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 --> 00:01:01,020 Now introducing your host, Toyosi Onwuemene. 12 00:01:01,020 --> 00:01:03,380 Welcome to the Clinician Researcher podcast. 13 00:01:03,380 --> 00:01:07,820 I'm your host, Toyosi Onwuemene, and it is a pleasure to be talking with you today. 14 00:01:07,820 --> 00:01:12,340 I'm especially excited because I have an amazing guest today on the show, Dr. Lance Okke. 15 00:01:12,340 --> 00:01:13,820 Lance, welcome to the show. 16 00:01:13,820 --> 00:01:14,820 Oh, thank you, Teyasi. 17 00:01:14,820 --> 00:01:17,180 Thank you so much for the opportunity. 18 00:01:17,180 --> 00:01:21,940 Lance, you are a clinician scientist, and I want to say that there are not many like 19 00:01:21,940 --> 00:01:25,780 you, and I know we went to residency together. 20 00:01:25,780 --> 00:01:30,020 I know you had clinical training like I do, and you are not PhD trained. 21 00:01:30,020 --> 00:01:32,140 So how did you make it? 22 00:01:32,140 --> 00:01:36,340 How did you transition from being a clinician to becoming a scientist? 23 00:01:36,340 --> 00:01:39,540 Yeah, no, Teyasi, thank you again for the opportunity. 24 00:01:39,540 --> 00:01:45,020 It's been now, I think I would say 12 years since this journey started, starting back 25 00:01:45,020 --> 00:01:51,060 to the end of my clinical year and infectious disease fellowship in summer of 2011, somewhere 26 00:01:51,060 --> 00:01:52,060 around there. 27 00:01:52,060 --> 00:01:58,900 And you know, my interest in kind of HIV and cardiovascular disease, which is my area of 28 00:01:58,900 --> 00:02:04,700 focus right now, came partially from the fact that I had developed an interest in HIV that 29 00:02:04,700 --> 00:02:12,060 occurred probably towards the end of my residency program, but also solidified by the good opportunity 30 00:02:12,060 --> 00:02:18,060 I had while I was a third year resident going to Kenya and seeing the state of HIV and HIV 31 00:02:18,060 --> 00:02:19,060 epidemic. 32 00:02:19,060 --> 00:02:24,940 I've been taken as inflection from kind of like massive deaths, but still high incidence, 33 00:02:24,940 --> 00:02:28,900 but better control and really kind of hit this plateau of like, well, what do we do 34 00:02:28,900 --> 00:02:33,980 now that we're keeping all the people that were dying five years ago alive into their 35 00:02:33,980 --> 00:02:35,820 40s, 50s and 60s? 36 00:02:35,820 --> 00:02:37,860 What is the next stage of epidemic look like? 37 00:02:37,860 --> 00:02:42,140 And is there risk associated with continued chronic infection? 38 00:02:42,140 --> 00:02:45,980 And so I came away from that 10 week rotation. 39 00:02:45,980 --> 00:02:52,580 The last time I was in the scene, I was like, yes, this is a problem that I want to pursue. 40 00:02:52,580 --> 00:02:56,740 And so I was able to kind of finish off a hospital stay here and then start my infectious 41 00:02:56,740 --> 00:03:01,940 disease fellowship and started my clinical research career in earnest in the summer of 42 00:03:01,940 --> 00:03:03,640 2012. 43 00:03:03,640 --> 00:03:08,060 And at that time, you know, like I always kind of had this impression that I had an 44 00:03:08,060 --> 00:03:14,020 idea, I had a focus and I thought I had like a mentoring team, but then it kind of, I found 45 00:03:14,020 --> 00:03:18,300 out very early on that the mentoring team that I had didn't really have the research 46 00:03:18,300 --> 00:03:24,740 infrastructure that was available and ready to support my career development. 47 00:03:24,740 --> 00:03:26,620 It was just absence. 48 00:03:26,620 --> 00:03:32,740 And so literally the first couple of papers I'd published were based on databases that 49 00:03:32,740 --> 00:03:39,220 I abstracted the data myself, 1500 patients looking at hypertension outcomes in this group 50 00:03:39,220 --> 00:03:45,860 and the use of evidence-based strategies for CBD control in that context. 51 00:03:45,860 --> 00:03:53,020 And so statin use, aspirin use, and we published our paper, I'm blanking on the first journal 52 00:03:53,020 --> 00:03:57,020 it was, but really this was just me going to the electronic health record and abstracting 53 00:03:57,020 --> 00:03:59,700 data myself for all 1400 patients. 54 00:03:59,700 --> 00:04:00,700 Whoa. 55 00:04:00,700 --> 00:04:01,700 Yep. 56 00:04:01,700 --> 00:04:07,220 It's a resource that was used by many after that, but it was just, I just did the work 57 00:04:07,220 --> 00:04:08,780 and it wasn't anything here. 58 00:04:08,780 --> 00:04:11,060 So I did it. 59 00:04:11,060 --> 00:04:17,260 And that's kind of what gave me the confidence to say, you know what, like in some cases, 60 00:04:17,260 --> 00:04:22,100 it's probably not the prescribed path forward, but in some cases you can make your own destiny 61 00:04:22,100 --> 00:04:24,780 and you can start your program from nothing. 62 00:04:24,780 --> 00:04:29,700 Fortunately, I had a division chief that was supportive and saying, you know what, if you 63 00:04:29,700 --> 00:04:33,780 feel like you can use the elbow grease to kind of do it yourself and move things forward, 64 00:04:33,780 --> 00:04:34,780 then do it. 65 00:04:34,780 --> 00:04:38,740 And I was fortunate to kind of have that time to develop and flounder around and figure 66 00:04:38,740 --> 00:04:40,140 it out. 67 00:04:40,140 --> 00:04:45,380 But soon after, probably about a year into this process, my mentor moved on to another 68 00:04:45,380 --> 00:04:47,260 position at another institution. 69 00:04:47,260 --> 00:04:52,940 And then I was like straight out by myself on, on without no support whatsoever, no mentor 70 00:04:52,940 --> 00:04:53,940 team to be seen. 71 00:04:53,940 --> 00:04:59,260 And then kind of things got really, really hairy for about a year and a half afterwards. 72 00:04:59,260 --> 00:05:05,980 Fortunately, I was able to make some cold calls and I found a really awesome collaborator 73 00:05:05,980 --> 00:05:09,860 and mentor and now a friend of mine in population health. 