mentor, increasingly, I think a lot of fields outside of hematology
are sort of looking at mentorship networks.
So you bring in different faculty and different role models from the peer stage all the way
to the faculty and beyond, who can sort of be part of your whole mentorship tree and
help you succeed.
And then I think just one more thing I think that's important to think about, and again,
plays in this whole aspect of mentorship, is that, you know, we have a lot, we put a
lot of emphasis on discussion about finding a good mentor and what the qualities are in
a good mentor, and that's sort of its own discussion.
But I think we also don't emphasize enough that in order for good mentorship to work,
it has to be a two-way street.
It's really a relationship, right?
And in order for any relationship to succeed, both parties or all parties have to be equally
invested.
And so there's a certain component, I think, of success as a trainee that then carries
over in the post-trainee realm, and that's that the mentees also need to learn how to
be good mentees, right?
They need to learn, you know, what are, or how, what is their role in the relationship
and what do they need to bring to the table and what kind of work do they sort of need
to do on their own in order to gain the skills they need to be successful during fellowship
for their future academic career.
So you know, I think the short answer to your question is mentorship, mentorship, mentorship.
But how we get there, I think, has a lot of nuance, and it's very exciting, but also challenging
to think about how we can improve that whole experience for the trainees.
I love that.
Thank you so much, because you talked about so many things.
I think one of the things that really spoke to me was about the psychosocial component
of mentoring, and you may get great academic mentoring, but that piece is missing, then
fellows may feel like they're not even getting what they want to, even though they may be
getting great academic development.
And so that's so important.
I love also what you talk about with the whole focus on the diet of the mentoring relationship,
but really thinking about mentoring networks.
And it's kind of, it's not traditional.
We've thought about mentoring in the traditional way, as you talked about, of like a one-man
mentor, one mentee.
And so how do we get out of that?
How do we encourage fellows to start thinking about these networks?
Yeah, it's a great question.
And I have to be totally candid.
When I was exposed to this idea of mentorship networks, it was actually a very new concept
to me.
When I was a fellow, so it doesn't feel like that long ago, but it actually was kind of
a long time ago, but it was like 15 years ago.
I used to tell people, I have three mentors, right?
I literally say this all the time.
So one mentor was the person I did my research with.
And then the second mentor was the person I wanted to be.
And then the third mentor was the person that I would gab on the phone with for like two
hours every week and just tell this person my deepest dark secrets and what I wanted
to do and get their advice.
But in the midst of that, I always knew the responsibilities that each one had.
And I did view one of them as not more important than the other, but one of them, I really
if I had to put my money down, I would say was my true primary mentor.
And by that, what I meant is I had full faith that if I succeeded, this person would feel
that they succeeded.
And if I failed, then they would feel like they failed.
So the reason I say that is to say that I think when we think about mentorship networks,
a few things come to mind.
So one is that it's important for trainees to think about all the different domains that
they need in mentorship.
So there is going to be someone or some people who fill that traditional research domain,
but there are also going to be people who fill that role modeling domain.
And then there are going to be some who fulfill sort of the life advice domain, right?
Sort of mirroring the three different domains that were important to me.
But a second aspect to this is that I think it's still important.
And what I'm about to say, I think is a little bit controversial still, so not everybody
agrees with me on this, but I still think it's important even as we expand mentorship
networks and go away from the traditional diet, I still think it is important to identify
at least one person who really breathes and dies by you.
I think that's important because what people have always said, and I think there's some
truth to this, is that if you have a group of mentors, if you have dual mentors, if you
have triple mentors, it's great because everyone fills different functions.
But at the end of the day, if no one feels accountable for you, then that's not a good
setup either, right?
And maybe that's where some of the psychosocial portion of this comes in.
So it's a long-winded way of saying that I think part of moving away from the diet into
a mentorship network is to identify the needs that specific mentees require.
But I think another portion of it is to still remember though that effective mentorship
still needs someone senior to deliver.
And if you lose that, then you kind of lose one of the most important essences of mentorship,
I think.
Now, that's really awesome, and thank you for shedding light on that.
