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 your host Toyosi Onwuemene, and it is a pleasure to be on the show today because I
have an extra special guest.
Peter, please introduce yourself to our audience.
Yeah, I'm Peter Kurre.
So just like the spice by way of pronunciation.
I'm currently at the Children's Hospital of Philadelphia.
I work as a physician scientist, and I direct the Comprehensive Formular Failure Center
here at CHOP.
Thank you.
Thank you for being on the show.
Now, Dr. Kurre, you are a highly accomplished person, and you've been in the game for a
really, really long time.
I want to ask, at what point in your journey did you see yourself not just as a clinician,
but as someone who's also a clinician scientist?
And just talk to us about that transition and about your journey as well.
Yeah, I think this goes back to, I guess, a role model.
My first job out of German medical school for a number of quirks in the German system
that may no longer exist, but certainly applied back then.
I found my first job in a very highly specialized field, pediatric stem cell transplantation.
The individual who ran that program at University of Dusseldorf was an inspiration because he
had to manage what I didn't really understood to be possible then, which is to be a physician
and to do great science.
It was collaborative and I think really impactful in many ways.
So I think that set me off.
And I think what affirmed it was that somewhere during the pediatric training, I understood
that the best pediatrics is not necessarily practiced by those who have a craving for
creativity, right?
You want someone who has deep experience and practices, what is evidence-based.
But then again, that runs into the need for, that's certainly I felt, to do something creative
and to explore.
So I guess I discovered the thrill of discovery and the beauty and fun that is in science.
I love it.
So mentorship was kind of part of what led you to this place, but also your own love
for discovery.
And it sounds like there was a little bit of maybe hesitation in that transition because
in a way it sounds like you really enjoyed the clinical care aspect of things, but there
was this tension of needing to kind of really move towards the science of the discovery.
I wonder if you want to speak to that.
Yeah, I've been in this country now for 30 years.
My initial motivation to come was to have balanced and thorough general pediatric training.
So I had been inspired by that individual, but I wasn't sure I could do it.
And so I was really looking for a path to good pediatric training.
And so I think it was then being in the United States and seeing that being a physician scientist
and working on both sides, if you will, was a reality that maybe was within reach for
me.
I love what you say because you crystallize a lot of the concerns I think that many younger
physicians have where they're like, I love seeing patients.
I love taking care of them.
I don't want to lose my clinical skills, but research is important as well.
What advice do you give to young faculty who are trying to balance this tension between
clinical care and research?
Yeah, I don't know.
Maybe this is bad news, but I think the most important skill in the successful transition
is to be comfortable with letting go.
Once you become an expert in something and you really have deep knowledge, you have to
appreciate that you can no longer have broad knowledge in everything.
So when you are an accomplished and certified pediatrician and then want to subspecialize,
there are many aspects of pediatrics you will have to be comfortable letting go.
I trained as a stem cell transplant, an antihematologist at the Hutch and Seattle Children's.
I think it was clear early on to me that I would never be a consummate GI specialist
and that I knew very little about pulmonary medicine, for example.
So you have to let go of something and be comfortable with that.
And I think many young trainees early on struggle with that because it is an accomplishment
to practice medicine and to be a gatekeeper, a pediatrician or an internal medicine doc
who knows how to diagnose a patient and how to help them create referrals.
But it's entirely different to be a subspecialist because there's many things you can no longer
pursue and you will not be an expert at.
And that's important to understand early on and to become comfortable with.
I appreciate you saying that.
It's almost like a fear of missing out.
And the reality is we're doing it all the time, right?
When we were medical students and we chose a specialty, we actually closed the door and
all the other specialties.
And so in a sense, what you're talking about is doing that more and more as you're moving
forward in your expertise, you are closing doors, but you have to be comfortable with
doing that.
Yeah, that's very right.
Yep.
I love that.
I want you now to just speak to some of the differences you see.
You've been in your career and you've kind of done this over the last few decades.
What are some differences you see now compared to when you were coming up as a clinician
scientist and now as younger clinician scientists are coming up?
I think there's a lot of good news, actually.
I really think that there are many, many great opportunities.
There are, I think, now more institutions that take an active role in fostering physician
scientists.
It's no longer limited to the major institutions, academic institutions.