74 00:05:09,860 --> 00:05:13,380 I'm not sure if I should be mentioning names, but who was really, really gracious, had no 75 00:05:13,380 --> 00:05:18,980 idea about HIV, but I came to him with a plan for continued retrospective studies, but also 76 00:05:18,980 --> 00:05:19,980 an intervention. 77 00:05:19,980 --> 00:05:28,700 It was based on his expertise in that intervention that I wrote my first, my first K proposal. 78 00:05:28,700 --> 00:05:35,620 Back forward two years later after six submissions, visions and revisions and erodemas and getting 79 00:05:35,620 --> 00:05:36,620 rejected. 80 00:05:36,620 --> 00:05:41,380 We finally on our seventh attempt, we're able to refine it to the point where we got it. 81 00:05:41,380 --> 00:05:42,380 We got funded. 82 00:05:42,380 --> 00:05:44,700 Wait, wait, wait, wait, wait, wait, seven attempts. 83 00:05:44,700 --> 00:05:45,700 Oh yeah. 84 00:05:45,700 --> 00:05:46,700 Yeah. 85 00:05:46,700 --> 00:05:51,500 I was good at summary statements summary statements. 86 00:05:51,500 --> 00:05:56,580 And, and, and, but, but that to me, it was kind of like the building, the academic muscle 87 00:05:56,580 --> 00:05:59,180 of kind of grantsmanship, right? 88 00:05:59,180 --> 00:06:00,180 All right. 89 00:06:00,180 --> 00:06:01,700 How am I going to make it better? 90 00:06:01,700 --> 00:06:06,820 The fifth time when I sent this proposal in and, and I didn't take, I didn't lose heart 91 00:06:06,820 --> 00:06:09,100 cause I knew my idea was a good one and one that was needed. 92 00:06:09,100 --> 00:06:11,180 We just kind of kept on working on it. 93 00:06:11,180 --> 00:06:16,500 And I think to me it's, it wasn't a hidden curriculum that educated me. 94 00:06:16,500 --> 00:06:23,420 It was really the classic curriculum of a, of a trial and trial and error centered science 95 00:06:23,420 --> 00:06:28,100 that educated me and how I kind of moved along with the scientific space from then on. 96 00:06:28,100 --> 00:06:31,540 And so that's what I would say. 97 00:06:31,540 --> 00:06:32,540 Wow. 98 00:06:32,540 --> 00:06:33,540 Wow. 99 00:06:33,540 --> 00:06:34,540 Okay. 100 00:06:34,540 --> 00:06:37,820 Lance, so much in your story. 101 00:06:37,820 --> 00:06:40,900 The first thing I heard is your passion. 102 00:06:40,900 --> 00:06:46,500 You found something you cared about and you dared to believe that you could build a research 103 00:06:46,500 --> 00:06:51,080 career out of something that you cared about and you thought would be impactful. 104 00:06:51,080 --> 00:06:57,280 And it sounds to me that that was a driving force and clearly you had a plan going into 105 00:06:57,280 --> 00:07:02,220 your fellowship research space where many people are still just trying to figure out 106 00:07:02,220 --> 00:07:03,220 what do I really like? 107 00:07:03,220 --> 00:07:04,700 What do I really care about? 108 00:07:04,700 --> 00:07:09,500 I wonder to what extent was that an advantage for you and what do people do if they don't 109 00:07:09,500 --> 00:07:10,500 have that? 110 00:07:10,500 --> 00:07:11,500 Yeah. 111 00:07:11,500 --> 00:07:14,780 You know, I think it's really interesting cause I'm actually having these conversations 112 00:07:14,780 --> 00:07:17,060 actively with our fellowship director right now. 113 00:07:17,060 --> 00:07:24,720 It's a really interesting space about what a clinical fellowship program really is. 114 00:07:24,720 --> 00:07:30,940 Is it a graduate school PhD program equivalent where you should really be kind of gearing 115 00:07:30,940 --> 00:07:36,620 the availability of potential opportunities within the realm of specialty to a bunch of 116 00:07:36,620 --> 00:07:40,460 like fresh PhD students and everybody tries to advertise what their lab was doing? 117 00:07:40,460 --> 00:07:44,300 Or is it a postdoc program where you should actually have some level of sophistication 118 00:07:44,300 --> 00:07:47,580 going into your research years or your fellowship? 119 00:07:47,580 --> 00:07:53,500 I tend to think it's the latter in which we do expect a certain level of sophistication 120 00:07:53,500 --> 00:07:58,140 and the goal of the fellowship program is not to kind of say, well, here are all the 121 00:07:58,140 --> 00:08:04,300 potential opportunities in hematology, like choose one, but really like, okay, you've 122 00:08:04,300 --> 00:08:09,180 had time to at least identify an idea and area of interest. 123 00:08:09,180 --> 00:08:14,540 Let us as a fellowship program, the postdoctoral program that it really is, foster that, build 124 00:08:14,540 --> 00:08:18,140 that and give you the resources to succeed in that regard. 125 00:08:18,140 --> 00:08:23,900 And so in many ways it's a heavier lift in the graduate program, right? 126 00:08:23,900 --> 00:08:27,980 Because the expectation is not that you're just going to walk in as a fresh PhD student 127 00:08:27,980 --> 00:08:32,300 and say, oh, here are all these labs carrying on what there's regular operations. 128 00:08:32,300 --> 00:08:33,820 Maybe you can pitch your code to one. 129 00:08:33,820 --> 00:08:43,100 It really is the fellowship program responsibility to customize their operations to make sure 130 00:08:43,100 --> 00:08:49,580 you succeed because you're exclusively a postdoc under their tutelage and the expectation is 131 00:08:49,580 --> 00:08:53,340 that they drive you towards independent investigation. 132 00:08:53,340 --> 00:09:01,540 So in many ways, I think that the key is that when you choose your fellowship programs and 133 00:09:01,540 --> 00:09:06,140 master's in development, that you're very, very intentional to kind of look not just 134 00:09:06,140 --> 00:09:12,700 at if you're a researcher, not just at, okay, is a clinical training going to be rigorous, 135 00:09:12,700 --> 00:09:18,100 but who is it within that division that you can see yourself modeling your career after 136 00:09:18,100 --> 00:09:25,980 to the best of your ability at the cross section of residency to researcher transition. 