1
00:00:00,000 --> 00:00:05,860
Welcome to the Clinician Researcher podcast, where academic clinicians learn the skills

2
00:00:05,860 --> 00:00:11,260
to build their own research program, whether or not they have a mentor.

3
00:00:11,260 --> 00:00:17,340
As clinicians, we spend a decade or more as trainees learning to take care of patients.

4
00:00:17,340 --> 00:00:22,380
When we finally start our careers, we want to build research programs, but then we find

5
00:00:22,380 --> 00:00:27,780
that our years of clinical training did not adequately prepare us to lead our research

6
00:00:27,780 --> 00:00:29,180
program.

7
00:00:29,180 --> 00:00:35,480
Through no fault of our own, we struggle to find mentors, and when we can't, we quit.

8
00:00:35,480 --> 00:00:40,580
However, clinicians hold the keys to the greatest research breakthroughs.

9
00:00:40,580 --> 00:00:46,200
For this reason, the Clinician Researcher podcast exists to give academic clinicians

10
00:00:46,200 --> 00:00:51,800
the tools to build their own research program, whether or not they have a mentor.

11
00:00:51,800 --> 00:01:01,060
Now introducing your host, Toyosi Onwuemene.

12
00:01:01,060 --> 00:01:03,260
Welcome to the Clinician Researcher podcast.

13
00:01:03,260 --> 00:01:07,580
I'm your host, Toyosi Onwuemene, and it is such a pleasure to be here today because I'm not

14
00:01:07,580 --> 00:01:08,580
by myself.

15
00:01:08,580 --> 00:01:13,460
Today, I have an extra special guest, Dr. Scott Peslak, and I'm going to ask him to

16
00:01:13,460 --> 00:01:14,460
introduce himself.

17
00:01:14,460 --> 00:01:16,460
First of all, I'm going to say, Scott, welcome to the show.

18
00:01:16,460 --> 00:01:17,460
Great.

19
00:01:17,460 --> 00:01:18,460
Thank you for having me, Toyosi.

20
00:01:18,460 --> 00:01:19,860
I really appreciate it.

21
00:01:19,860 --> 00:01:22,480
So our audience would like to get to know you better.

22
00:01:22,480 --> 00:01:26,800
So if you would please introduce yourself, especially in the context of your career as

23
00:01:26,800 --> 00:01:29,020
a clinician scientist.

24
00:01:29,020 --> 00:01:32,020
Absolutely.

25
00:01:32,020 --> 00:01:35,140
So my background is, essentially, I went to the University of Scranton.

26
00:01:35,140 --> 00:01:37,460
I graduated there in 2006.

27
00:01:37,460 --> 00:01:43,340
And when I first started thinking about what I wanted to do with my career, I really was

28
00:01:43,340 --> 00:01:47,300
focused on a career in Madison.

29
00:01:47,300 --> 00:01:53,660
And I had a very series of really important experiences with the research that I had done,

30
00:01:53,660 --> 00:01:57,300
both the University of Scranton as well as summer research programs that got me interested

31
00:01:57,300 --> 00:02:00,220
in research we could talk about in a little bit as well.

32
00:02:00,220 --> 00:02:04,740
And I applied to the MD-PhD program at the University of Rochester, and I was there for

33
00:02:04,740 --> 00:02:08,600
eight years from 2006 to 2014.

34
00:02:08,600 --> 00:02:10,100
And then I came to the University of Pennsylvania.

35
00:02:10,100 --> 00:02:11,500
I've been here ever since.

36
00:02:11,500 --> 00:02:18,380
I did my internship and residency in internal medicine here at UPenn, followed by my fellowship

37
00:02:18,380 --> 00:02:20,620
in hematology and oncology.

38
00:02:20,620 --> 00:02:25,260
And I just started as a professor of medicine in the Department of Medicine or Division

39
00:02:25,260 --> 00:02:28,380
of Hematology and Oncology at UPenn here just this past July.

40
00:02:28,380 --> 00:02:34,420
So I have a brand new lab in which I study sickle cell disease and thalassemia and other

41
00:02:34,420 --> 00:02:35,420
hemoglobinopathies.

42
00:02:35,420 --> 00:02:40,180
And I see red cell disorders as well as adult patients with sickle cell disease and thalassemia

43
00:02:40,180 --> 00:02:42,020
in the clinic here at UPenn.

44
00:02:42,020 --> 00:02:46,660
And so I'm very excited to be able to share my journey through that whole process.

45
00:02:46,660 --> 00:02:51,500
But I really have tremendously privileged to be able to work with this very special

46
00:02:51,500 --> 00:02:56,460
group of patients, both in terms of the research that I do as well as the clinical care that

47
00:02:56,460 --> 00:02:58,340
I take care of too.

48
00:02:58,340 --> 00:02:59,780
Wow, Scott.

49
00:02:59,780 --> 00:03:06,580
One of the things I hear as you describe your journey is that that took a long time.

50
00:03:06,580 --> 00:03:13,780
Can you speak to how much time it takes and the fact that you're not yet there at the

51
00:03:13,780 --> 00:03:15,060
top of your career, right?

52
00:03:15,060 --> 00:03:17,940
You really are kind of still just starting out, even though you've been doing this for

53
00:03:17,940 --> 00:03:19,340
a while.

54
00:03:19,340 --> 00:03:24,860
Sometimes many early career faculty or fellows think, wow, if I really want to start in research

55
00:03:24,860 --> 00:03:30,420
and you actually had a chance to start a little bit earlier than most, what are some of the

56
00:03:30,420 --> 00:03:34,700
concerns and challenges and benefits of just thinking about how long it all takes?

