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 here today.
I have an outstanding clinician scientist to introduce to you today.
Her name is Dr. Stella Chou.
Stella, welcome to the show.
Thank you.
So, Stella, for our audience, would you please introduce yourself, especially in the context
of how you came to be doing this thing, where you're a clinician and a scientist at the
same time?
Sure.
So, I'm a pediatric hematologist by training, who then got a fellowship training in transfusion
medicine.
So, I practice both non-malignant hematology and transfusion medicine, primarily in pediatrics,
but I do care for young adults as well.
And I think really how I got here was pretty circuitous.
I went to med school because I wanted to be a pediatrician, and during med school, I became
interested actually in pediatric oncology.
But when I came to CHUMP, I was exposed to all aspects of pediatric hematology that actually
piqued my interests in a different way.
And probably the reason why I ended up in hematology versus oncology, honestly, is because
for my second year during fellowship, I chose to join the lab of Dr. Mitchell Weiss, who's
now at St. Jude's.
And I joined his lab to study a disease that affects children with Down syndrome.
So, patients with trisomy 21 who get either transient abnormal myelopoiesis or myeloid
leukemia.
And at first, it really combined my interest in hematopoiesis as well as oncology.
But I think in working with Mitch, I just leaned more and more towards hematology.
And after I completed my fellowship, I ended up doing a transfusion medicine fellowship
a few years later.
And again, that was something that just was an opportunity that came my way, and I decided
to take it and met a number of people in the transfusion medicine community who sort of
helped me make that decision.
And since then, I have primarily worked more in the hematology, transfusion, medicine space,
but the project I came to do as a second year fellow, I guess now it's almost 20 years ago
when I joined Mitch's lab.
We still work on that problem in my own lab, but we have much better tools two decades
later, I think.
But it's interesting to look back and say, for instance, grants that I wrote as a fellow,
what were the questions we were asking and trying to answer?
And some of those questions are still unanswered and we're still trying to answer, which is
part of science.
But I guess my point is that I think I ended up here because of just different people in
my career and then the different opportunities that came my way being at Chopin and Penn.
Awesome.
Thank you for sharing.
Now, I see in your story, someone who was open to opportunities and someone who recognized
and took opportunities.
Can you tell me about what it was in your makeup, either your prior history or family
history, your experiences that allowed you to be that kind of person who just kind of
took opportunities as they came?
I think probably it's how I was raised.
My parents were both immigrants to the US.
I think people oftentimes look at me now and just expect that I had every opportunity in
my lifetime, but my grandfather actually immigrated here and was a magician and then ended up having
his own laundry mat business, which provided him with the means to then end up buying real
estate and doing very well for himself.
But both my parents do not hold college degrees and still I'm actually the first generation
of my family to have a college degree, which you can imagine is very different, especially
now as my own daughter is applying for college for this next fall.
It's the types of applications and the types of opportunities she has compared to what
I have.
But I think what my parents always instilled in me was that opportunities are in front
of you.
You just have to recognize when something's an opportunity and take it.
And I think their opportunities were very different than the opportunities that I had
to take.
But I think nonetheless, it sort of was a lesson in life that I think my parents imparted
on myself and my four siblings just by their actions.
They never really said those words to us.
I think it was really by their actions and how they just supported us.
And they always tried to do everything for us that would allow us to have every opportunity,
even though we didn't always have all the means that other people in my school had.
So I think that's probably where it's most grounded from.
Thank you for sharing that.
I mean, I see just it sounds like a family culture of looking for opportunity, recognizing
it and seizing it when it comes, but also being prepared for the opportunity when it
arises.
And I think I've been really fortunate to be a place where people are very supportive.
And I think that helps because you can try something and if you fail, they're fine with
that and you can try to do something else.
And so I think always knowing that you can try things and if you're willing to take a
little bit of failure or you're willing to not have the expectation always that you will
succeed in the way you think you're going to succeed, because I think that's something
else that I learned along the way, is what do we consider a success and what you might
think of as success might be different from who you report to per se.
But in the end, I think that it really matters what you think is success and what you think
brings meaning to what you do when you come to work every day.
Wow.
You said two things that are really amazing and I just want to come back to.
So first you talk about failure and not being afraid to fail and the importance of having
environments that allow you to do that so that you don't feel as if you're taking a
risk it's an unalterable risk or you can't change direction.
I want you to speak a little bit more about what that looks like, do you think, in today's
environments for clinicians who are trying to make this transition to research, do we
have the same kinds of supportive environments today?
I think so.