137 00:09:25,980 --> 00:09:31,180 And then really first and foremost, base your decision on a fellowship choices based on 138 00:09:31,180 --> 00:09:35,380 if you can find that person kind of division, if you can, it's not gonna be a perfect fit. 139 00:09:35,380 --> 00:09:39,380 But if there's no one that's not even close to a fit to what you're doing, then that's 140 00:09:39,380 --> 00:09:42,660 probably not the best program for you. 141 00:09:42,660 --> 00:09:47,540 And so I would encourage residents coming up just trying to go up into this space to 142 00:09:47,540 --> 00:09:52,980 really kind of be critical of how they see their mentors from our from our interest alignment 143 00:09:52,980 --> 00:09:54,700 standpoint when they choose our fellowship programs. 144 00:09:54,700 --> 00:09:56,060 That would be my biggest. 145 00:09:56,060 --> 00:09:57,740 No, that's really good. 146 00:09:57,740 --> 00:09:58,740 That's really good. 147 00:09:58,740 --> 00:10:01,340 And I think that's really what you talked about about whether it's a graduate program 148 00:10:01,340 --> 00:10:05,500 versus a postdoctoral program where you should come with some level of sophistication. 149 00:10:05,500 --> 00:10:09,100 But the challenge is there is no research training in our clinical training. 150 00:10:09,100 --> 00:10:14,940 So by the time you come to your postdoctoral program, you're not like a PhD trained person 151 00:10:14,940 --> 00:10:18,260 who's pretty much been doing research for four or five years. 152 00:10:18,260 --> 00:10:23,020 You literally are a clinician who's been stuck doing clinical work for at least eight years. 153 00:10:23,020 --> 00:10:26,020 So to some extent, they're not sophisticated. 154 00:10:26,020 --> 00:10:28,860 How can how can people become sophisticated? 155 00:10:28,860 --> 00:10:32,180 Or to what extent can programs help sophisticated people? 156 00:10:32,180 --> 00:10:33,180 If you can say that. 157 00:10:33,180 --> 00:10:36,660 Yeah, you know, I think I think I think it's a really interesting thought to see. 158 00:10:36,660 --> 00:10:42,580 I think that we underestimate the value of our clinical knowledge. 159 00:10:42,580 --> 00:10:47,420 So on one end where the postdoc comes in with a lot of like basic science training in the 160 00:10:47,420 --> 00:10:53,180 context of like basic science research and methodology and all that they don't have the 161 00:10:53,180 --> 00:10:58,940 ability to kind of generate relevant ideas that a clinician has based on their actual 162 00:10:58,940 --> 00:11:02,220 kind of touch and feeling of medical conditions and how they manifest. 163 00:11:02,220 --> 00:11:04,220 And so I think there's a trade off. 164 00:11:04,220 --> 00:11:09,940 You know, the post is a little post with has been and of course, there's dimensions for 165 00:11:09,940 --> 00:11:11,340 kind of comparison there, right? 166 00:11:11,340 --> 00:11:18,900 Like so if it's a really heavy basic science PhD lab, like super molecular, super granular, 167 00:11:18,900 --> 00:11:25,180 whatever, then of course, you as a clinician coming into that environment, have a whole 168 00:11:25,180 --> 00:11:28,220 a really, really steep curve to climb. 169 00:11:28,220 --> 00:11:32,860 Whereas for someone that's going to come into my research program, all I require is that 170 00:11:32,860 --> 00:11:39,420 they have some work and knowledge of HIV and epidemiology coming in to that and what they 171 00:11:39,420 --> 00:11:44,300 don't have where the gaps exist, you fill in your skill sets kind of like make sure 172 00:11:44,300 --> 00:11:46,580 you kind of you're up and running. 173 00:11:46,580 --> 00:11:53,420 So I consider writing that fellowships are not fellowship programs or research years 174 00:11:53,420 --> 00:11:58,060 are really your opportunity to kind of like build your skills in the context of the career 175 00:11:58,060 --> 00:12:02,420 that you're trying to generate, watching how your PI operates and filling in the skills 176 00:12:02,420 --> 00:12:05,500 that you don't have to kind of reset level sophistication. 177 00:12:05,500 --> 00:12:13,500 It's not like let me see if I'm interested in in crypto caucus or basic biochemistry 178 00:12:13,500 --> 00:12:15,620 or or whole genome sequencing. 179 00:12:15,620 --> 00:12:18,980 It's literally like, here's here's a restricted set. 180 00:12:18,980 --> 00:12:22,460 You've you've expressed this interest, how can we kind of fill in those skill sets and 181 00:12:22,460 --> 00:12:27,180 what you need to kind of take it and go and you know, if that time is literally that you're 182 00:12:27,180 --> 00:12:30,820 spending two years in a lab, spending those two years learning those methodologies that 183 00:12:30,820 --> 00:12:35,700 the postdocs the PhD postdocs had coming in, then that's that's valid, right? 184 00:12:35,700 --> 00:12:36,700 That is absolutely valid. 185 00:12:36,700 --> 00:12:41,260 And that's what you should be doing for that entire two years, the hope that eventually, 186 00:12:41,260 --> 00:12:47,140 in a two to four year time frame, you feel that you've you're on an accelerated curriculum, 187 00:12:47,140 --> 00:12:51,260 but one that's that's empowered and driven by the fact that you had clinical context 188 00:12:51,260 --> 00:12:53,740 walking into that wet lab and going. 189 00:12:53,740 --> 00:12:57,620 And so it's not going to be like a PhD student that comes off the street is like, I'm taking 190 00:12:57,620 --> 00:13:03,900 my clinical expertise, emerging kind of methodology and whatever in molecular genetics or whatever 191 00:13:03,900 --> 00:13:05,460 the field may be. 192 00:13:05,460 --> 00:13:10,660 And I expect that because I had some prerequisite of expertise going into that, that this path 193 00:13:10,660 --> 00:13:15,220 of sophistication should be accelerated and the time that the fellowship researchers give 194 00:13:15,220 --> 00:13:16,220 you. 195 00:13:16,220 --> 00:13:20,700 So and we know for that, especially in the basic sciences, two years may not be enough. 