57
00:03:34,700 --> 00:03:35,700
Yeah.

58
00:03:35,700 --> 00:03:37,740
I think that's a question I get asked a lot.

59
00:03:37,740 --> 00:03:42,420
I would say by people that I work with, but more so by family members saying, oh, you're

60
00:03:42,420 --> 00:03:43,420
still in training.

61
00:03:43,420 --> 00:03:46,420
And finally I can say, no, I've finally completed training.

62
00:03:46,420 --> 00:03:54,540
I think my perspective on the journey is that it is a long time, but I will say that the

63
00:03:54,540 --> 00:04:02,180
process is when I tell people that are looking for advice as to how to approach this long

64
00:04:02,180 --> 00:04:03,780
training process.

65
00:04:03,780 --> 00:04:08,260
I think getting early experiences, you mentioned, is really important because before you commit

66
00:04:08,260 --> 00:04:13,580
to a long term training program, particularly programs like MD-PhD that usually lasts at

67
00:04:13,580 --> 00:04:19,220
least eight years, four years of medical school, and then typically four to five years in a

68
00:04:19,220 --> 00:04:24,200
PhD, you want to make sure that you have had the kind of experiences that will prepare

69
00:04:24,200 --> 00:04:29,140
you for that journey and also to make sure that's what you want to do with your career.

70
00:04:29,140 --> 00:04:36,540
And it's hard to know initially, but I always tell my trainees to really try to get as much

71
00:04:36,540 --> 00:04:41,700
experience doing research in the lab during their undergraduate career.

72
00:04:41,700 --> 00:04:45,340
Some people will have longitudinal projects during their undergraduate career.

73
00:04:45,340 --> 00:04:48,980
Some people at small institutions like my own University of Scranton, I did research

74
00:04:48,980 --> 00:04:53,140
there, but also did summer programs at the University of Stony Brook and Princeton University.

75
00:04:53,140 --> 00:04:57,200
And so I got a variety of experiences and some people will take a gap year to be able

76
00:04:57,200 --> 00:05:01,740
to figure that out, one or two years in which they can do research as a technician, research

77
00:05:01,740 --> 00:05:06,300
technician in a laboratory or a more in-depth experience.

78
00:05:06,300 --> 00:05:09,500
And I think I usually tell people to, you know, you don't want to prolong the process

79
00:05:09,500 --> 00:05:14,340
any longer than is necessary, but you want to make sure that this is the right fit for

80
00:05:14,340 --> 00:05:15,580
you.

81
00:05:15,580 --> 00:05:21,420
And so I think as long as it is, as long as you've had those experiences shadowing in

82
00:05:21,420 --> 00:05:25,740
the clinic, as well as doing basic research or translational research in the lab, getting

83
00:05:25,740 --> 00:05:32,020
that hands-on experience, I view the time as more of a journey than actually having

84
00:05:32,020 --> 00:05:33,580
a definitive end point.

85
00:05:33,580 --> 00:05:38,340
Because ultimately, if it's really what you want to do with your career, the whole process

86
00:05:38,340 --> 00:05:44,300
is about getting those experiences, making connections, networking throughout your MD

87
00:05:44,300 --> 00:05:46,760
and your PhD time period.

88
00:05:46,760 --> 00:05:55,500
So I usually encourage people that I mentor to think of it as a process of really establishing

89
00:05:55,500 --> 00:05:59,100
your interest in your career as opposed to saying, I need to get this number of papers

90
00:05:59,100 --> 00:06:05,500
out or I need to get this kind of training from a resume standpoint.

91
00:06:05,500 --> 00:06:09,820
It's more about viewing it as a total journey, I would say.

92
00:06:09,820 --> 00:06:14,620
I appreciate your saying that because I think that when we look at it as a destination,

93
00:06:14,620 --> 00:06:18,140
then of course eight years is too long to get to a destination.

94
00:06:18,140 --> 00:06:22,460
But when you look at it as enjoying the journey, it's like, wow, I get eight years to really

95
00:06:22,460 --> 00:06:24,780
do this thing that I enjoy doing.

96
00:06:24,780 --> 00:06:30,620
And I love the way you talk about really making sure that this is what you want to do and

97
00:06:30,620 --> 00:06:32,280
then making a commitment, right?

98
00:06:32,280 --> 00:06:34,820
Because it is a commitment.

99
00:06:34,820 --> 00:06:38,020
And what you don't want to do is in the middle of all that say, well, I'm not sure this is

100
00:06:38,020 --> 00:06:39,700
what I wanted to do.

101
00:06:39,700 --> 00:06:43,220
I imagine, though, that you had challenges along the way.

102
00:06:43,220 --> 00:06:49,180
And I wonder at what point in your eight-year journey and beyond did you stop and say, I'm

103
00:06:49,180 --> 00:06:51,020
not sure this is for me?

104
00:06:51,020 --> 00:06:52,500
And what kept you going?

105
00:06:52,500 --> 00:06:53,500
Yeah.

106
00:06:53,500 --> 00:06:54,640
It's a great question.

107
00:06:54,640 --> 00:07:00,500
And I think everybody has during the process, these existential crises in some way and thinking,

108
00:07:00,500 --> 00:07:02,420
is this really what I want to do?

109
00:07:02,420 --> 00:07:04,900
Is this the career that I really want to pursue?

110
00:07:04,900 --> 00:07:11,540
I'll get to my experience in a minute, but I think the key part about understanding how

111
00:07:11,540 --> 00:07:15,940
to get through that is having the right mentorship and the right support around you.