I think there are more careers that one can look at depending on how much science you
want to do and what the context for that science should be.
I think that there's really a golden age of science in my mind.
The tools that the, I guess, the IT revolution and engineering have provided us have created
an amazing set of resources to tap into.
I think this is already great news.
I think this is a wonderful time to become a physician scientist.
I think the greatest risk is distraction.
I think over the, what I still think is a short course of my career, I think there's
so many more demands on especially young physician scientists in the transition.
Everyone now needs to be their own PR specialist vis-a-vis social media.
I think that there is an increased demand for how healthcare is delivered.
I guess you catch what would be the electronic medical record that we spend a lot of time
with.
So I think there's a lot of distraction that has nothing to do with our patient care or
very little.
And on the other side, the science is accelerating in just the pace of publications.
I think that can be a daunting set, or it may appear to be a daunting set of obstacles.
But at the end of the day, the greatest science I know is my own, and that should be the same
for every physician scientist.
You should believe deeply that what you do is worthwhile, impactful, and has a future.
And when you do, things will fall into place until you'll be able to compartmentalize and
maybe drown out some of the distraction.
I love how you summarize it.
I actually really love your positive outlook as well, just that there is great opportunity.
There's so many new technologies that can be incorporated into our research programs.
And I appreciate what you speak about distraction.
And there is so much now in healthcare that's required of physicians, and not all of them
are necessarily directly beneficial to the patient.
And so really, you speak to the need for focus, but creating structures that allow you to,
as you say, drown out the noise so that you can really focus on your research.
And I like what you say about your research is your own.
You're the one leading it.
If you don't lead it, nobody else is going to.
All the other stuff somebody else can do at some point.
But if you don't lead your research, the thing that drives you, the passion you have, no
one else is going to move it forward.
And so it's almost like there is an imperative or maybe an obligation we have, and not a
bad obligation, but really to really move our work forward.
And I love what you shared in that.
And I think the...
Yeah, I think you're hitting on a key aspect, and maybe one of the ultimate struggles in
being a physician scientist, and especially coming from a physician side, that's very
much outcome driven, right?
We want to do well by patients.
And we change many different variables of the treatment at the same time, looking for
a top-notch outcome.
That would be a very bad approach to science.
And so there is an inherent tension in how we practice medicine and how we practice science.
And I can certainly say for myself that it took a few years to understand and appreciate
that and to take a different approach to my science than I do to my patients.
Yeah.
One of the things you highlight in that statement is that you come through clinical training
and you know a lot of patient care, but you don't know much research.
It's not part of your training.
And there are so many nuances to addressing a research question that's completely different
from how you care for patients.
And I think that that's lost in our understanding as clinicians.
And there was a sense that if we take care of patients, we must know how to do the research.
I wonder if you can speak to that gap, and how do physicians fill that gap?
I think I've learned a lot from the scientists I interact with and from having been in science
for a while.
And I think a colleague I found has a particularly nice way of asking questions that captures
some of what I want to speak to here.
She will typically pose a question with, well, doctor, isn't there a different way of interpreting
your results and make a suggestion to ask a question?
I think that's inherent in science.
It's how we do science, right?
Look for alternative explanations.
And that isn't always what we do in the patient arena, but I think it would benefit us to
do more of that.
Isn't there a different way of looking at this situation?
And I think that one experience that helped me with that is having worked at different
institutions, just the diversity of experience that can really shape your outlook.
And I think that translates into how you interact with patients.
And it certainly has helped the science.
I love it.
So in growing in the science, in learning to ask better questions, in challenging your
assumptions, you actually become a better clinician as well.
Oh, I strongly think so.
Yeah, I believe that.
I love it.
Now, you've been in the game a long time.
What has kept you in the game?
Yeah.
The thrill of discovery on the science side.
It's like climbing a mountain and being the first to see the other side of what's there
when you reach the peak.
And it's not always a Mount Everest.
Sometimes they're just little molehills, but the thrill never goes away.
On the patient side, well, it's the patients.
My first internship was with a solo pediatrician.
And I think that's shaped how I look at healthcare and pediatrics in many ways.
I just love being in the room with the kids and with the parents.
