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 such a pleasure to be here today because I'm not
by myself.
Today, I have an extra special guest, Dr. Scott Peslak, and I'm going to ask him to
introduce himself.
First of all, I'm going to say, Scott, welcome to the show.
Great.
Thank you for having me, Toyosi.
I really appreciate it.
So our audience would like to get to know you better.
So if you would please introduce yourself, especially in the context of your career as
a clinician scientist.
Absolutely.
So my background is, essentially, I went to the University of Scranton.
I graduated there in 2006.
And when I first started thinking about what I wanted to do with my career, I really was
focused on a career in Madison.
And I had a very series of really important experiences with the research that I had done,
both the University of Scranton as well as summer research programs that got me interested
in research we could talk about in a little bit as well.
And I applied to the MD-PhD program at the University of Rochester, and I was there for
eight years from 2006 to 2014.
And then I came to the University of Pennsylvania.
I've been here ever since.
I did my internship and residency in internal medicine here at UPenn, followed by my fellowship
in hematology and oncology.
And I just started as a professor of medicine in the Department of Medicine or Division
of Hematology and Oncology at UPenn here just this past July.
So I have a brand new lab in which I study sickle cell disease and thalassemia and other
hemoglobinopathies.
And I see red cell disorders as well as adult patients with sickle cell disease and thalassemia
in the clinic here at UPenn.
And so I'm very excited to be able to share my journey through that whole process.
But I really have tremendously privileged to be able to work with this very special
group of patients, both in terms of the research that I do as well as the clinical care that
I take care of too.
Wow, Scott.
One of the things I hear as you describe your journey is that that took a long time.
Can you speak to how much time it takes and the fact that you're not yet there at the
top of your career, right?
You really are kind of still just starting out, even though you've been doing this for
a while.
Sometimes many early career faculty or fellows think, wow, if I really want to start in research
and you actually had a chance to start a little bit earlier than most, what are some of the
concerns and challenges and benefits of just thinking about how long it all takes?
Yeah.
I think that's a question I get asked a lot.
I would say by people that I work with, but more so by family members saying, oh, you're
still in training.
And finally I can say, no, I've finally completed training.
I think my perspective on the journey is that it is a long time, but I will say that the
process is when I tell people that are looking for advice as to how to approach this long
training process.
I think getting early experiences, you mentioned, is really important because before you commit
to a long term training program, particularly programs like MD-PhD that usually lasts at
least eight years, four years of medical school, and then typically four to five years in a
PhD, you want to make sure that you have had the kind of experiences that will prepare
you for that journey and also to make sure that's what you want to do with your career.
And it's hard to know initially, but I always tell my trainees to really try to get as much
experience doing research in the lab during their undergraduate career.
Some people will have longitudinal projects during their undergraduate career.
Some people at small institutions like my own University of Scranton, I did research
there, but also did summer programs at the University of Stony Brook and Princeton University.
And so I got a variety of experiences and some people will take a gap year to be able
to figure that out, one or two years in which they can do research as a technician, research
technician in a laboratory or a more in-depth experience.
And I think I usually tell people to, you know, you don't want to prolong the process
any longer than is necessary, but you want to make sure that this is the right fit for
you.
And so I think as long as it is, as long as you've had those experiences shadowing in
the clinic, as well as doing basic research or translational research in the lab, getting
that hands-on experience, I view the time as more of a journey than actually having
a definitive end point.
Because ultimately, if it's really what you want to do with your career, the whole process
is about getting those experiences, making connections, networking throughout your MD
and your PhD time period.
So I usually encourage people that I mentor to think of it as a process of really establishing
your interest in your career as opposed to saying, I need to get this number of papers
out or I need to get this kind of training from a resume standpoint.
It's more about viewing it as a total journey, I would say.
I appreciate your saying that because I think that when we look at it as a destination,
then of course eight years is too long to get to a destination.
But when you look at it as enjoying the journey, it's like, wow, I get eight years to really
do this thing that I enjoy doing.
And I love the way you talk about really making sure that this is what you want to do and
then making a commitment, right?
Because it is a commitment.
And what you don't want to do is in the middle of all that say, well, I'm not sure this is
what I wanted to do.
I imagine, though, that you had challenges along the way.
And I wonder at what point in your eight-year journey and beyond did you stop and say, I'm
not sure this is for me?
And what kept you going?