112
00:07:15,940 --> 00:07:23,860
I think this process of being a clinician researcher is not a solo journey.

113
00:07:23,860 --> 00:07:26,580
It takes a whole team of people to be able to do that.

114
00:07:26,580 --> 00:07:31,500
So having mentorship along the way, I think some people who are maybe just starting the

115
00:07:31,500 --> 00:07:34,700
process might view it as, I need to do this on my own.

116
00:07:34,700 --> 00:07:35,700
I need to be strong.

117
00:07:35,700 --> 00:07:37,740
I need to figure everything else out by myself.

118
00:07:37,740 --> 00:07:40,700
And that is not, I would not recommend that.

119
00:07:40,700 --> 00:07:45,660
And it's also not the way that really science works, even when you get into faculty and

120
00:07:45,660 --> 00:07:46,660
collaborations.

121
00:07:46,660 --> 00:07:51,520
Really, it's all about having the right mentorship team and the right support team around you.

122
00:07:51,520 --> 00:07:56,900
So establishing that and keeping contact with different kinds of mentors along the process.

123
00:07:56,900 --> 00:08:01,540
Your person who is your primary research mentor will likely not be the same person that is

124
00:08:01,540 --> 00:08:06,300
your primary clinical mentor or your primary career mentor, or even your primary writing

125
00:08:06,300 --> 00:08:07,300
mentor.

126
00:08:07,300 --> 00:08:08,580
These could all be different people.

127
00:08:08,580 --> 00:08:12,540
And so having different people to go to with different kinds of challenges that you encounter

128
00:08:12,540 --> 00:08:13,820
is really critical.

129
00:08:13,820 --> 00:08:18,680
So I would strongly encourage your listeners to establish and ask for mentorship all along

130
00:08:18,680 --> 00:08:19,680
the way.

131
00:08:19,680 --> 00:08:24,460
And coming in, it's important when you have an internship to have an ask from that person,

132
00:08:24,460 --> 00:08:26,500
to not just say, can you be my mentor?

133
00:08:26,500 --> 00:08:31,300
You want to think about before you meet with that mentor and say, this is what I would

134
00:08:31,300 --> 00:08:37,260
be helpful to have from your mentorship process and your own experiences to help me continue

135
00:08:37,260 --> 00:08:38,540
along this whole process.

136
00:08:38,540 --> 00:08:41,060
And so that's really critical.

137
00:08:41,060 --> 00:08:46,800
My journey, I would say, is that I was very fortunate in my first rotation during my MD

138
00:08:46,800 --> 00:08:51,540
at the University of Rochester to find an incredible physician scientist mentor, Jim

139
00:08:51,540 --> 00:08:58,060
Pallas, who's a pediatric physician who cared for patients with different rare blood disorders

140
00:08:58,060 --> 00:09:03,660
and cancers clinically and studied aspects of the red blood cell and how it develops

141
00:09:03,660 --> 00:09:07,140
and the embryo and the fetus and eventually into adulthood.

142
00:09:07,140 --> 00:09:13,120
And so I was interviewed with him initially in my process moving to Rochester for the

143
00:09:13,120 --> 00:09:17,260
program and rotated with him first, ended up back in his lab for my thesis project.

144
00:09:17,260 --> 00:09:21,380
And he was an incredibly important mentor throughout the whole process to the point

145
00:09:21,380 --> 00:09:26,700
where I still collaborate and talk with him for larger big picture career mentorship still

146
00:09:26,700 --> 00:09:28,420
today.

147
00:09:28,420 --> 00:09:33,380
And I think there are time periods, right, during the transition processes, particularly

148
00:09:33,380 --> 00:09:37,720
for people doing MD-PhDs, where it can be really challenging.

149
00:09:37,720 --> 00:09:42,500
So I think when you're within the first two years of your MD program, things are pretty

150
00:09:42,500 --> 00:09:44,100
laid out for you.

151
00:09:44,100 --> 00:09:45,580
It's almost like going back to high school.

152
00:09:45,580 --> 00:09:47,060
You're all in one big room together.

153
00:09:47,060 --> 00:09:49,180
You have all your friends.

154
00:09:49,180 --> 00:09:50,180
You're meeting a lot of new people.

155
00:09:50,180 --> 00:09:51,660
You eat lunch together.

156
00:09:51,660 --> 00:09:52,660
It's very interesting.

157
00:09:52,660 --> 00:09:57,140
And then you leave your class after two years and you go to the PhD program.

158
00:09:57,140 --> 00:10:02,100
And so essentially all the connections you've made at a personal level go away in some way.

159
00:10:02,100 --> 00:10:05,340
And that could be really challenging for a lot of young trainees.

160
00:10:05,340 --> 00:10:10,620
And so establishing, having that longitudinal mentorship is really important at that stage

161
00:10:10,620 --> 00:10:15,780
and choosing a lab where you feel like it really aligns with not only your research

162
00:10:15,780 --> 00:10:23,220
interests, but your personal viewpoint as to how you want to approach science and medicine.

163
00:10:23,220 --> 00:10:27,060
That's hard to know at first, but going and doing rotations, going to lab meetings, meeting

164
00:10:27,060 --> 00:10:30,820
the people in your lab, seeing if that's the right fit for you is really critical.