196 00:13:20,700 --> 00:13:22,580 It might be three, four. 197 00:13:22,580 --> 00:13:27,900 But the advice obviously is just to take as long as you need to go because that's your 198 00:13:27,900 --> 00:13:28,900 last. 199 00:13:28,900 --> 00:13:29,900 I like it. 200 00:13:29,900 --> 00:13:30,900 I like it. 201 00:13:30,900 --> 00:13:31,900 So okay. 202 00:13:31,900 --> 00:13:36,940 What I'm hearing so when you talk about that level of sophistication, I think it doesn't 203 00:13:36,940 --> 00:13:38,660 come naturally and it doesn't come easily. 204 00:13:38,660 --> 00:13:42,340 And it's definitely not part of our training, right, because going through medical school, 205 00:13:42,340 --> 00:13:43,340 there's a curriculum. 206 00:13:43,340 --> 00:13:45,000 You're you're going to follow the curriculum. 207 00:13:45,000 --> 00:13:47,540 There's not like your own curriculum that you create. 208 00:13:47,540 --> 00:13:48,900 Maybe you take an elective or two. 209 00:13:48,900 --> 00:13:49,900 You're going through residency. 210 00:13:49,900 --> 00:13:50,900 It's the same thing. 211 00:13:50,900 --> 00:13:54,420 You're kind of just like sheep going through the whole process. 212 00:13:54,420 --> 00:13:56,140 And so where do you develop that level? 213 00:13:56,140 --> 00:13:57,700 I mean, I get what you're saying. 214 00:13:57,700 --> 00:13:59,460 It's like you're a clinician. 215 00:13:59,460 --> 00:14:02,900 You know where the problems are and you know what's interesting to you. 216 00:14:02,900 --> 00:14:09,820 And I think where people start is why well, who is the superstar mentor? and how can I 217 00:14:09,820 --> 00:14:12,860 you know, build my career around this mentor? 218 00:14:12,860 --> 00:14:17,100 And what you're talking about is flipping the script and saying, No, no, no. 219 00:14:17,100 --> 00:14:18,100 Who am I? 220 00:14:18,100 --> 00:14:19,220 What do I want to do? 221 00:14:19,220 --> 00:14:22,380 And what are the resources around to support me? 222 00:14:22,380 --> 00:14:23,460 That's not on. 223 00:14:23,460 --> 00:14:25,380 That's not a common way of thinking. 224 00:14:25,380 --> 00:14:27,740 Yeah, it's not a common way of thinking. 225 00:14:27,740 --> 00:14:33,980 I think is one that that I think probably is most beneficial to you, right? 226 00:14:33,980 --> 00:14:37,420 It's like you need to just have a really clear interest. 227 00:14:37,420 --> 00:14:41,540 It's actually a you know, I serve as associate fellowship director for the ID program. 228 00:14:41,540 --> 00:14:47,300 It's actually for me and evaluative criterion for the fellows that were getting is like, 229 00:14:47,300 --> 00:14:49,820 tell me who you are, right? 230 00:14:49,820 --> 00:14:56,420 Tell me who you are and tell me how you're looking based on who you are on where who 231 00:14:56,420 --> 00:14:58,220 you want to work with going forward. 232 00:14:58,220 --> 00:15:03,300 Yeah, you only know so many of the details of the people to factor in our division. 233 00:15:03,300 --> 00:15:07,380 But if you know who you are well enough, you can figure out and be strategic of how you 234 00:15:07,380 --> 00:15:12,820 fit align your interests with existing resources in most places. 235 00:15:12,820 --> 00:15:15,980 But I mean, I think I think the key is tell me who you are. 236 00:15:15,980 --> 00:15:18,660 And and and be very thoughtful. 237 00:15:18,660 --> 00:15:24,140 Of course, with the guidance of going up, going on as junior fellowship years about 238 00:15:24,140 --> 00:15:29,180 what skills you need to get to get to their level, what are the skill sets you need, because 239 00:15:29,180 --> 00:15:34,140 that's where the fellowship is right is filling in those gaps based on your interest and then 240 00:15:34,140 --> 00:15:40,140 letting you I agree, it hasn't been the traditional way that things are are done. 241 00:15:40,140 --> 00:15:47,820 But I think in many ways, it's unless unless we we kind of foster that level of ingenuity 242 00:15:47,820 --> 00:15:56,220 back that we're building kind of like isolated research trees of like, oh, this is the Jones 243 00:15:56,220 --> 00:16:02,380 line of investigators and everyone is in 1975. 244 00:16:02,380 --> 00:16:10,740 We're kind of Austrian, like independent investigators, then it has to be the approach is like, what 245 00:16:10,740 --> 00:16:12,380 is this make it happen? 246 00:16:12,380 --> 00:16:13,820 Because somehow they did. 247 00:16:13,820 --> 00:16:14,820 Yeah, yes. 248 00:16:14,820 --> 00:16:15,820 No, I love it. 249 00:16:15,820 --> 00:16:18,020 It's not you're not building a clone army. 250 00:16:18,020 --> 00:16:21,620 And somehow, sometimes the prevailing model is the clone army. 251 00:16:21,620 --> 00:16:23,020 I'm a superstar success. 252 00:16:23,020 --> 00:16:24,500 Come be like me. 253 00:16:24,500 --> 00:16:26,140 And there's a lot of that. 254 00:16:26,140 --> 00:16:30,460 But really, it's it's helping people foster their independence is already something that 255 00:16:30,460 --> 00:16:31,580 you're excited about. 256 00:16:31,580 --> 00:16:32,980 How do we help you grow that? 257 00:16:32,980 --> 00:16:34,460 Because you're going to grow it well. 258 00:16:34,460 --> 00:16:35,460 And this is a hard journey. 259 00:16:35,460 --> 00:16:37,900 You submitted seven times. 260 00:16:37,900 --> 00:16:41,180 It's not the kind of thing you want to keep resubmitting something you don't care about. 261 00:16:41,180 --> 00:16:45,220 And many times I do feel like many young people are stuck in that in that place. 262 00:16:45,220 --> 00:16:47,300 The junior faculty are stuck in that place. 