And then not to underestimate the fact that being around young people who ask questions
and who want to do their own thing is just as exciting.
Those three things really.
That's really awesome.
I'm excited just listening to you talking about that.
It's like, wow, this is really cool.
Now, I will tell you, in an age where there's so much physician burnout and people are quitting,
how does being a research scientist change your experience relative to the global experience?
Yeah.
I mean, I've only done one thing, so I can't really speak to what it looks like when one
is a full-time physician or a full-time scientist.
But I can say that balancing the two is part of the answer here.
I go to the clinic on my ambulatory clinic days and it just is invigorating to be with
the patients.
And by the same token, some of the noise that we deal with in patient care falls away when
I come back to the lab and think about experiments when I design.
Those experiments I write the grants.
So I think it's the ability to go from one to the other and have them reinforce each
other.
I like the reinforcing of each other.
And it's true.
I mean, we came to this.
For those of us who started as clinicians, we came because of patients.
And the work we do is our goal is to advance patient care.
Yeah.
Now, it's almost like you make it sound so easy, but I bet there have been challenges
along the way.
What are some of the greatest challenges you faced along the way?
Rejection, right.
And I mean, I don't mean that to be in a personal way, but our clinical training, there's plenty
of ways in which we are taught that I'm terribly conducive, that maybe I reject.
Certainly science is that way, right?
So there is a strong inclination for scientists to criticize, to look for alternative explanations.
But I think that the answer here is you have to be comfortable with the process.
So it's not the immediate outcome, right?
My first grant, probably my first few grants were rejected, not funded, but it's a process.
And so it's not about the immediate success.
It's about being persistent and it just makes the joy that greater.
And I think that can be a challenge because the clinic, you know, you go into the exam
room and it's a great experience.
Invariably the patients, their kids, they're positive.
So I think that's a positive experience.
When things go well, then, you know, the parents are great.
It's a wonderful situation.
It's like a candy jar.
Why wouldn't you go back?
Right.
And I think it's important to understand that science is not like that.
And of course, clinical care isn't all like that.
But I think to be comfortable with the fact that it's not all immediate gratification
that you're in it for the long game and takes a little while to understand that there is
beauty in that.
Now rejection really is a pretty prominent feature of science and the whole scientific
enterprise.
Now that you've been doing it a long time and you've probably had a lot of rejections,
does it get easier?
How do you handle rejection today compared to when you first started?
Yeah, it does definitely get easier.
Some of it is built into the process.
So initially you have, you know, one project, a few experiments, someone doesn't like them,
you don't get funded.
Ultimately, when you grow into your career, you have different projects, many trainees,
different types of grants.
And so you balance one with the other success here, maybe lack of success and a bit of rejection
on the other side.
So I think that's a big part of it.
But the other part is that I have learned an incredible amount of ultimately actually
science from my reviewers of papers and grants.
Some of the projects in my lab, I've been investigating the biology of vesicles in the
hematopoietic context, extracellular vesicles and what their cargo protein, microRNA, what
role they play in regulating hematopoiesis.
That first came to us because the reviewer asked us about an observation that was sort
of a sideshow in an early paper and said, have you ever considered this?
And so that led to now well over a decade of research funding papers.
And so I think what I've come to understand is that the criticism, even the harsh criticism
can sometimes hold incredible value.
You just have to go back and be willing to digest it.
Wow.
I love those insights.
It's, I mean, it's true.
I mean, I think about my experience too.
You're always annoyed at the reviewer.
When you go back and you think about it, you realize that if you're willing to be open,
there's some insight and gems that you can take and make into something.
And that at the end, I feel like my manuscripts are definitely enhanced by the reviewers and
certainly grants as well.
And so, but there's also in your talking, there's also an openness though to feedback.
And I wonder how people can encourage that in their journey.
Because I think that the initial response is to be close-minded, but how do you take
that rejection and make it a gift?
You made it a gift.
It's been a gift to your research lab for the last 10 years.
How do you do that?
How do other people do that?
Yeah.
I just go back.
So when I get, I guess they used to be called pink sheets from NIH grants, right?
So I go back to my critiques and I read them, I reread them, I, you know, I like them.
So I think you really have to be willing to read carefully, to read between the lines
and to digest.