165
00:10:30,820 --> 00:10:34,180
The other time period that can be challenging, I think, in terms of knowing whether it's

166
00:10:34,180 --> 00:10:39,360
the right thing to do or not is on the back end of the PhD, moving back to the medical,

167
00:10:39,360 --> 00:10:44,140
the third and fourth year of medical school, in which everything, essentially at the end

168
00:10:44,140 --> 00:10:49,260
of your PhD, you are really the expert in the world probably in your small niche of

169
00:10:49,260 --> 00:10:51,840
what you're working on in the lab.

170
00:10:51,840 --> 00:10:57,260
And then you go back to third year of medicine where you know nothing essentially about all

171
00:10:57,260 --> 00:10:59,060
the rotations that you're doing.

172
00:10:59,060 --> 00:11:00,580
And I think it can be really challenging.

173
00:11:00,580 --> 00:11:06,300
I distinctly remember, it's very challenging when you are on a rotation in which you have

174
00:11:06,300 --> 00:11:12,180
patients that are very ill, because I think, particularly as a scientist, you want to be

175
00:11:12,180 --> 00:11:19,380
able to have a significant degree of planning and control over what you're doing and your

176
00:11:19,380 --> 00:11:24,940
research and overall, and things happen clinically that are unpredictable.

177
00:11:24,940 --> 00:11:32,420
And so having support around you to be able to talk to your co-medical students, having

178
00:11:32,420 --> 00:11:36,940
program mentors to get through some of these more challenging patient encounters where

179
00:11:36,940 --> 00:11:40,900
no matter what you do, even if you're the best clinician in the world, some of these

180
00:11:40,900 --> 00:11:43,940
patients become very, very ill and even die.

181
00:11:43,940 --> 00:11:49,700
And so this can be very challenging, I think, for people who are doing MD-PhD programs or

182
00:11:49,700 --> 00:11:56,180
MD with research, because it's a very different approach to your daily job and to how you're

183
00:11:56,180 --> 00:11:59,760
approaching science and medicine between the two.

184
00:11:59,760 --> 00:12:02,980
And having that experience early, everybody goes through it at some point.

185
00:12:02,980 --> 00:12:03,980
It's normal.

186
00:12:03,980 --> 00:12:08,860
I just want your listeners to know it's very normal to be face to that challenge and struggle

187
00:12:08,860 --> 00:12:09,860
somewhat through it.

188
00:12:09,860 --> 00:12:14,140
But having that mentorship and knowing that others have gone through it before you is

189
00:12:14,140 --> 00:12:18,140
really the most important thing to be able to weather these transitions and to continue

190
00:12:18,140 --> 00:12:20,460
on your career.

191
00:12:20,460 --> 00:12:21,540
That's really excellent.

192
00:12:21,540 --> 00:12:23,020
Thank you for highlighting all those things.

193
00:12:23,020 --> 00:12:27,540
So one of the things that kind of like a big theme of what I hear you talking about is

194
00:12:27,540 --> 00:12:28,540
community.

195
00:12:28,540 --> 00:12:32,100
And that's community and the people who surround you when you're going through different phases

196
00:12:32,100 --> 00:12:36,580
of your training, and also community and the mentors that lead you along the way and guide

197
00:12:36,580 --> 00:12:38,900
you along the way.

198
00:12:38,900 --> 00:12:43,420
And in your journey, as you were talking about how you never did it by yourself and you don't

199
00:12:43,420 --> 00:12:48,020
encourage anybody to do it by themselves, and I do think isolation can be a challenge,

200
00:12:48,020 --> 00:12:52,300
because you mentioned at the end, someone else has gone through the same problem.

201
00:12:52,300 --> 00:12:56,440
When we're going through a challenge, especially when research is not working or projects are

202
00:12:56,440 --> 00:13:01,340
not going as you want them to, there's this sense that I'm the only one in the world to

203
00:13:01,340 --> 00:13:04,220
whom this has ever happened and therefore I quit.

204
00:13:04,220 --> 00:13:07,760
And being able to talk to someone else, even if they can't help you, for them to be able

205
00:13:07,760 --> 00:13:12,380
to say, oh, I experienced this as well, already normalizes your experience and it makes a

206
00:13:12,380 --> 00:13:13,380
difference as well.

207
00:13:13,380 --> 00:13:14,380
Yeah.

208
00:13:14,380 --> 00:13:19,700
And if I could just add to that part too, I think that that's a, I'd say particularly

209
00:13:19,700 --> 00:13:23,500
when you make the transition to the next phase of training and residency, internship and

210
00:13:23,500 --> 00:13:30,540
residency and fellowship, if you don't have that support system and ask others for help,

211
00:13:30,540 --> 00:13:34,520
burnout is a really big problem in medicine and in science.

212
00:13:34,520 --> 00:13:38,020
And so if you're trying to do both, it can be very challenging.

213
00:13:38,020 --> 00:13:44,260
And so I think one of the, one of the, my most, I think the best parts about being a

214
00:13:44,260 --> 00:13:50,220
clinician researcher is that you have people on both sides of the community to help support

215
00:13:50,220 --> 00:13:51,220
you through that.

216
00:13:51,220 --> 00:13:53,160
You have the scientists, you have the clinicians.

217
00:13:53,160 --> 00:13:58,620
You can go to either one, depending on what, what you're struggling with or what the challenge

218
00:13:58,620 --> 00:14:03,940
is at any given point in a daily basis or in a career phase basis.

219
00:14:03,940 --> 00:14:10,820
And I think that the, the most useful thing is if something is, if you have a very challenging

220
00:14:10,820 --> 00:14:14,080
days, for example, it'd be really challenging patients on service.