I mean, I think it is so important.
It's that every mentee has different aspects of their lives.
And so to think that one person is going to be able to meet all those needs is a little
bit unrealistic and maybe too much of an expectation for one person.
But I want to go back to something you talked about, and that is about the mentee needing
to be ready to be a good mentee.
How do fellows learn to be great mentees?
How do they get that education, and what are some insights you would give us to what does
a great mentee look like?
Yeah, this is a great, great question.
And part of it is that in real world terms, as you know, as all of us in academic medicine
and education know, there's a huge hidden curriculum that we don't teach anybody, but
people just pick up.
And it's the same everywhere, right?
So how do trainees, how do fellows learn to be good mentees?
They learn by talking to their other co-fellows and former graduates and sort of young junior
faculty.
And they learn sort of the skills and the life patterns, and they pick those up from
other stories, and then they internalize them.
And on the one hand, I think it's great that this sort of hidden curriculum evolves organically
because then most fellows end up learning what is required to be a good mentee.
But the truth is that I think we do a big disservice to a huge portion of our fellows
by not teaching them in a formal fashion what is mentorship and what are your expectations
as a mentee, right?
And again, as you were saying a little bit earlier, I think we all know the expectations
of mentors, right?
The mentors should be people who are seasoned in their research or at least very effective
at their research.
They're good at analyzing and giving advice, but there's a lot of soft skills in mentorship
too that mentors should have, right?
They should be accessible.
They should be personable.
They should care about you, right?
They should make you feel like you're valued.
But on the mentee end, even though we don't talk about it, I think the skills that people
identify that come through with good mentees are, number one, good mentees need to be
invested in the process of mentorship.
They need to know when to take initiative, to move projects forward and to move conversations
forward.
They need to be responsible.
They need to feel a sense of responsibility for both the projects they're working on and
also the relationship.
They also need to be committed to developing the relationship and the project.
I think what we sometimes see, and it's not really anyone's fault, obviously, but what
we sometimes see in unsuccessful mentee mentor pairings is that one person is just not as
invested as the other.
And although frequently it ends up being a mentor that's not invested, a lot of times
it ends up being a mentee that has sort of unrealistic expectations.
So sometimes a mentee will enter into a relationship with a very well-established and reputable
mentor, but then walk away with sort of, quote unquote, nothing to show, right?
No research productivity, no papers, no grants, nothing, and no real life advice.
But sometimes it's because the mentee sort of thought that everything would be handed
on a platter because this mentor is so well-seasoned and well-regarded.
But instead, in order to make that relationship work, maybe the mentee had to sit down with
the mentor and learn what's expected of me, what's my role, what part do I need to sort
of do in order to build this relationship and the project.
So I think you're right.
As much as we talk about mentors having expectations, mentees also need to have the same expectations
of themselves, even though they differ.
Thank you for talking about the hidden curriculum.
I mean, that's a big thing.
And you know what's interesting?
For many people who are self-aware, they're able to master the hidden curriculum in short
order, but people do struggle with the hidden curriculum.
I wonder, and this is kind of like really asking for your opinion, how do we make the
hidden curriculum more explicit?
Yeah.
And you know, this is such a fun question to ask because if we look at what comes out
of the hidden curriculum, right?
First off, what is the hidden curriculum?
It's the stuff we don't teach that everyone sees and knows and internalizes.
And some of the hidden curriculum is very, very bad, right?
That's where we all learn bias.
That's unconscious bias, right?
That's contributed to so many things that we're trying to now combat actively.
But some of the hidden curriculum is really good, you know?
And as an example, I would say near peer mentorship is one of these concepts, right?
That's emerging now where anyone at any point in the training pathway and beyond can identify
someone who's just a little bit senior, who is reliable and who's doing things that the
mentee wants to do and can impart those same sort of life skills.
So I think the hidden curriculum includes some good aspects like near peer mentorship.
And so in terms of how do we optimize the hidden curriculum and make it a formal curriculum,
part of it is, of course, introducing mentees early on to these sorts of concepts.