I think actually over the years there's been more and more support to take an idea, make
it a question, write it in a grant, hopefully get funded, and then bring it to realization.
I think there's many routes that you might take and some of them are certainly baby steps
whereas other things might seem like they are riskier.
I'm really going to try this.
But I think if you have the attitude that you can make it happen by garnering the right
people to help you do it.
So I think we never do anything by ourselves.
We get the help from the trainees who are in our lab or the research assistants or the
research coordinators who we work with to all the people who help get things done.
The core labs, our admins, our sponsored projects office, there's so many people who are involved.
And then also the people that you look to as mentors and sponsors.
I think you know that you have so many different places where you might be able to get help.
But I do think people is a major facet.
I feel like if I find that there's a challenging problem, I think I have the mindset of, well,
let me find someone who probably can solve this problem and see if I can work with them.
And I think sometimes you have to choose wisely, right?
So sometimes you don't go to like be the expert.
You go to someone who, you know, knows the field well, but will also have the time and
the space to work with you.
And I think most things that we do end up really being a team effort.
So I think nowadays, more than even when I started out, collaboration is really something
that everybody supports and that institutions have found ways to allow for collaboration.
So either they have small pilot grants for that or they have seminar series that try
to bring different groups together.
So then you meet people on a regular basis that you might not have had that interest
group not have come together.
And then certainly it seems like most funding agencies do support collaborative efforts.
So I think that's a big piece of it.
And I also think there is the element of being realistic.
So for instance, when I started doing the work that has been done really in collaboration
with New York Blood Center, with Connie Westoff and Sydney DeVege, looking at using molecular
typing and doing high resolution typing at the RH locus to see how we could better match
patients with sickle cell disease to their donors.
I think we took baby steps, like first we showed that it was important.
And now currently we have pilot clinical trials in a small subset of patients who were actually
providing genotype matched blood.
And we knew that logistically we had to get blood from the New York Blood Center, which
is at a depot in Long Island City to Philadelphia.
We know that patients reschedule or patients have other reasons why they might not come
that particular day, or if we have something that shows up in their antibody screen that
day and we might have to change course a little bit.
So really we started out as a pilot study.
And I think the next step will be to extend that study still as a single institution study
before we can take it on to the next step, which is a multi-institutional study.
But to do that will require even more collaboration.
So we're going to need other blood centers aside from New York Blood Center being involved.
We'll need multiple institutions who would be able and willing to participate.
And there's probably a lot of other facets that we would have to figure out in terms
of information technology, how we're going to transfer all that data between different
blood centers, different hospital sites, and then having patient data on one side, donor
data on the other side.
It's pretty complex.
So we've taken in baby steps to be realistic.
We didn't go from, oh, this is important to let's try to get this directly in the clinic.
But I think in the end, I hope that within my career that this is going to be something
that's going to be available for patients because I think there's advances that are
being made outside of the work that we're doing, which will allow methods that will
allow us to sequence at a much more cost effective way.
There's probably going to be other work that's done.
For instance, there's a national group through the DHHS who's looking at an antibody registry
for hospitals to report their antibodies.
So in that sense, it's like trying to find a way where there's going to be a method to
communicate information from different hospital sites about transfusion data, and that potentially
would help be a platform for anything we would want to do in the future.
So I think melding things that are things that you work on, but knowing what everybody
else is working on and seeing how that might help.
I feel like I've gotten way far off.
You can try to bring it back.
No, actually, I feel like you did a great job of just kind of...
First of all, I think one of the things you did was go to a 30,000 foot view and talk
to us about how this is big picture.
There's so much going on.
It's very complicated.
And what you succeeded in doing is taking something that's a small piece of it and then
just advancing it just a little step at a time.
And even now, you are doing kind of collaborative projects even between centers and talking
about how that gets bigger.
Multiple centers will need to be involved, multiple blood centers.
And I think what you're talking about is just the cascading effect of the work that we do
when we start small and not expecting...
Because many times, and Stella, you're senior enough that people look to you and they're
like, oh my gosh, she's so successful.
Look at all the awesome stuff she's doing.
And what people miss is the baby steps that you took when you first started and the fact
that you still are taking baby steps and that's what's moving you forward.
And I think it's important that people recognize that.
I think the other thing I love that you said at the very beginning is you talked about
collaboration, but you didn't start with mentors.
You started with those around you immediately.
And I feel like you talked about your trainees in the lab.
You talked about the research assistants.
You talked about choosing specialized mentors carefully.