221
00:14:14,080 --> 00:14:20,320
You can go back to lab and, and ask questions kind of to, to transition back and forth between

222
00:14:20,320 --> 00:14:24,620
the two can be very challenging, I think, but it can also be somewhat of a respite on

223
00:14:24,620 --> 00:14:28,500
both sides because you could have a very challenging patients and do some experiments in lab and

224
00:14:28,500 --> 00:14:29,500
vice versa.

225
00:14:29,500 --> 00:14:33,280
You can be really frustrated with where your research is going and you could take up a

226
00:14:33,280 --> 00:14:38,060
whole new direction or, you know, really focus on the clinical aspects of your work for a

227
00:14:38,060 --> 00:14:39,060
period of time.

228
00:14:39,060 --> 00:14:45,260
And I think that's really one of the best antidotes to burnout that I've seen in people

229
00:14:45,260 --> 00:14:49,060
who are successful in pursuing a career as a clinician researcher.

230
00:14:49,060 --> 00:14:55,580
Absolutely. So what I hear is that in a sense, your frustrations can become an advantage.

231
00:14:55,580 --> 00:14:59,420
How do you take the frustrations that you see in the clinical space and think about

232
00:14:59,420 --> 00:15:05,700
how to best answer questions in the, in the research space when research is not working,

233
00:15:05,700 --> 00:15:09,820
looking to your patients kind of as a source of inspiration for where the next place, the

234
00:15:09,820 --> 00:15:11,220
next step might lead.

235
00:15:11,220 --> 00:15:16,580
Yeah, absolutely. I think this is that, and, and, you know, I'm, I'm a classical hematologist,

236
00:15:16,580 --> 00:15:22,380
so I study non-cancer blood disorders. And I think there's a long and storied history

237
00:15:22,380 --> 00:15:29,540
of this approach in hematology. You know, if you look back at to really all of the major,

238
00:15:29,540 --> 00:15:36,480
the giants in classical hematology ran labs and, and also saw patients and their clinical

239
00:15:36,480 --> 00:15:41,180
care and the observations they made on the clinical side really informed almost everything

240
00:15:41,180 --> 00:15:47,620
and what they did on the research side. And so I think for some period of time that, that

241
00:15:47,620 --> 00:15:53,540
approach went away, but I feel like it's returning now, especially with a lot of the really advanced

242
00:15:53,540 --> 00:15:57,940
genetic techniques that we can have where for a while we would, as hematologists look

243
00:15:57,940 --> 00:16:02,700
for syndromes and syndromal presentations and understand how that works. Now we can

244
00:16:02,700 --> 00:16:08,980
take patients that are very, very potentially ill and complicated diseases, understand their

245
00:16:08,980 --> 00:16:12,700
genetics better on the clinical side, and then apply that to the work that we're doing

246
00:16:12,700 --> 00:16:17,340
in the lab. And I think that there's nowhere else that that is more evident than one of

247
00:16:17,340 --> 00:16:21,180
the main things that I do, which is studying sickle cell disease. We've known for many

248
00:16:21,180 --> 00:16:26,300
years, one of the things that I study in lab is trying to increase levels of a protective

249
00:16:26,300 --> 00:16:30,820
form of hemoglobin, something called fetal hemoglobin. And this is, it is resistant to

250
00:16:30,820 --> 00:16:35,360
the sickling effects that, that are present in sickle cell disease. And so if we can find

251
00:16:35,360 --> 00:16:40,300
ways to increase levels of this subtype of hemoglobin, then we can really treat patients

252
00:16:40,300 --> 00:16:45,180
very effectively. And we know that there are certain patients who have genetic changes

253
00:16:45,180 --> 00:16:51,500
that have higher levels of fetal hemoglobin at baseline. And that leads to essentially

254
00:16:51,500 --> 00:16:56,580
have them having a much more reduced density and frequency of pain episodes and many, many

255
00:16:56,580 --> 00:17:02,060
fewer complications. And only recently we have identified the genetic basis behind those

256
00:17:02,060 --> 00:17:06,940
where they're actually changing the ways that certain regulators are expressing levels of

257
00:17:06,940 --> 00:17:11,500
fetal hemoglobin or pressing their expression. And so it's really exciting. I think that's

258
00:17:11,500 --> 00:17:16,220
something that people have identified for many, many years, for example, in sickle cell disease.

259
00:17:16,220 --> 00:17:20,780
We're finally understanding now what is the genetic basis behind that. And we, and we

260
00:17:20,780 --> 00:17:25,540
use some of those observations that we see on the clinical side to really drive our scientific

261
00:17:25,540 --> 00:17:27,460
research.

262
00:17:27,460 --> 00:17:35,340
It's really exciting. And at the very beginning, you use the C word. You use the classical,

263
00:17:35,340 --> 00:17:40,260
you said classical hematology, which is the official term. I, I wouldn't say there's some

264
00:17:40,260 --> 00:17:44,780
debate I would say I would, I would be one of those people in the debate. But yeah, so

265
00:17:44,780 --> 00:17:47,860
it was interesting. I was going to ask you if you, if you would call yourself a classical

266
00:17:47,860 --> 00:17:53,220
hematologist, I know our audience is not necessarily specifically hematology, but would you speak

267
00:17:53,220 --> 00:17:59,260
to that? Would you speak to kind of the challenges and nomenclature, but, but deep more deeply

268
00:17:59,260 --> 00:18:04,260
the challenges and recruiting faculty to classical hematology? What, what is that about from

269
00:18:04,260 --> 00:18:07,420
your perspective? How do we change that?