But I think part of it is also adopting some of these organic structures and seeing if
they can benefit from sort of an institutional or systemic structure.
So as an example, right, in our fellowship program and I think many other fellowship
programs as well, you know, we sort of recognize that the fellows when they come in are going
to latch on to the second year fellows and the third year fellows.
So you know, every fellow in our program and many others too will get like a buddy system,
right?
And the buddy is initially supposed to just help the first year fellows get acquainted
with fellowship and sort of go through the nuts and bolts.
But a lot of times the buddy system ends up delving into issues of real life and also
research, you know, mentorship and so forth.
You know, some of the fellows have reached out to their buddy to talk about starting
a new family, you know, where do they get support for this?
Where do they get childcare?
You know, how do they find a mentor?
You know, who's a good mentor?
And so I think, you know, we were doing this sort of buddy system for a long time without
even realizing that it actually is near peer mentoring.
And I think things like that, it's worth asking the question, do we want to take something
like that and actually make it a formal thing?
Or do we value the organic nature of it that we have to find the right balance where that
we as a program, we don't overstep and make something that's organic and wonderful into
something that's very bureaucratic.
I think that that's sort of the trick here to try to make these bits of the informal
curriculum better.
No, that's a really great point because the organic nature of it kind of helps it to be
a safe environment where people feel like they can ask these personal questions and
turn it into a bureaucratic thing, mate.
They change the nature of it and maybe it won't be as helpful.
So there's definitely a fine balance.
But really, I think one of the points that I feel like is so important that you make
that I want to just reiterate is just peer mentoring is important and that people, as
they're thinking about mentoring or mentorship networks, they should be thinking about peers
as part of that network as well.
Yeah, absolutely.
Oh, sorry, go ahead.
No, I was going to say, do you want to speak more about that?
Yeah.
And I think what you were saying, Toci, is so important nowadays because along these
same lines, we're actually just having discussions about this at our institution.
Along the same lines, we're starting to have discussions that senior fellows and faculty
need to be lumped together and viewed the same.
And I know this is a little bit of a controversial concept and not everyone at our medical center
necessarily agrees, but this is literally fresh in our minds.
And I've heard a lot of senior leadership talk about this idea.
And the more I think about it, the more I feel like it actually makes sense because,
again, for academic fellowship programs that are training largely academic physicians,
even though we have this true barrier and crossover between being a trainee versus being
an attending physician, the career development arc starts early.
It starts in fellowship.
And the elements of success within fellowship end up laying the groundwork for later success
as a young faculty member.
And so I do feel that senior fellows and junior faculty probably do represent the same continuum
and need to be thought of similarly with the same sort of support structures.
And I think part of that, then, is this concept of near peer mentoring.
Because when you're a fellow, in your first year or second year or so forth, you look
to the senior fellows.
And then when you transition to faculty, you start to look to your peer faculty and some
of the younger faculty.
Most of us, when we're junior faculty, we're not going to immediately go to our chair with
every single problem we have and talk to them for advice.
We're going to go to our colleagues, the ones who have been at our institution for just
a little bit longer, and sort of reach out to them and get their insight.
So I think the near peer mentoring approach, which is so important and begins in fellowship,
is the same thing that transitions when one goes into a junior faculty role.
And we should probably be thinking about these as one continuum.
It's definitely an important one to have.
I love what you were talking about.
And I actually want to take a step back and just talk about who succeeds in this clinician
scientist thing, right?
We bring so many people through.
And we talked about earlier, it's 50-50.
But if you could go back and look at your fellows at the beginning or even at any time
during the program, who succeeds?
Yeah.
So this is a loaded question.
Everything you're asking is loaded and so important.
And I'm glad that we're dissecting this because I feel, and I'm assuming that you do too,
and others in active medicine, that the definition of this is dramatically changing as it needs
to, right?
So I mean, as you know, because we all sort of went through this together, historically,
the idea was that if you're in a fellow in an academic program, then you're going to
go for an academic job.
And what is an academic job?
It's basically emerging as a clinician investigator or as an investigator sometimes.
Clinician investigator or lab investigator, right?