And I really love that because sometimes I think there's a sense from, I think especially
people who are just starting out, that there is one mentor, one senior person who's going
to open the door and all things are going to fall in place.
And I think many people are disappointed when they find that that doesn't happen.
And I love that you started really with the reality of starting with who's around you,
who's immediately available to help you.
And when you look ahead to those who've gone far ahead, it's like who is specifically suited
to help you, not just because of their expertise, but actually having the time and the interest
to help you.
So I love that you put so many things together.
And I wonder if you want to speak to the whole piece of mentorship and how that plays a role
in your advancement.
I mean, certainly, I think I was also really fortunate because I had multiple mentors in
my early career.
So I chose to work at Mitch Weiss's lab and he was my primary mentor and he was a phenomenal
mentor.
He was a great manager in the lab.
He thought it was fun to come into the lab and show me how to do things like literally
hands on.
But at the same time, he was more than just an academic mentor.
I think he is one of the few men who I have seen in science who really partnered with
his wife, who is also a physician scientist.
And I always found it refreshing to see his contributions to their family.
So he would sometimes just have a hard stop at five o'clock because he was the one who
was responsible to pick up his children from daycare.
So I think his way of just balancing work and life as well was important to me.
But he was also a sponsor.
So I think one of the things that I always tell trainees that I interact with now is
that you really have to find something that you love doing.
And like you said, looking back now, I went through a period in his lab where I said,
I'm going to finish my project and then I'm going to move on.
So I came to his lab without any basic lab research experience.
I picked up a pipette the first time coming to his lab.
And I didn't think that that was where my career was going.
I wanted it for the experience, but not necessarily to run my own lab.
And I would say that finishing fellowship, I thought that I was going to finish my project
and move on.
And he said, you have to do what makes you happy.
If this is not what makes you happy, then you should choose to move on.
And I thought that at the time I would get a master's in clinical epidemiology next and
move on to really more clinical research.
But as it happened, just other forces that were happening in my life and being married
also to a physician and having two people that would need the right choice of an institution
in their next career steps, we stayed here.
And that was one of the reasons why I ended up doing the transfusion medicine fellowship
a few years later.
But I think just finding what makes you happy is what's really important.
And sometimes it's a little transition period.
So I will admit, I wrote my KOE.
And I thought, in my mind, I'm not exactly sure why I'm writing my KOE because I'm not
really going to be doing this anymore.
But I wrote it and then I got it.
So then I stayed in the lab for a few more years.
And I think really what happened was it took time to gain more skills and gain more confidence
in the lab, which I did not have initially because I did not have a PhD prior to my lab
experience.
And then I think what really catches you is you actually discover something and just the
satisfaction and the joy you get of discovering something, having a body of work that you
publish is quite satisfying.
And I think that's probably what hooked me was the high you get off of that.
So I still do think of Mitch as a mentor, a sponsor, a friend, a colleague.
She's been a wonderful person in my life.
I also was really lucky that through him, actually, I met Connie Westhoff, who is a
giant in the field of transfusion medicine and R.H. genetics, and she too was also a
mentor and a sponsor.
And obviously we still collaborate.
And even as she is moving on, probably in the next few years, she's slowly trying to
take on retirement.
I still go to her all the time because she has this wealth of knowledge, which I'm convinced
nobody else on the planet Earth has besides her, but she was also a wonderful mentor and
career advocate for me.
And then I also had to mention Katie Mano, who was my clinical mentor in hematology.
And she's the one who actually provided the opportunity of considering a transfusion medicine
fellowship.
And I think at the time, looking from her point of view, she saw it as a place where
Chopp could probably use another person who was well versed in both hematology and transfusion
medicine.
And she probably just saw certain things in me that seemed like that would be a good fit
for me.
And she was super duper right.
So I think just having, I've just been really lucky to have people in my career who have
helped me find that opportunity.
And partly, I think because they've taken the time to get to know me and really know
me to help me choose the right pathway.
I love it.
One of the things that really resonates with me as you're sharing is that you really had
multiple relationships that were instrumental in your forward motion.
And it was mentoring relationships, but it was also the intersection between what's going
on in your career, what was going on in your personal life and making things work.
And so ultimately, I think what I'm hearing you also say is just how you have to look
at everything in the context of your life, also in the context of what you enjoy doing,
and then see what opportunities make the most sense for you.
So then I'm almost hearing you say there's no cookie cutter way forward, and there is
no one person or one thing that is in charge of moving everything forward.
It's just really integrating all the experiences that you're having to pick the thing that
makes the most sense to move forward in.
Is that fair to say?
Exactly.