270
00:18:07,420 --> 00:18:14,060
Absolutely. So I think, I think as I mentioned, as I mentioned initially, a lot of the initial

271
00:18:14,060 --> 00:18:19,100
seminal work and the giants in the field and hematology were done in the field of what

272
00:18:19,100 --> 00:18:22,900
do you want to call it? Classical hematology, benign hematology is how I was trained, but

273
00:18:22,900 --> 00:18:26,860
people don't really, these aren't benign disorders, right? They're really significant or just

274
00:18:26,860 --> 00:18:31,740
hematology, but that gets to be a little bit confusing. So, and, and I think with the advent

275
00:18:31,740 --> 00:18:37,860
of the tremendous amount of anti-cancer therapies that were emerged in the nineties and early

276
00:18:37,860 --> 00:18:42,820
two thousands, a lot of the focus and people that were interested in hematology went to

277
00:18:42,820 --> 00:18:50,780
the malignant hematology side. And so I think a lot of our most talented trainees in that

278
00:18:50,780 --> 00:18:57,180
period of time were recruited over to, to malignant hematology. I consider that as well,

279
00:18:57,180 --> 00:19:01,340
you know, until I came, until I came to Penn and started my fellowship and I had, you know,

280
00:19:01,340 --> 00:19:08,300
tremendous mentors here. So in particular, Dr. Charles Abrams, who is a long time faculty

281
00:19:08,300 --> 00:19:13,060
here in Leeds, a lot of the research efforts and really a fantastic hematologist and, and

282
00:19:13,060 --> 00:19:18,220
Dr. Joel Bennett, who recently passed, was a really a giant in the field of hemostasis

283
00:19:18,220 --> 00:19:23,100
thrombosis here at Penn, were both tremendous mentors to me. And they, I think it really

284
00:19:23,100 --> 00:19:31,960
appealed to me in terms of, of classical hematology, that you can study something that is fascinating

285
00:19:31,960 --> 00:19:39,060
from a biological perspective across the lifespan and, and also have the kind of relationship

286
00:19:39,060 --> 00:19:44,340
that primary care doctors have with their patients. And so that combination of things,

287
00:19:44,340 --> 00:19:50,060
the, the really the chronic, chronic care of a serious disease and the deep relationships

288
00:19:50,060 --> 00:19:56,820
with patients and studying really fascinating biology drew me to, to hematology. And so,

289
00:19:56,820 --> 00:20:01,460
but I would say not a lot of, you know, it gets changing now because we have some really

290
00:20:01,460 --> 00:20:07,220
exciting new therapies coming out in the hemoglobinopathy space, particularly with gene therapy, with

291
00:20:07,220 --> 00:20:11,660
sickle cell disease and thalassemia, which has fascinating biology behind it and getting

292
00:20:11,660 --> 00:20:15,780
a lot of people interested in it, but, and newer therapies that are being developed,

293
00:20:15,780 --> 00:20:20,620
of which I study, you know, the kind of pharmacologic, I, inducers of fetal hemoglobin in different

294
00:20:20,620 --> 00:20:24,980
signaling pathways in the treatment of sickle cell disease, but it's still challenging

295
00:20:24,980 --> 00:20:30,580
to recruit people. I will say that that, that has changed in the last several years in which

296
00:20:30,580 --> 00:20:34,500
we've gotten many more residents that are applying into the program that are interested

297
00:20:34,500 --> 00:20:38,460
in classical or benign hematology. And that's really exciting for the field, but there's

298
00:20:38,460 --> 00:20:47,300
still a tremendous shortage of physicians that are trained in this field. And so I think

299
00:20:47,300 --> 00:20:54,700
we as clinician researchers really need to be able, need to advocate for our work and

300
00:20:54,700 --> 00:21:00,340
to talk. I feel like we are really good at talking to other specialists in the field

301
00:21:00,340 --> 00:21:06,100
about, you know, the latest paper that's come out describing the newest signaling pathways

302
00:21:06,100 --> 00:21:12,780
and sickle cell disease, but we are, I would say generally less adept at describing this

303
00:21:12,780 --> 00:21:19,580
to in a way that helps recruit younger trainees to the field. And there's, it really depends

304
00:21:19,580 --> 00:21:23,100
on the audience, right? So you have to try to figure out, I don't want to say to be a

305
00:21:23,100 --> 00:21:29,420
salesman, but you want it to show why you fell in love with this deal in the first place.

306
00:21:29,420 --> 00:21:33,860
And so I think trying to use as many outlets as possible to do that, you know, whether

307
00:21:33,860 --> 00:21:37,460
it's through publications, which is really critical for what we do in the lab, but also

308
00:21:37,460 --> 00:21:42,940
through social media platforms, through giving talks, through community organizations, you

309
00:21:42,940 --> 00:21:47,980
know, this, this month is September is Sickle Cell Awareness Month. And so we are, have

310
00:21:47,980 --> 00:21:52,980
a lot of outreach programs for both the patient level and the community level to talk about

311
00:21:52,980 --> 00:21:58,180
what we do. And I think the more interest that there is, and the more we talk about

312
00:21:58,180 --> 00:22:04,980
our work in a way that makes it equally exciting for others who may not be in our exact field,

313
00:22:04,980 --> 00:22:11,700
the more that we can recruit and have people really join us on this journey to treat patients

314
00:22:11,700 --> 00:22:16,300
across the whole lifespan with these really chronic and debilitating disorders that maybe

315
00:22:16,300 --> 00:22:22,820
aren't as historically as interesting to people as malignancies in cancer, but are equally,

316
00:22:22,820 --> 00:22:26,900
equally compelling and even more so, I would argue in a biological sense and desperately

317
00:22:26,900 --> 00:22:30,860
needed to be able to care for this really underserved population.