263 00:16:47,300 --> 00:16:54,220 Now I want I want you to speak about this whole concept of knowing yourself knowing 264 00:16:54,220 --> 00:16:59,460 what you want, because you took a year and did a hospitalist fellowship. 265 00:16:59,460 --> 00:17:04,540 Like what I'm hearing is that you don't want people coming to your fellowship program starry 266 00:17:04,540 --> 00:17:08,900 eyed saying I'm not really sure what I want to do. 267 00:17:08,900 --> 00:17:09,900 That's not going to fly. 268 00:17:09,900 --> 00:17:12,780 Yeah, I would say that's a fair characterization. 269 00:17:12,780 --> 00:17:18,260 Honestly, I say that, but our program is probably more forgiving in that regard than many other 270 00:17:18,260 --> 00:17:19,260 in the country. 271 00:17:19,260 --> 00:17:20,260 Right. 272 00:17:20,260 --> 00:17:23,780 And that they're actually I remember when I was interviewing for ID fellowships at a 273 00:17:23,780 --> 00:17:26,740 number of places, I interviewed widely across the country. 274 00:17:26,740 --> 00:17:28,940 They actually asked the question straight up. 275 00:17:28,940 --> 00:17:32,980 Who are you going to work with when you get here? 276 00:17:32,980 --> 00:17:35,420 Now I personally think that's a little bit extreme. 277 00:17:35,420 --> 00:17:37,340 I never framed a question that way. 278 00:17:37,340 --> 00:17:43,020 But I do say, what are your interests, and let us do the work of trying to align you 279 00:17:43,020 --> 00:17:47,700 with the best person based on your interest. 280 00:17:47,700 --> 00:17:54,780 What we don't want to do is give you like 15 options and say, Okay, well, you know, 281 00:17:54,780 --> 00:17:59,060 you have 15 options of all the things you can do in infectious diseases. 282 00:17:59,060 --> 00:18:00,780 And I don't know what I want to do. 283 00:18:00,780 --> 00:18:08,540 And then all of a sudden, between 4048 weeks of continuous clinical medicine, you're in 284 00:18:08,540 --> 00:18:11,220 July one of your second year, you're supposed to figure it out magic. 285 00:18:11,220 --> 00:18:15,580 Like, what are your decisions being based off of? 286 00:18:15,580 --> 00:18:21,460 If, if, if, if, if we're not giving you a time to kind of think and so, in my opinion, 287 00:18:21,460 --> 00:18:27,380 that thinking should have happened slowly, but longitudinally over a long period of time, 288 00:18:27,380 --> 00:18:29,980 whether it be like two years prior or whatever. 289 00:18:29,980 --> 00:18:35,420 And if it is, it also is okay to say if that's not your path, and that's not how you accompany 290 00:18:35,420 --> 00:18:38,460 things, how you process things, and that's okay, too. 291 00:18:38,460 --> 00:18:42,780 I mean, I think there are many fine clinician educators out there, right? 292 00:18:42,780 --> 00:18:46,780 There are many fine people that have actually kind of figured it out like two months before 293 00:18:46,780 --> 00:18:50,460 and says I run around transplant ID, and now I want to study after jillis for the rest 294 00:18:50,460 --> 00:18:53,220 of my life, if that's the case, and that's great. 295 00:18:53,220 --> 00:18:56,220 I will say that is is rare. 296 00:18:56,220 --> 00:19:01,620 That's typically what happens, and we should I feel that there's a little bit of a, we 297 00:19:01,620 --> 00:19:05,900 have a responsibility to our trainees to let them know that the likelihood of them figuring 298 00:19:05,900 --> 00:19:09,540 out their life and research in the two months leading up to when you have to make a decision 299 00:19:09,540 --> 00:19:15,020 on July 1st or their second year fellowship is is highly unlike that that was that thread 300 00:19:15,020 --> 00:19:17,500 that narrative should be. 301 00:19:17,500 --> 00:19:18,700 Sure. 302 00:19:18,700 --> 00:19:21,060 So it's almost like right now. 303 00:19:21,060 --> 00:19:23,700 We are dependent on the chemistry. 304 00:19:23,700 --> 00:19:28,500 You see if as you're seeing patients, there'll be chemistry between you and a certain population, 305 00:19:28,500 --> 00:19:31,420 and then you'll know that this is a population you're working with. 306 00:19:31,420 --> 00:19:35,880 What you're talking about is forgetting the romance chemistry that may may help you figure 307 00:19:35,880 --> 00:19:41,620 it out and just being thoughtful, being thoughtful about what you care about and how the resources 308 00:19:41,620 --> 00:19:44,140 of the institution potentially could support you. 309 00:19:44,140 --> 00:19:48,560 And if that means taking time off to figure it out, it is important, but it really takes 310 00:19:48,560 --> 00:19:50,140 time to think. 311 00:19:50,140 --> 00:19:54,300 And when you're in the midst of your clinical training, you are so busy clinically, you 312 00:19:54,300 --> 00:20:00,180 may not have that space to think and coming to these decisions, take thought, they take 313 00:20:00,180 --> 00:20:02,100 time they take space. 314 00:20:02,100 --> 00:20:06,000 And you should be thinking about how do you create the space to be able to make a good 315 00:20:06,000 --> 00:20:07,500 informed decision. 316 00:20:07,500 --> 00:20:08,500 Absolutely. 317 00:20:08,500 --> 00:20:12,100 And I think I think the reason why there has to be longitudinal choices, think about he 318 00:20:12,100 --> 00:20:14,060 went through this process. 319 00:20:14,060 --> 00:20:18,780 You start from when you're an intern and take that time period consecutively. 320 00:20:18,780 --> 00:20:25,100 If in case of internal medicine, to the time you the day you finish your clinical fellowship, 321 00:20:25,100 --> 00:20:26,200 right. 