I don't think it's a, no, it's a single read and immediate realization.
I think that the openness and the acceptance and the opportunity that comes with some of
the critique isn't always immediately apparent.
I am afraid I don't have a sort of a magic bullet or a go-to strategy for what you're
asking.
But I think allowing the process to take hold and a critique just to percolate through your
mind is one way that's worked for me.
Sure.
I also hear you talking about the resilience because you keep going back, right?
You don't first read the, I mean, I think I'm also kind of hearing that, I mean, you're
going back to resubmit or you're going back to readdress the issues.
And so because you keep going back to it, you have the opportunity each time you go
back to take something different from the first time.
And the, I guess the other aspect of that is of course, the interaction with peers,
right?
So I'm a big believer in working with, so in terms of, in the case of NIH grants, working
with the institutes, what is it they want?
What are they, what are their critiques?
What's their interpretation of the critiques you've received?
So, and it's just one example, the theme here is talk to other people, see how they interpret
what comes back and bounce ideas or rebuttal of others.
And I think those interactions can be incredibly insightful.
Sometimes the discussion with maybe where you get insight where you least expect it.
So you know, there's, whether I talk to the program officer or a medical student in the
elevator, the insight is everywhere.
You just have to look for it.
Yeah.
You need to mine it.
I also hear you speaking to the collaboration.
There's just collaboration happening on many levels, collaboration happening in your lab,
collaboration is happening with other investigators, collaboration kind of with the reviewers too,
because their insights now are part of your program.
And you're also talking about with the institutes as well.
What are they looking for?
How are they interpreting the reviews?
And so it's almost this sense of, I mean, we talk about team science, but it really
is kind of the greater team science.
Yeah.
And I think that the sciences reach such a complexity that you really need to, you need
to consider the environment.
I mean, not just the physical environment, but also the intellectual environment as part
of your resource, a necessary resource.
And I strongly encourage reaching out to others beyond your own institution.
Because, you know, we all have a tendency to sit in our own little ivory tower and other
people's towers at different altars.
I love it.
I, yes, I totally, totally resonate with that.
There's just so much diverse perspectives when you step outside of the institution.
That's a relief.
And people love to be tapped for advice and guidance, right?
I mean, I've had some of the strongest support and greatest insights in my career from folks
who I emailed out of the blue with a specific question or who I approached during a meeting.
These can be great interactions.
That's really insightful.
And thank you for sharing that.
All right.
So we are coming to the end of the episode.
And I wanted to ask if there is a young junior faculty person really just starting out right
now distracted by so many things and they don't feel like they can succeed, what advice
do you have for them?
Believe in yourself and persist.
If you want it, it will happen.
And don't be distracted by people like myself who present their career in sort of a linear
fashion.
It's not like that.
The linearity of the existing hindsight and the back and forth, the curves in how things
proceed for you, part of how curbs are shaped.
I like that.
We look to our mentors, those who have gone ahead and we're like, their life is so good.
And what we've missed are the challenges that they have, the challenges and the obstacles
they've overcome to get there.
And so earlier on, you're in that phase of overcoming obstacles.
So sometimes it can feel insurmountable.
But that is the path.
That is the journey everybody is on.
I love it.
Thank you.
Thank you for sharing your insights.
I wonder if you have any closing statements, something that we haven't touched on that
you feel like it's important to share with our audience.
It's all doable.
Put your mind to it.
And again, I think that nothing's beyond reach.
And I think don't be intimidated when people tell you that you have an MD behind your name
and you're not made to be a scientist.
It's not like that.
I love it.
So much positivity, so much encouragement, so much inspiration.
Thank you so much, Peter, for just your insights and just for being on the show.
Thank you.
I really appreciate the opportunity to ask.
I think this is great.
I really enjoyed my time.
Thank you.
All right, everybody.
You've heard Dr. Peter Kurre.
This is doable.
You can do it.
Don't, don't be discouraged.
This is a hard journey, but you can do it.
There is somebody else who needs to hear this episode.
It's been really insightful.
Please share it with them if you're a mentor and mentee needs to hear this.
If you're a mentee, you have a network that you can share it with as well.
And I invite you to do that.
All right.
Thank you for joining us.
We look forward to talking with you again on the next episode.
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.
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