318
00:22:30,860 --> 00:22:38,660
Absolutely. And I think that a lot of upcoming fellows or junior faculty may not have the

319
00:22:38,660 --> 00:22:42,940
role models or mentorship that allows them to continue these interests. But I love what

320
00:22:42,940 --> 00:22:48,700
you talk about in advocating for our own careers, like where we're responsible. And so sometimes

321
00:22:48,700 --> 00:22:54,140
it is easier to say, well, this is what I have around me. I'll just go with the flow.

322
00:22:54,140 --> 00:22:57,980
It's harder is to say, this is what I really want to do and who can help me get there.

323
00:22:57,980 --> 00:23:02,980
I was going to say, I think doing this early in the career is really helpful too. I've

324
00:23:02,980 --> 00:23:09,500
been doing this, my wife is incredibly talented, a high school teacher at a private school

325
00:23:09,500 --> 00:23:14,260
west of Philadelphia. And I go every year and talk to the students there to try to tell

326
00:23:14,260 --> 00:23:18,900
them about all the exciting things I'm doing in hematology and just in general medicine

327
00:23:18,900 --> 00:23:24,060
and try to make it interactive about all the different aspects of being a physician, scientist,

328
00:23:24,060 --> 00:23:30,100
and all the levels of what you can do with training, whether it's doing MD and doing

329
00:23:30,100 --> 00:23:34,100
a significant research experience or doing MD PhD. And it's really been very rewarding

330
00:23:34,100 --> 00:23:40,160
because I think I had not even heard the words MD PhD before I got to college. And I see

331
00:23:40,160 --> 00:23:45,420
students really light up when they see this because I think they are interested in caring

332
00:23:45,420 --> 00:23:51,460
for people and medicine. And I think they also are stimulated by a lot of the science

333
00:23:51,460 --> 00:23:58,420
that they're learning through my wife's classes and through other classes that they hear about

334
00:23:58,420 --> 00:24:03,180
in high school. And the fact that they might be able to do this combination of things in

335
00:24:03,180 --> 00:24:08,260
a career, I think is something that the earlier that we talk to students about these kinds

336
00:24:08,260 --> 00:24:13,100
of pathways, the better. Not just hematology really in general, but I will advocate for

337
00:24:13,100 --> 00:24:14,820
my field as well.

338
00:24:14,820 --> 00:24:20,380
Absolutely. So we're coming up to the end of the show. And I want to ask, because one

339
00:24:20,380 --> 00:24:25,340
thing you spoke to that does resonate with me is the importance of early exposure. But

340
00:24:25,340 --> 00:24:31,300
for many junior faculty, even early career faculty who haven't had the research experiences

341
00:24:31,300 --> 00:24:36,260
or the research exposure that's needed, there's sometimes a sense that it's too late. All

342
00:24:36,260 --> 00:24:42,700
I have is clinical experience. I guess I'll just stay with clinical and not move into

343
00:24:42,700 --> 00:24:48,620
research. I want you to speak to like, when is it too late to pursue a research career?

344
00:24:48,620 --> 00:24:53,500
And for someone who's starting late in the game, what strategies might they use potentially

345
00:24:53,500 --> 00:24:54,500
to be successful?

346
00:24:54,500 --> 00:25:01,420
Yeah, it's a really, really important question. I think that from a research perspective,

347
00:25:01,420 --> 00:25:06,300
and I think you don't really realize this until you start running a lab, most by far,

348
00:25:06,300 --> 00:25:12,820
the most important quality of somebody that is interested in pursuing research is being

349
00:25:12,820 --> 00:25:19,060
interested and motivated in doing the research. I think a lot of, as you mentioned, a lot

350
00:25:19,060 --> 00:25:24,100
of people will say, oh, I don't know how to do this certain technique. I'm not sure I

351
00:25:24,100 --> 00:25:28,300
don't have the necessary the skills to be able to do that. You're bringing a different

352
00:25:28,300 --> 00:25:32,140
perspective. So if you're a clinician that's interested in getting into research, the kinds

353
00:25:32,140 --> 00:25:37,300
of experience that you have taken care of patients, the kinds of questions you can ask

354
00:25:37,300 --> 00:25:43,020
is incredibly valuable for any lab that's out there because you can design and think

355
00:25:43,020 --> 00:25:48,940
about questions that somebody who is not clinically trained would never think of. And so that's

356
00:25:48,940 --> 00:25:56,660
an incredible value addition for the lab. And you can learn the techniques. So for instance,

357
00:25:56,660 --> 00:26:01,220
and I experienced this myself going off to residency and then coming back to the lab,

358
00:26:01,220 --> 00:26:06,100
there's a lot of changes in science in that five or six years. You know, CRISPR technology

359
00:26:06,100 --> 00:26:10,780
didn't exist when I finished my PhD. And I came back and there's all kinds of complicated

360
00:26:10,780 --> 00:26:14,260
techniques and I learned it. And that's what I use at a daily basis in my lab right now.