322 00:20:26,200 --> 00:20:30,020 And now you're about four or five years in and out, all of a sudden, it was to be a research, 323 00:20:30,020 --> 00:20:32,300 you supposed to have a research plan. 324 00:20:32,300 --> 00:20:37,900 What I would encourage is that you have to be thoughtful of the small steps along the 325 00:20:37,900 --> 00:20:42,100 way that kind of gear you towards that interest all the way through because you're not going 326 00:20:42,100 --> 00:20:46,420 to have two weeks to just kind of sit back and kind of strategize, okay, here's my life 327 00:20:46,420 --> 00:20:51,180 now, but the but the journey is actually meant interested in many ways in that thread, right 328 00:20:51,180 --> 00:20:53,860 of like, here's where I started. 329 00:20:53,860 --> 00:20:55,540 Here's how I was interested in hematology. 330 00:20:55,540 --> 00:20:57,700 Then I did some extra around hematology. 331 00:20:57,700 --> 00:20:59,180 I really, really liked it. 332 00:20:59,180 --> 00:21:03,140 And then I was like, well, hmm, this sickle cell clinic is kind of cool. 333 00:21:03,140 --> 00:21:04,780 I'm going to do a little bit more of that. 334 00:21:04,780 --> 00:21:07,580 And then I got to hematology fellowship and like, okay, well, here are the aspects of 335 00:21:07,580 --> 00:21:09,860 sickle cell that I'm really interested in. 336 00:21:09,860 --> 00:21:14,100 And so let me try to find a program that have people kind of doing that. 337 00:21:14,100 --> 00:21:17,460 I may not know all the answers right now, but I like sickle cell. 338 00:21:17,460 --> 00:21:21,460 And I like this aspect of patient centered sickle cell research. 339 00:21:21,460 --> 00:21:22,700 I'm going to do that. 340 00:21:22,700 --> 00:21:27,260 And then you get to somewhere that where someone's doing that and boom, like, in a way you go, 341 00:21:27,260 --> 00:21:30,340 but it's not going to be a epiphany. 342 00:21:30,340 --> 00:21:35,100 It's not and it's not but it was because of the lack of time we have to decompress and 343 00:21:35,100 --> 00:21:42,300 strategize and I think the earlier we tell folks to kind of actually have this longitudinal 344 00:21:42,300 --> 00:21:47,780 evolution over time that occurs in small increments over the course of those four years leading 345 00:21:47,780 --> 00:21:53,540 up to your first day of clinical clinical research fellowship, I think is key. 346 00:21:53,540 --> 00:21:58,540 I mean, in many ways, it's scary because you're like, well, you're making big decisions. 347 00:21:58,540 --> 00:22:04,420 You're making big, such big life decisions with no time to decompress and strategize. 348 00:22:04,420 --> 00:22:05,420 Right. 349 00:22:05,420 --> 00:22:06,420 And in many ways, that's true. 350 00:22:06,420 --> 00:22:10,100 I mean, it's always been my problem with going back to medical school, how do you decide 351 00:22:10,100 --> 00:22:15,580 medicine or surgery or pediatrics or OBGYN based on what information and all of a sudden 352 00:22:15,580 --> 00:22:19,060 midway through your third year, you have to start to make decisions of how you're going 353 00:22:19,060 --> 00:22:25,380 to spend the rest of your life with a surgeon or as a medicine doc or a pediatrician based 354 00:22:25,380 --> 00:22:27,820 on what information did you make that decision? 355 00:22:27,820 --> 00:22:31,600 However, we make those and from those decisions anyway. 356 00:22:31,600 --> 00:22:37,940 So I think the same applies here where it's like literally like taking that time, the 357 00:22:37,940 --> 00:22:43,020 small little time you get with the small increments over time to really kind of find out where 358 00:22:43,020 --> 00:22:45,660 you're landing and then come to that point in time. 359 00:22:45,660 --> 00:22:50,260 And maybe maybe for the rare few of us to have that epiphany, that's good for you. 360 00:22:50,260 --> 00:22:55,340 But I think that's not the typical path and one that we should expect to expect in most 361 00:22:55,340 --> 00:22:56,340 cases. 362 00:22:56,340 --> 00:22:57,340 Sure. 363 00:22:57,340 --> 00:23:02,460 So what I'm hearing is more we've got to cultivate the interest over time and foster people really 364 00:23:02,460 --> 00:23:06,100 thinking about what is it that they really want to do. 365 00:23:06,100 --> 00:23:12,580 Okay, so I want to go back to the seven applications you did for a career development award. 366 00:23:12,580 --> 00:23:18,980 At what point along that journey did you want to quit and what kept you going? 367 00:23:18,980 --> 00:23:23,140 Yeah, I am very internally motivated. 368 00:23:23,140 --> 00:23:31,460 So to me, it was always like I'm just gonna I'm stubborn, I'm just gonna prove I can do 369 00:23:31,460 --> 00:23:33,260 it. 370 00:23:33,260 --> 00:23:36,780 And it was it was it was my it wasn't the pressure from others. 371 00:23:36,780 --> 00:23:38,980 It wasn't like the fear of failure. 372 00:23:38,980 --> 00:23:42,460 I'm just wired where it's like, I'm gonna get I'm just gonna ram this thing through 373 00:23:42,460 --> 00:23:43,460 one way or the other. 374 00:23:43,460 --> 00:23:48,260 And so I can't really say that I ever felt like within because I had it in my head that 375 00:23:48,260 --> 00:23:52,300 you know, this is a good idea. 376 00:23:52,300 --> 00:23:55,580 I want to prove to myself that I can do this. 377 00:23:55,580 --> 00:23:58,320 And so and so I'm gonna do it. 378 00:23:58,320 --> 00:24:02,820 You know, the times if there's a time where I felt like quitting, or I felt like lost 379 00:24:02,820 --> 00:24:04,660 enough words, like maybe I should be doing something different. 380 00:24:04,660 --> 00:24:07,900 It was actually when my mentor left in early 2004. 381 00:24:07,900 --> 00:24:12,900 So my beginning my third year of clinical fellowship, and I was like, yeah, this is 382 00:24:12,900 --> 00:24:16,420 like there's really no clear path forward here. 383 00:24:16,420 --> 00:24:22,100 But you know, I kind of embrace that challenge and say, Okay, well, let's just at the worst 384 00:24:22,100 --> 00:24:24,060 case in the worst case. 385 00:24:24,060 --> 00:24:29,460 And, and here's where I always is probably insensitive to the to the experiences a lot 386 00:24:29,460 --> 00:24:30,460 of people. 