Yeah.
It's a great question.
And I think everybody has during the process, these existential crises in some way and thinking,
is this really what I want to do?
Is this the career that I really want to pursue?
I'll get to my experience in a minute, but I think the key part about understanding how
to get through that is having the right mentorship and the right support around you.
I think this process of being a clinician researcher is not a solo journey.
It takes a whole team of people to be able to do that.
So having mentorship along the way, I think some people who are maybe just starting the
process might view it as, I need to do this on my own.
I need to be strong.
I need to figure everything else out by myself.
And that is not, I would not recommend that.
And it's also not the way that really science works, even when you get into faculty and
collaborations.
Really, it's all about having the right mentorship team and the right support team around you.
So establishing that and keeping contact with different kinds of mentors along the process.
Your person who is your primary research mentor will likely not be the same person that is
your primary clinical mentor or your primary career mentor, or even your primary writing
mentor.
These could all be different people.
And so having different people to go to with different kinds of challenges that you encounter
is really critical.
So I would strongly encourage your listeners to establish and ask for mentorship all along
the way.
And coming in, it's important when you have an internship to have an ask from that person,
to not just say, can you be my mentor?
You want to think about before you meet with that mentor and say, this is what I would
be helpful to have from your mentorship process and your own experiences to help me continue
along this whole process.
And so that's really critical.
My journey, I would say, is that I was very fortunate in my first rotation during my MD
at the University of Rochester to find an incredible physician scientist mentor, Jim
Pallas, who's a pediatric physician who cared for patients with different rare blood disorders
and cancers clinically and studied aspects of the red blood cell and how it develops
and the embryo and the fetus and eventually into adulthood.
And so I was interviewed with him initially in my process moving to Rochester for the
program and rotated with him first, ended up back in his lab for my thesis project.
And he was an incredibly important mentor throughout the whole process to the point
where I still collaborate and talk with him for larger big picture career mentorship still
today.
And I think there are time periods, right, during the transition processes, particularly
for people doing MD-PhDs, where it can be really challenging.
So I think when you're within the first two years of your MD program, things are pretty
laid out for you.
It's almost like going back to high school.
You're all in one big room together.
You have all your friends.
You're meeting a lot of new people.
You eat lunch together.
It's very interesting.
And then you leave your class after two years and you go to the PhD program.
And so essentially all the connections you've made at a personal level go away in some way.
And that could be really challenging for a lot of young trainees.
And so establishing, having that longitudinal mentorship is really important at that stage
and choosing a lab where you feel like it really aligns with not only your research
interests, but your personal viewpoint as to how you want to approach science and medicine.
That's hard to know at first, but going and doing rotations, going to lab meetings, meeting
the people in your lab, seeing if that's the right fit for you is really critical.
The other time period that can be challenging, I think, in terms of knowing whether it's
the right thing to do or not is on the back end of the PhD, moving back to the medical,
the third and fourth year of medical school, in which everything, essentially at the end
of your PhD, you are really the expert in the world probably in your small niche of
what you're working on in the lab.
And then you go back to third year of medicine where you know nothing essentially about all
the rotations that you're doing.
And I think it can be really challenging.
I distinctly remember, it's very challenging when you are on a rotation in which you have
patients that are very ill, because I think, particularly as a scientist, you want to be
able to have a significant degree of planning and control over what you're doing and your
research and overall, and things happen clinically that are unpredictable.
And so having support around you to be able to talk to your co-medical students, having
program mentors to get through some of these more challenging patient encounters where
no matter what you do, even if you're the best clinician in the world, some of these
patients become very, very ill and even die.
And so this can be very challenging, I think, for people who are doing MD-PhD programs or
MD with research, because it's a very different approach to your daily job and to how you're
approaching science and medicine between the two.
And having that experience early, everybody goes through it at some point.
It's normal.
I just want your listeners to know it's very normal to be face to that challenge and struggle
somewhat through it.
But having that mentorship and knowing that others have gone through it before you is
really the most important thing to be able to weather these transitions and to continue
on your career.
That's really excellent.
Thank you for highlighting all those things.
So one of the things that kind of like a big theme of what I hear you talking about is
community.
And that's community and the people who surround you when you're going through different phases
of your training, and also community and the mentors that lead you along the way and guide
you along the way.