361
00:26:14,260 --> 00:26:21,980
And so I think there's it's really not too late to pursue research because the experience

362
00:26:21,980 --> 00:26:28,180
you've had up to that point are absolutely going to be incredibly beneficial and valued

363
00:26:28,180 --> 00:26:34,940
by the group that you're in. I think that the question about how to how to get that

364
00:26:34,940 --> 00:26:41,420
experience later on, I would say that this comes down to mentorship as well. You know,

365
00:26:41,420 --> 00:26:46,900
talking to, for example, your your primary clinical mentor or your the chief of your

366
00:26:46,900 --> 00:26:51,420
division or subdivision at your institution, they've interacted with a lot of people. And

367
00:26:51,420 --> 00:26:55,020
even if they're not a basic scientist, they know people who are and they know people who

368
00:26:55,020 --> 00:27:00,580
are presented at different scientific presentations in your division. So one way would be to speak

369
00:27:00,580 --> 00:27:06,580
with them. Another would be to try to start going to some of the sessions and talks both

370
00:27:06,580 --> 00:27:11,460
by people internally as well as invited speakers, because the more you hear about different

371
00:27:11,460 --> 00:27:15,100
kinds of techniques and different kinds of research, even if it doesn't seem like it's

372
00:27:15,100 --> 00:27:18,620
directly related to what you're interested in the field, the more connections you can

373
00:27:18,620 --> 00:27:24,300
make to be able to to get into that that aspect. So I would say that if you feel like you have

374
00:27:24,300 --> 00:27:29,020
a passion for performing research, whether it's really anywhere in the spectrum, clinical,

375
00:27:29,020 --> 00:27:34,420
translational or basic science, identifying mentors and asking if you can participate

376
00:27:34,420 --> 00:27:39,180
in a project and getting that experience is really critical. And people very rarely will

377
00:27:39,180 --> 00:27:44,540
say no to you because they recognize good mentors will recognize the value of the training

378
00:27:44,540 --> 00:27:49,360
you've had thus far in your career. And you both benefit from that kind of collaboration

379
00:27:49,360 --> 00:27:52,900
and work in the research side of the lab.

380
00:27:52,900 --> 00:27:57,460
I love it. If you're interested, that may be the most important quality you have your

381
00:27:57,460 --> 00:28:02,300
interest and motivation and connect to community. And if you don't know a research community

382
00:28:02,300 --> 00:28:07,620
that you can connect to, there are other people who can connect you. I love it. Well, thank

383
00:28:07,620 --> 00:28:12,740
you, Scott. You just shared some amazing insights today. And I feel like it's I mean, I'm not

384
00:28:12,740 --> 00:28:17,540
starting right now. But if I was, it would it would be very just inspiring to hear you

385
00:28:17,540 --> 00:28:22,340
speak about how it's not too late. And I really do appreciate you sharing your insights. I

386
00:28:22,340 --> 00:28:25,020
wonder if you have any closing thoughts that you want to share?

387
00:28:25,020 --> 00:28:29,220
Yeah, I thank you, twice, for having me on. And I really appreciate it. And I I would

388
00:28:29,220 --> 00:28:35,340
say that I think my my closing thought and recommendation would be really try to get

389
00:28:35,340 --> 00:28:41,580
as as many experiences as you can along the whole journey. You know, oftentimes the most

390
00:28:41,580 --> 00:28:50,940
useful and important aspects of what have led me to my current interests are our experiences

391
00:28:50,940 --> 00:28:56,260
that may not seem directly relevant at the time. But you know, especially when you're

392
00:28:56,260 --> 00:29:02,860
training saying yes to different experiences, to giving invited talks to networking is really,

393
00:29:02,860 --> 00:29:08,920
really critical. So I can't I can't overstate the importance of making connections throughout

394
00:29:08,920 --> 00:29:13,060
your whole process, because the connections that I made during my PhD, I still use today,

395
00:29:13,060 --> 00:29:17,820
and are incredibly important for collaborations on my ongoing work. So I would say, you know,

396
00:29:17,820 --> 00:29:24,180
being being active, being engaged, network strongly and make lots of connections and

397
00:29:24,180 --> 00:29:28,900
really try and go out on go on a limb and try new experiences, because that's where

398
00:29:28,900 --> 00:29:35,060
the most important experiments aspect to your career, career development, and really understanding

399
00:29:35,060 --> 00:29:39,300
who you are as a clinician scientist. That that is where that happens when you kind of

400
00:29:39,300 --> 00:29:41,860
move outside your comfort zone.

401
00:29:41,860 --> 00:29:46,440
I love it. Thank you, Scott. All right, everyone, you've heard him. If this is what you want

402
00:29:46,440 --> 00:29:51,380
to do, you should pursue it. And it doesn't mean it'll be easy. But what you are interested

403
00:29:51,380 --> 00:29:57,220
in is worth fighting for. And so definitely someone else needs to hear this either a peer

404
00:29:57,220 --> 00:30:04,500
mentor or mentee or perhaps you want to share it with your group, please do it as somebody

405
00:30:04,500 --> 00:30:10,060
else needs to hear this and definitely be encouraged in their career. Scott, thank you

406
00:30:10,060 --> 00:30:14,180
again for being on the show. Thank you very much for having me. All right, everyone. We'll

407
00:30:14,180 --> 00:30:23,900
see you again next time.

408
00:30:23,900 --> 00:30:29,260
Thanks for listening to this episode of the clinician researcher podcast, where academic

409
00:30:29,260 --> 00:30:34,660
clinicians learn the skills to build their own research program, whether or not they

410
00:30:34,660 --> 00:30:40,220
have a mentor. If you found the information in this episode to be helpful, don't keep

411
00:30:40,220 --> 00:30:46,900
it all to yourself. Someone else needs to hear it. So take a minute right now and share

412
00:30:46,900 --> 00:30:53,420
it. As you share this episode, you become part of our mission to help launch a new generation

413
00:30:53,420 --> 00:31:10,660
of clinician researchers who make transformative discoveries that change the way we do healthcare.