387 00:24:30,460 --> 00:24:37,060 In many cases, we're, we're, we're blessed, we're fortunate to have such a high ceiling 388 00:24:37,060 --> 00:24:40,700 as a highly trained medical professional. 389 00:24:40,700 --> 00:24:44,740 What is truly the fear of failure here is not like the person out on the street working 390 00:24:44,740 --> 00:24:49,260 40 hours a week for $15 an hour at the loser job there potentially on the street, I can't 391 00:24:49,260 --> 00:24:53,180 make their rent at worst. 392 00:24:53,180 --> 00:24:58,900 At worst, you get a clinical job somewhere, and your family will be fine, and you'll earn 393 00:24:58,900 --> 00:24:59,900 whatever money. 394 00:24:59,900 --> 00:25:03,300 You'll do what you want to do for the rest of your life, but at least you're financially 395 00:25:03,300 --> 00:25:04,300 secure. 396 00:25:04,300 --> 00:25:09,180 So, to me, like, I was like, you know, if I'll just do this, they tell me I can't do 397 00:25:09,180 --> 00:25:10,180 it anymore. 398 00:25:10,180 --> 00:25:13,660 It comes, still have a pretty good job somewhere. 399 00:25:13,660 --> 00:25:15,940 I can't complain that much. 400 00:25:15,940 --> 00:25:21,620 So yeah, I wasn't really driven by that fear of failure or, and I think a lot of it in 401 00:25:21,620 --> 00:25:28,020 many ways too, was that I've never really completely tied my identity, love, esteem 402 00:25:28,020 --> 00:25:29,020 to this work. 403 00:25:29,020 --> 00:25:36,220 Like, this work I enjoy is work I care about, but fundamentally, I know that there are many 404 00:25:36,220 --> 00:25:37,220 other things I can be doing. 405 00:25:37,220 --> 00:25:40,980 I just choose to do this, and if it doesn't work, you go do something else. 406 00:25:40,980 --> 00:25:43,260 I'm not a failure, so to speak. 407 00:25:43,260 --> 00:25:44,260 Oh, wow. 408 00:25:44,260 --> 00:25:45,260 I love that. 409 00:25:45,260 --> 00:25:50,420 It's a fundamental faith in yourself and your ability to move work forward. 410 00:25:50,420 --> 00:25:55,740 It's also recognizing that you'll be okay if it doesn't work out, and it's worth doing 411 00:25:55,740 --> 00:26:00,660 as long as you can do it, and it sounds like you enjoy doing it, and therefore you did 412 00:26:00,660 --> 00:26:01,660 it. 413 00:26:01,660 --> 00:26:07,740 And I love that because it's really about really loving the work that we do and not 414 00:26:07,740 --> 00:26:11,420 doing work just because somebody gifted it to you, which is a different, you know, you 415 00:26:11,420 --> 00:26:15,220 come at it differently, you interact with the work differently as well. 416 00:26:15,220 --> 00:26:18,820 So I really appreciate that you talked about that. 417 00:26:18,820 --> 00:26:25,300 One thing you alluded to is the finances, and I want to speak to that because Dr. Lance, 418 00:26:25,300 --> 00:26:31,260 okay, you're doing all this awesome research work and resubmitting and submitting the K, 419 00:26:31,260 --> 00:26:33,060 how are you making ends meet? 420 00:26:33,060 --> 00:26:37,260 Yeah, you know, it's an interesting question to see. 421 00:26:37,260 --> 00:26:42,220 I, you know, and there are many ways my thoughts can go on that. 422 00:26:42,220 --> 00:26:50,340 But I will say this, that it is difficult, it is interesting, it is sobering to know 423 00:26:50,340 --> 00:26:55,460 that, you know, I could kind of drop all these extra hours of work that I'm doing right in 424 00:26:55,460 --> 00:27:00,060 these grants and actually go make more money in private practice or wherever, right? 425 00:27:00,060 --> 00:27:01,060 Is it tempting? 426 00:27:01,060 --> 00:27:03,940 Not really, because I mean, I enjoy my work. 427 00:27:03,940 --> 00:27:06,460 And I mean, everything looks seems monotonous. 428 00:27:06,460 --> 00:27:11,580 All the other options seem pretty monotonous to me where I don't have my intellectual, 429 00:27:11,580 --> 00:27:17,100 academic creativity as a driver of what I do every day when I wake up in the morning. 430 00:27:17,100 --> 00:27:18,100 That is a loss. 431 00:27:18,100 --> 00:27:21,980 It's not failure, but it's a loss if you don't have that in your life anymore. 432 00:27:21,980 --> 00:27:27,020 And so in many ways, as a researcher, you've made a decision that you're going to take 433 00:27:27,020 --> 00:27:33,820 the institutional discount on your earnings, just so that you can preserve your academic 434 00:27:33,820 --> 00:27:37,340 creativity as a driving force of the work that you do every day. 435 00:27:37,340 --> 00:27:41,180 Whether that's right or wrong, I think is really open for question. 436 00:27:41,180 --> 00:27:44,780 Now, of course, I'm biased one way versus the other. 437 00:27:44,780 --> 00:27:49,740 But in many ways, I've, I guess, come to terms with it that, you know, at least I don't have 438 00:27:49,740 --> 00:27:57,420 to round C24 patients every waking day of my life, because that would be really, really 439 00:27:57,420 --> 00:27:58,420 tough for me. 440 00:27:58,420 --> 00:28:03,380 And so I say this is a privilege, Jackson, that I get to do the work that I enjoy. 441 00:28:03,380 --> 00:28:06,020 And every day that I get to do this work is a privilege. 442 00:28:06,020 --> 00:28:10,500 And if it might sell, you're going to be docked partially because of it, then so be it. 443 00:28:10,500 --> 00:28:16,300 I think fundamentally, though, in terms of value added for what we do as researchers, 444 00:28:16,300 --> 00:28:20,220 as scientists, the entire system is completely wrong, right? 445 00:28:20,220 --> 00:28:25,300 But we know the realities of how institutions are compensated and how health systems make 446 00:28:25,300 --> 00:28:26,300 their money. 447 00:28:26,300 --> 00:28:31,260 And so unfortunately, this is probably a reality of being a researcher that will face for the 448 00:28:31,260 --> 00:28:34,740 duration of our careers, but hopefully I'm wrong. 