And it used to be that everyone was both a clinician and a lab investigator.
Then they sort of diverged and both became sort of equally valid.
But with the complexity of medicine now, with real issues in the pipeline of recruitment
and retention, with real issues of not having actually a pitifully low number of underrepresented
minorities in throughout academic medicine, especially in hematology, with real issues
of access to care, so many patients not having access to a physician, much less one who specializes
in the treatments that we do.
I think the old paradigms have to completely come tumbling down.
And as a result, it makes it both really difficult but also really exciting to try to redefine
what it means to be successful, right?
So as an example, in the olden days, if a fellow tried to go into a lab, maybe when
you and I were in fellowship, a fellow tried to go into a lab and didn't publish their
nature paper or their cell paper, then that's a failure, right?
But nowadays, that might not be, right?
Because we have fellows who come into our program like extremely well-versed and experienced
in basic science research.
And then when they go through fellowship, either they fall in love with something else
or they fall in love with patient care or their project just doesn't work out, but they
realize that all the skills they learned in the lab are actually really useful and can
be morphed into, say, phase one trials or clinical trials, right, or explaining these
sorts of very complex therapies to patients who ordinarily wouldn't have access to a
trial, but the fellow and the trainee then becomes a facilitator to help promote health
equity and access, right?
So I think now the definition doesn't really exist the way that it did before.
And it gets back to sort of the domains of mentorship.
There's a career development portion, but there's also a psychosocial portion.
And I would say the same thing about our overall career development in general, right?
There are certain benchmarks that we all set for ourselves, and we try to achieve them,
and sometimes we do, and sometimes they don't.
But there's also a personal sense of satisfaction and destiny even and fulfillment.
And I think those are things that although we expect fellows, even while they're interviewing
for our program to know, in reality, they don't know, and many times they don't know
until very late in their training and sometimes beyond.
And so it's a long way of saying that I don't know what the right definition is, but I think
we have to take into account overall life experiences and constantly ask our fellows
and encourage them to ask themselves, are you happy?
Are you doing what you want?
Do you feel like your purpose is being served?
Because I think if we include those elements into traditional benchmarks of success, then
we'll find that, number one, we're actually doing a good job overall, all of our programs
are and all of our fellows are.
And then number two, I think we'll also find that that's improving the overall experience
of healthcare for everyone.
I love it.
So it's expanding the definition of success.
And the truth is that the definition of success was always expanded, but as long as we were
defining it narrowly, we could find the fellows who succeeded and those who didn't.
And so I do love what you talk about because fulfillment is important in the psychosocial
aspects as well.
And then at the end, the program thinks the fellow is successful, but the fellow thinks
that fellow is successful as well.
Absolutely.
And even like operationally at the institutional level, again, even though we have historically
had this idea that there are academic physicians and then there are our clinician, and the
academic physicians are the ones who do some type of research and the clinicians see patients.
I mean, as we all know in oncology and also in hematology, a huge part of what we do is
ambulatory care in the community.
And within oncology and malignant hematology and even to a certain extent in classical
hematology, a lot of the clinical trials enrollments are happening in the community with community
physicians.
And then even at academic centers, we're all recognizing that there's a tremendous need
for pure clinicians within academic centers, especially in classical hematology.
I'm sure Duke is the same way in many other places, but anyway, at Yale, all across our
cancer center network, 50% of the volume of patients that are seen by attending physicians
is classical inpatients.
And every center has that.
And so we have a real need for not just researchers in classical hematology, but also clinicians.
We're super excited because we actually just hired one of our senior fellows to be a pure
classical hematology clinician, but with an academic appointment on our academic clinician
track.
So, and basically I just say that to say that I think that these definitions of fellow success
are going hand in hand, these redefinitions of fellow success are going hand in hand with
redefining what it means to be an academic clinician and even an academic investigator.
I appreciate that perspective.
Thank you.
It's that so much is changing.
And I think in medicine, sometimes we're slow to change, but ultimately the reality is that
we're preparing the fellows for the new world that they're entering and the new world they're
entering is a different one that we entered 12, 13, 14 years ago.