Yep.
That's what I tried to convey to you.
Yeah.
Now I like it.
I love it because I think it's that we are, we're hard workers as clinicians.
I don't think that's anything that has to be said, but just even as we work hard, seeing
what opportunities arise and not feeling like there has to be just one way, because then
I think we could be disappointed.
Which brings me to what you talked about, success.
Let's talk about success.
So what were you referring to when you talked about the different definitions of success?
Well, I think how you define success, even just in the realm of say a clinician researcher,
some might define success because they get promoted or they publish in a really high
impact journal.
For me, success is, I think success is doing every day what I truly love.
I wake up in the morning and I think about what I'm going to try to tackle in a day and
you never get it all done, but you just have that motivation every day to go to work and
get something accomplished.
I think for me, the thing that's been the most meaningful is seeing, again, we're taking
baby steps, but seeing how some of the work that we do actually impacts patient care and
seeing that we're moving the needle slowly, but we're moving the needle.
I think for me, knowing that what we do every day in the lab or in our clinical research
studies, there's going to be an outcome that actually matters is how I define success.
Whereas on the other side, we do some pretty basic stuff in the lab and sometimes we're
successful too.
We figure out what are proteins doing or we have a certain hypothesis and we're right
in our hypothesis.
That's satisfying also, but to me, that's less satisfying than knowing that the work
we do can impact patient care or patient outcomes.
I think that's the part that drives me the most and probably because I think I'm a clinician
at heart and the questions I ask and the questions I tried to answer for myself are really clinical
questions at the heart, but just using different tools.
Absolutely.
I feel like you speak to a lot of perspectives of clinicians because ultimately for many
of us, we started out as clinicians first and then we made this transition to research.
Really at the heart of our clinical heart is making things better for patients.
I hear you speak about the opportunities you have to make an impact in the lives of patients
and seeing your research turn into that is very satisfying for you.
I also hear you talking about success as success and enjoying every day, success and enjoying
your journey.
Not looking for the end goal, though you have a lot of wonderful things that you've accomplished
over the course of your career.
You've gotten those things too, but not looking at those items as the things that define you
as successful, but the fact that you're making an impact.
You're doing work that you find meaningful.
You're doing it every day.
You're making discoveries that are interesting and important to you.
I'm just hearing the threat of personal daily satisfaction.
Yeah.
I think that's what's really important because otherwise it'd be really hard to do our jobs
where we're pulled in so many different directions and we have so many different responsibilities
and we're just trying to always do our best in each of the different arenas, but we know
that that's always challenging.
It is.
And something that you didn't say that I feel like is part of the theme of what you're saying
is you can't live somebody else's dream because that's very hard to do.
And the fact that you're living your own dream allows you to manage all the challenges that
are surrounding it and still move things forward.
I don't know if you want to speak a little bit about that.
I think the way I see it is I prioritize things.
So I see sometimes I prioritize based on what I feel like I need to do versus what other
people can do.
So I could volunteer to say cover another clinic or something, but would that really
be the best use of my time or would I contribute the most to us as a group?
And that's probably no.
But there are other things that I know I can do.
So for instance, somebody asked me to look at their specific aims page for their K award
and I know that's particularly important that I could potentially give them feedback at
this stage where they still have a month to do it and I prioritize that much higher.
So I think you really have to prioritize what's really important.
I think one of the challenges we all have these days is that there seems to be a lot
of tasks that we all have to do.
There's endless emails about things that you need to fill out or do and it can be onerous
to get all those things done.
But I think prioritizing them and then seeing where you can delegate things or seeing where
you can do something quickly rather than spend too much time on it helps me at least manage
the day to day so that I get to spend time on things that I think are what's really important
and what I really want to do so that you don't get overwhelmed by all that other task-oriented
work that we oftentimes have.
I love it.
I found that I think you gave us some kind of organization of type gems in all of that.
One you talk about working in your zone of genius.
So there are many things you can do but what are the things that you are uniquely qualified
to do that you actually like to do?
Another thing is recognizing that while everything needs to get done, everything doesn't need
to get done equally well.
And what are the things that you can drop your standards on but still get done?
And what are the things that you absolutely need to focus on?
And then one thing you said also that I really, really, really, I don't know, it gets me excited
to think about is moving your work forward.
And that's so important because if you don't move your work forward, nobody else will.
And other work needs to be moved forward and you surely do need to be part of that as a
collaborative person.
But prioritizing the work that really means a lot to you, really moves your career forward
is important.
And I do think that many of us early on always think about, well, how do we satisfy the needs
of everybody else?