And in your journey, as you were talking about how you never did it by yourself and you don't
encourage anybody to do it by themselves, and I do think isolation can be a challenge,
because you mentioned at the end, someone else has gone through the same problem.
When we're going through a challenge, especially when research is not working or projects are
not going as you want them to, there's this sense that I'm the only one in the world to
whom this has ever happened and therefore I quit.
And being able to talk to someone else, even if they can't help you, for them to be able
to say, oh, I experienced this as well, already normalizes your experience and it makes a
difference as well.
Yeah.
And if I could just add to that part too, I think that that's a, I'd say particularly
when you make the transition to the next phase of training and residency, internship and
residency and fellowship, if you don't have that support system and ask others for help,
burnout is a really big problem in medicine and in science.
And so if you're trying to do both, it can be very challenging.
And so I think one of the, one of the, my most, I think the best parts about being a
clinician researcher is that you have people on both sides of the community to help support
you through that.
You have the scientists, you have the clinicians.
You can go to either one, depending on what, what you're struggling with or what the challenge
is at any given point in a daily basis or in a career phase basis.
And I think that the, the most useful thing is if something is, if you have a very challenging
days, for example, it'd be really challenging patients on service.
You can go back to lab and, and ask questions kind of to, to transition back and forth between
the two can be very challenging, I think, but it can also be somewhat of a respite on
both sides because you could have a very challenging patients and do some experiments in lab and
vice versa.
You can be really frustrated with where your research is going and you could take up a
whole new direction or, you know, really focus on the clinical aspects of your work for a
period of time.
And I think that's really one of the best antidotes to burnout that I've seen in people
who are successful in pursuing a career as a clinician researcher.
Absolutely. So what I hear is that in a sense, your frustrations can become an advantage.
How do you take the frustrations that you see in the clinical space and think about
how to best answer questions in the, in the research space when research is not working,
looking to your patients kind of as a source of inspiration for where the next place, the
next step might lead.
Yeah, absolutely. I think this is that, and, and, you know, I'm, I'm a classical hematologist,
so I study non-cancer blood disorders. And I think there's a long and storied history
of this approach in hematology. You know, if you look back at to really all of the major,
the giants in classical hematology ran labs and, and also saw patients and their clinical
care and the observations they made on the clinical side really informed almost everything
and what they did on the research side. And so I think for some period of time that, that
approach went away, but I feel like it's returning now, especially with a lot of the really advanced
genetic techniques that we can have where for a while we would, as hematologists look
for syndromes and syndromal presentations and understand how that works. Now we can
take patients that are very, very potentially ill and complicated diseases, understand their
genetics better on the clinical side, and then apply that to the work that we're doing
in the lab. And I think that there's nowhere else that that is more evident than one of
the main things that I do, which is studying sickle cell disease. We've known for many
years, one of the things that I study in lab is trying to increase levels of a protective
form of hemoglobin, something called fetal hemoglobin. And this is, it is resistant to
the sickling effects that, that are present in sickle cell disease. And so if we can find
ways to increase levels of this subtype of hemoglobin, then we can really treat patients
very effectively. And we know that there are certain patients who have genetic changes
that have higher levels of fetal hemoglobin at baseline. And that leads to essentially
have them having a much more reduced density and frequency of pain episodes and many, many
fewer complications. And only recently we have identified the genetic basis behind those
where they're actually changing the ways that certain regulators are expressing levels of
fetal hemoglobin or pressing their expression. And so it's really exciting. I think that's
something that people have identified for many, many years, for example, in sickle cell disease.
We're finally understanding now what is the genetic basis behind that. And we, and we
use some of those observations that we see on the clinical side to really drive our scientific
research.
It's really exciting. And at the very beginning, you use the C word. You use the classical,
you said classical hematology, which is the official term. I, I wouldn't say there's some
debate I would say I would, I would be one of those people in the debate. But yeah, so
it was interesting. I was going to ask you if you, if you would call yourself a classical
hematologist, I know our audience is not necessarily specifically hematology, but would you speak
to that? Would you speak to kind of the challenges and nomenclature, but, but deep more deeply
the challenges and recruiting faculty to classical hematology? What, what is that about from
your perspective? How do we change that?