I love how you said that because that's exactly what it is.
And I think we have to keep reminding ourselves that this sort of redefinition and reassessment
and change is good because we need it, because that's what our patients need.
That's what the field of science needs, right?
Absolutely.
I love it.
You shared so many great gems.
I would say that as we're wrapping up, what is one thing you want to leave with Earth
listeners?
What do you want to say that perhaps needs to be emphasized or hasn't been said yet?
Let's see, what should we emphasize?
So mentorship still to me remains the most important aspect, even though the definitions
of mentorship are changing.
I think we need to think about ways to formalize a lot of the organic nature of mentorship,
kind of like you and I talked about, while still preserving some of the serendipity that
can happen with a good mentorship pairing.
And I think we're all sort of struggling with how to do that.
A lot of programs, including our own, create mentorship committees, right?
When fellows come in, they get paired to faculty for career development advice.
And sometimes those pairings work, sometimes they don't.
But we also know that when we remove that from the equation, then suddenly the fellows
want it.
And it's the same for the junior faculty.
So how do you create these structures, but then allow for the flexibility for that organic
nature to happen, I think is important.
I think another thing that we need to think about, and again, this ultimately goes back
to, again, success of a fellow as an academic clinician afterwards, is how do we and should
we, and I think the answer is yes, but how do we and should we be incentivizing faculty
to mentor, right?
Because a lot of faculty take on mentorship just out of goodwill, and also because we
got good mentors and we want to pay that back.
But as medicine becomes more complex, as financial reimbursement models become increasingly a
big driver in academic hiring even, how do we start to systemically and institutionally
incentivize mentorship so that all of us will want to be mentors and realize that when we
invest in people the way they invested in us, then that's how we continue the field
and we all benefit.
So I think those are two concepts, of course, they're beyond our own discussion, but I think
they tie back to what we can do to increase the likelihood that our fellows will be successful,
because I think we have to not just invest in mentorship, but also invest in the future
of mentorship, whatever that means.
I love it, when you talk about the serendipity, it's almost like someone needs to come up
with a mentoring matchmaking service, kind of like dating services exist right now.
Create the structure and then watch for the chemistry.
Absolutely, yes, yes.
Some of us have talked about apps, right?
Can we create an app that does this?
I mean, the traditional thing of asking around who's got research projects and then meeting
with them and then creating databases and notebooks and websites of which faculty have
research projects going on.
I mean, it's basically evolving into a dating app.
So yeah, I think we should just call it what it is and do it.
I agree, and thank you for your patience.
I have been having connection difficulties for everyone who's listening and wondering
what all the positives are.
And Alfred, thank you so much.
You have been such a pleasure to talk to you.
You have such great insight.
I feel like at some point I'm going to need to invite you back again so that we can talk
about some more of the nuances of the mentoring and defining success, because there's so much
really to unpack.
And I just want to thank you.
You shared so much wisdom, so much insight.
And I know our listeners will learn so much from it.
Thank you so much, Dorothy.
And thank you for everything you've done in our field and also with this podcast and all
the things you're doing now to sort of propel trainees and our whole field forward.
Thank you.
I think we have a shared goal.
And so I'm glad to have you as a partner globally in this effort.
Thank you for being here.
Thank you.
All right, everyone.
You've heard Dr. Lee.
He's talked a lot about things that fellows need to think about in terms of being successful.
If you've enjoyed this podcast episode, please share it with somebody else.
If you're a mentor who's listening, please share it with your mentees and ask them to
share it with their peer mentors or their peers so that more people can kind of learn
a lot about the hidden curriculum and then continue to work towards their own success.
All right, until next time, take care.
Thanks for listening to this episode of the Clinician Researcher Podcast, where academic
clinicians learn the skills to build their own research program, whether or not they
have a mentor.
If you found the information in this episode to be helpful, don't keep it all to yourself.
Someone else needs to hear it.
So take a minute right now and share it.
As you share this episode, you become part of our mission to help launch a new generation
of clinician researchers who make transformative discoveries that change the way we do healthcare.