And then at the end of the day, we hope there's time to move our work forward.
It's really our work comes first.
And then we find time later to move other people's work forward as well.
Right.
And I think it's particularly true because there aren't too many of us that practice
hematology, transfusion medicine, and then have a particular skill set.
So for instance, we had a project where we were making in-vitro derived red cells from
induced cloripotent stem cells that we genetically engineered to have specific Rh variants or
Rh null.
And I think what was special about that project was that I was sort of like a matchmaker in
the sense that we had Connie Westhoff from the New York Blood Center who's like an Rh
expert and we had Gordon Keller from Canada who's an expert in developmental hematopoiesis
and cloripotent stem cells and Jim Pallas at Rochester who also really understands developmental
red cell development.
And then we had people from CHOP.
So Paul Gaudu and Dina French who are long time collaborators at CHOP who work mostly
on iPS cells.
But bringing all of that different expertise to put together in this project was very unique
because it was like little pieces of the puzzle and getting it all together.
And we're so far from, you know, that's another goal of mine is by the end of my career, I'd
like to know that that work went somewhere where, you know, it's actually in the blood
bank.
We actually have reagents that we developed in the blood bank helping us to facilitate
antibody identification.
Or maybe, you know, and this is probably a much higher goal, is that we see the Rh null
cells that we created actually get to a place where we can make an ass that they can be
used.
I don't know for transfusion unless we're going to transfuse neonates with them, but
as like a drug carrier or something where you use it for immune modulation, but something
in the clinic.
And I think it has like a certain utility.
I think, again, it's there's so many aspects of it, which we're good at some of those aspects.
And I'm still looking for, you know, collaborators to help with some of the other aspects of
making it a reality.
But it's, again, bringing together all these different people that have different expertise
is one of the most enjoyable parts, I think, of the work that we do.
I love it.
It's I love how you use the term matchmaker.
It's recognizing where you're strong and where you're not strong, and then looking around
to see who are the people in your network that can fill the gaps.
And even if they're not in your network, you know, how do you expand your networks to fill
gaps that allow your work to move forward because you can't do it by yourself.
So really speaking to the power of collaboration.
Yeah, that's that's really awesome.
Well, Stella, we're coming to the end of this time.
And I really want you, if you could just, you know, speaking to someone who let's say
we have a clinician who's in their early fellowship years, they're like, well, I've never picked
up a pipette.
I have no idea how I would contribute.
I don't even know that I could be successful as a scientist.
What would you say to them?
I would say they 100% could do it.
I think if you've gotten to this part of your career, you are motivated and intelligent
enough to pick up a pipette in your early 30s and you have many, many more decades to
come.
So I think they can definitely do it.
I think, again, probably choosing the right project and the right mentor is, of course,
critical.
So choose a project that, you know, sparks a real interest to you and choose a mentor
who you really think you're going to connect with.
So I think, you know, you have to find a mentor who will have the time to mentor you, who
has experience mentoring.
But ultimately, I think just knowing if the two of you connect on a personal level, I
think really matters because that person should be someone you spent a lot of time with and
who you're going to spend time with for probably the duration of your career, I think, if they're
a good mentor.
So that's a really important aspect.
Absolutely.
And Stella, if you don't mind, what about someone who says, holy cow, I owe so much
money.
Like, is this a viable career?
I think so.
And I think that recently there has actually been more programs that will pay for your
educational expenses, at least for medical school in that sense.
I was lucky because I had all of my med school loans essentially paid for by the NIH because
I stayed in research.
And that wasn't the reason why I stayed in research, but there are those opportunities.
And I think in the end, we do come out with a fair amount of debt when you go to medical
school.
But I think that over time, you pay that down.
And I think in general, we make a significant enough salary that you should choose to do
something you really want to do and not worry about the debt because it will over time seem
like a smaller and smaller issue.
Thank you, Stella.
I really appreciate you speaking to that.
So everyone, you heard Dr. Chow.
Don't let debt be the driving factor for your career decision.
You want to do something you love and then you figure out how to make everything else
work and it will work.
You can make it happen.
You're an innovative person.
You've come this far in your career.
You can make hard things happen.
So definitely if you want to consider this career or you're in the process and think
you have quitting, don't quit.
You have the capacity to succeed.
So Stella, I want to thank you for being on the show.
Thank you for your words of wisdom.
And it just was a fantastic, fantastic time.
And I want to thank you for your time.
Thanks for the invitation.
All right, everyone.
We'll see you next time on the Clinician Researcher Podcast.
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