Absolutely. So I think, I think as I mentioned, as I mentioned initially, a lot of the initial
seminal work and the giants in the field and hematology were done in the field of what
do you want to call it? Classical hematology, benign hematology is how I was trained, but
people don't really, these aren't benign disorders, right? They're really significant or just
hematology, but that gets to be a little bit confusing. So, and, and I think with the advent
of the tremendous amount of anti-cancer therapies that were emerged in the nineties and early
two thousands, a lot of the focus and people that were interested in hematology went to
the malignant hematology side. And so I think a lot of our most talented trainees in that
period of time were recruited over to, to malignant hematology. I consider that as well,
you know, until I came, until I came to Penn and started my fellowship and I had, you know,
tremendous mentors here. So in particular, Dr. Charles Abrams, who is a long time faculty
here in Leeds, a lot of the research efforts and really a fantastic hematologist and, and
Dr. Joel Bennett, who recently passed, was a really a giant in the field of hemostasis
thrombosis here at Penn, were both tremendous mentors to me. And they, I think it really
appealed to me in terms of, of classical hematology, that you can study something that is fascinating
from a biological perspective across the lifespan and, and also have the kind of relationship
that primary care doctors have with their patients. And so that combination of things,
the, the really the chronic, chronic care of a serious disease and the deep relationships
with patients and studying really fascinating biology drew me to, to hematology. And so,
but I would say not a lot of, you know, it gets changing now because we have some really
exciting new therapies coming out in the hemoglobinopathy space, particularly with gene therapy, with
sickle cell disease and thalassemia, which has fascinating biology behind it and getting
a lot of people interested in it, but, and newer therapies that are being developed,
of which I study, you know, the kind of pharmacologic, I, inducers of fetal hemoglobin in different
signaling pathways in the treatment of sickle cell disease, but it's still challenging
to recruit people. I will say that that, that has changed in the last several years in which
we've gotten many more residents that are applying into the program that are interested
in classical or benign hematology. And that's really exciting for the field, but there's
still a tremendous shortage of physicians that are trained in this field. And so I think
we as clinician researchers really need to be able, need to advocate for our work and
to talk. I feel like we are really good at talking to other specialists in the field
about, you know, the latest paper that's come out describing the newest signaling pathways
and sickle cell disease, but we are, I would say generally less adept at describing this
to in a way that helps recruit younger trainees to the field. And there's, it really depends
on the audience, right? So you have to try to figure out, I don't want to say to be a
salesman, but you want it to show why you fell in love with this deal in the first place.
And so I think trying to use as many outlets as possible to do that, you know, whether
it's through publications, which is really critical for what we do in the lab, but also
through social media platforms, through giving talks, through community organizations, you
know, this, this month is September is Sickle Cell Awareness Month. And so we are, have
a lot of outreach programs for both the patient level and the community level to talk about
what we do. And I think the more interest that there is, and the more we talk about
our work in a way that makes it equally exciting for others who may not be in our exact field,
the more that we can recruit and have people really join us on this journey to treat patients
across the whole lifespan with these really chronic and debilitating disorders that maybe
aren't as historically as interesting to people as malignancies in cancer, but are equally,
equally compelling and even more so, I would argue in a biological sense and desperately
needed to be able to care for this really underserved population.
Absolutely. And I think that a lot of upcoming fellows or junior faculty may not have the
role models or mentorship that allows them to continue these interests. But I love what
you talk about in advocating for our own careers, like where we're responsible. And so sometimes
it is easier to say, well, this is what I have around me. I'll just go with the flow.
It's harder is to say, this is what I really want to do and who can help me get there.
I was going to say, I think doing this early in the career is really helpful too. I've
been doing this, my wife is incredibly talented, a high school teacher at a private school
west of Philadelphia. And I go every year and talk to the students there to try to tell
them about all the exciting things I'm doing in hematology and just in general medicine
and try to make it interactive about all the different aspects of being a physician, scientist,
and all the levels of what you can do with training, whether it's doing MD and doing
a significant research experience or doing MD PhD. And it's really been very rewarding
because I think I had not even heard the words MD PhD before I got to college. And I see
students really light up when they see this because I think they are interested in caring
for people and medicine. And I think they also are stimulated by a lot of the science
that they're learning through my wife's classes and through other classes that they hear about
in high school. And the fact that they might be able to do this combination of things in
a career, I think is something that the earlier that we talk to students about these kinds
of pathways, the better. Not just hematology really in general, but I will advocate for
my field as well.
Absolutely. So we're coming up to the end of the show. And I want to ask, because one
thing you spoke to that does resonate with me is the importance of early exposure. But
for many junior faculty, even early career faculty who haven't had the research experiences
or the research exposure that's needed, there's sometimes a sense that it's too late. All
I have is clinical experience. I guess I'll just stay with clinical and not move into
research. I want you to speak to like, when is it too late to pursue a research career?
And for someone who's starting late in the game, what strategies might they use potentially
to be successful?
Yeah, it's a really, really important question. I think that from a research perspective,
and I think you don't really realize this until you start running a lab, most by far,
the most important quality of somebody that is interested in pursuing research is being
interested and motivated in doing the research. I think a lot of, as you mentioned, a lot
of people will say, oh, I don't know how to do this certain technique. I'm not sure I
don't have the necessary the skills to be able to do that. You're bringing a different
perspective. So if you're a clinician that's interested in getting into research, the kinds
of experience that you have taken care of patients, the kinds of questions you can ask
is incredibly valuable for any lab that's out there because you can design and think
about questions that somebody who is not clinically trained would never think of. And so that's
an incredible value addition for the lab. And you can learn the techniques. So for instance,
and I experienced this myself going off to residency and then coming back to the lab,
there's a lot of changes in science in that five or six years. You know, CRISPR technology
didn't exist when I finished my PhD. And I came back and there's all kinds of complicated
techniques and I learned it. And that's what I use at a daily basis in my lab right now.
And so I think there's it's really not too late to pursue research because the experience
you've had up to that point are absolutely going to be incredibly beneficial and valued
by the group that you're in. I think that the question about how to how to get that
experience later on, I would say that this comes down to mentorship as well. You know,
talking to, for example, your your primary clinical mentor or your the chief of your
division or subdivision at your institution, they've interacted with a lot of people. And
even if they're not a basic scientist, they know people who are and they know people who
are presented at different scientific presentations in your division. So one way would be to speak
with them. Another would be to try to start going to some of the sessions and talks both
by people internally as well as invited speakers, because the more you hear about different
kinds of techniques and different kinds of research, even if it doesn't seem like it's
directly related to what you're interested in the field, the more connections you can
make to be able to to get into that that aspect. So I would say that if you feel like you have
a passion for performing research, whether it's really anywhere in the spectrum, clinical,
translational or basic science, identifying mentors and asking if you can participate
in a project and getting that experience is really critical. And people very rarely will
say no to you because they recognize good mentors will recognize the value of the training
you've had thus far in your career. And you both benefit from that kind of collaboration
and work in the research side of the lab.
I love it. If you're interested, that may be the most important quality you have your
interest and motivation and connect to community. And if you don't know a research community
that you can connect to, there are other people who can connect you. I love it. Well, thank
you, Scott. You just shared some amazing insights today. And I feel like it's I mean, I'm not
starting right now. But if I was, it would it would be very just inspiring to hear you
speak about how it's not too late. And I really do appreciate you sharing your insights. I
wonder if you have any closing thoughts that you want to share?
Yeah, I thank you, twice, for having me on. And I really appreciate it. And I I would
say that I think my my closing thought and recommendation would be really try to get
as as many experiences as you can along the whole journey. You know, oftentimes the most
useful and important aspects of what have led me to my current interests are our experiences
that may not seem directly relevant at the time. But you know, especially when you're
training saying yes to different experiences, to giving invited talks to networking is really,
really critical. So I can't I can't overstate the importance of making connections throughout
your whole process, because the connections that I made during my PhD, I still use today,
and are incredibly important for collaborations on my ongoing work. So I would say, you know,
being being active, being engaged, network strongly and make lots of connections and
really try and go out on go on a limb and try new experiences, because that's where
the most important experiments aspect to your career, career development, and really understanding
who you are as a clinician scientist. That that is where that happens when you kind of
move outside your comfort zone.
I love it. Thank you, Scott. All right, everyone, you've heard him. If this is what you want
to do, you should pursue it. And it doesn't mean it'll be easy. But what you are interested
in is worth fighting for. And so definitely someone else needs to hear this either a peer
mentor or mentee or perhaps you want to share it with your group, please do it as somebody
else needs to hear this and definitely be encouraged in their career. Scott, thank you
again for being on the show. Thank you very much for having me. All right, everyone. We'll
see you again next time.
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
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