449 00:28:34,740 --> 00:28:35,740 I love that. 450 00:28:35,740 --> 00:28:40,740 I think what I hear undergirding that is that I love my work. 451 00:28:40,740 --> 00:28:42,940 I like to do this work. 452 00:28:42,940 --> 00:28:49,300 And the value it brings to me is worth the cost, because it costs you to do this work. 453 00:28:49,300 --> 00:28:50,880 But you don't look at it as a cost. 454 00:28:50,880 --> 00:28:53,140 You look at it as what you're enjoying. 455 00:28:53,140 --> 00:28:57,700 And I just think it's really refreshing and beautiful because I feel like in medicine, 456 00:28:57,700 --> 00:29:00,140 there's so much of I got to do this, I got to do this. 457 00:29:00,140 --> 00:29:01,140 This is an obligation. 458 00:29:01,140 --> 00:29:03,420 This is what I got to do, and which is fine. 459 00:29:03,420 --> 00:29:07,340 You feel like you have to do it, but you get to a point in your career. 460 00:29:07,340 --> 00:29:11,740 And that's usually in making that transition from fellowship to faculty, where you don't 461 00:29:11,740 --> 00:29:15,980 have to just do whatever, where you get to choose. 462 00:29:15,980 --> 00:29:20,380 And you should choose a thing that matters to you. 463 00:29:20,380 --> 00:29:22,260 Yeah, I love it. 464 00:29:22,260 --> 00:29:23,820 Thank you for sharing that. 465 00:29:23,820 --> 00:29:26,620 All right, we have come to the end of the show. 466 00:29:26,620 --> 00:29:31,740 And I want to ask you, what final thing have we left unsaid that somebody needs to hear, 467 00:29:31,740 --> 00:29:35,660 especially someone who's thinking, but I don't know, I don't know what I want to do with 468 00:29:35,660 --> 00:29:37,300 my life. 469 00:29:37,300 --> 00:29:39,980 This research thing sounds cool. 470 00:29:39,980 --> 00:29:42,140 What advice would you have? 471 00:29:42,140 --> 00:29:46,340 What I would say to OC and thank you so much again for the opportunity is this that I want 472 00:29:46,340 --> 00:29:51,840 to anchor on that last point that I made about the privilege of being able to use your ingenuity 473 00:29:51,840 --> 00:29:55,100 and your creativity to drive the work that you care about. 474 00:29:55,100 --> 00:30:01,540 The researcher, the scientists in many ways, it has the privilege and is unique within 475 00:30:01,540 --> 00:30:05,100 our realm of clinical medicine of being able to do that. 476 00:30:05,100 --> 00:30:06,100 Right. 477 00:30:06,100 --> 00:30:13,500 And so to me, no matter how difficult it is with NIH fund rates and like what are the 478 00:30:13,500 --> 00:30:18,900 how far on what are the award rates for each institution and how hard is it to get your 479 00:30:18,900 --> 00:30:21,380 kid or how hard is it to make a transition. 480 00:30:21,380 --> 00:30:23,260 I know why I choose this work. 481 00:30:23,260 --> 00:30:28,340 And it's because of what I said, which is I get to use my ingenuity, my creativity to 482 00:30:28,340 --> 00:30:30,260 do work that I care about. 483 00:30:30,260 --> 00:30:36,460 And as long as that's the driving force for my work that I've devoted my professional 484 00:30:36,460 --> 00:30:41,260 life to do, then I think I'll be OK. 485 00:30:41,260 --> 00:30:47,200 And I want I hope that that because I mean, I think I really truly believe that once you 486 00:30:47,200 --> 00:30:51,580 kind of abandon that opportunity with with your professional choices early in your career, 487 00:30:51,580 --> 00:30:53,380 it's really hard to go back to it. 488 00:30:53,380 --> 00:30:59,180 And so I hope that for trainees, for fellows listening to this, they don't abandon, they 489 00:30:59,180 --> 00:31:03,580 don't forfeit that privilege of using your creativity to drive your work. 490 00:31:03,580 --> 00:31:09,360 Like it's the it's the mandate of the researcher, the scientist and one that's that's available 491 00:31:09,360 --> 00:31:12,340 to all who graduated medical school. 492 00:31:12,340 --> 00:31:16,540 I want to look into careers in academia, which if you forfeit it only if you want to. 493 00:31:16,540 --> 00:31:21,340 And if you do think about it before you do and think about what wakes you up in the morning. 494 00:31:21,340 --> 00:31:22,900 And so that's why I do what I do. 495 00:31:22,900 --> 00:31:25,800 And I had a pay cut pay cut nonetheless. 496 00:31:25,800 --> 00:31:29,540 But I'm thankful to have the ability and privilege to do it. 497 00:31:29,540 --> 00:31:30,900 Oh, that's so awesome. 498 00:31:30,900 --> 00:31:32,340 Lance, thank you so much. 499 00:31:32,340 --> 00:31:33,580 Thank you for being on the show. 500 00:31:33,580 --> 00:31:34,580 Yeah. 501 00:31:34,580 --> 00:31:35,580 Thank you, Tersi. 502 00:31:35,580 --> 00:31:36,820 All right, everyone. 503 00:31:36,820 --> 00:31:37,820 You heard Lance. 504 00:31:37,820 --> 00:31:42,020 This is this this work is is it's meaningful. 505 00:31:42,020 --> 00:31:43,020 It's fun. 506 00:31:43,020 --> 00:31:44,020 We get to use our creativity. 507 00:31:44,020 --> 00:31:47,500 We get to do amazing things and make impact at the same time. 508 00:31:47,500 --> 00:31:52,360 And if you want to, you absolutely can and definitely believe in yourself and do what 509 00:31:52,360 --> 00:31:55,940 it takes to to fill the gaps that you have. 510 00:31:55,940 --> 00:31:56,940 All right. 511 00:31:56,940 --> 00:31:58,300 It's been a pleasure talking to you all. 512 00:31:58,300 --> 00:32:08,300 I look forward to talking with you again the next time. 513 00:32:08,300 --> 00:32:13,660 Thanks for listening to this episode of the Clinician Researcher podcast, where academic 514 00:32:13,660 --> 00:32:18,940 clinicians learn the skills to build their own research program, whether or not they 515 00:32:18,940 --> 00:32:20,440 have a mentor. 516 00:32:20,440 --> 00:32:26,420 If you found the information in this episode to be helpful, don't keep it all to yourself. 517 00:32:26,420 --> 00:32:28,300 Someone else needs to hear it. 518 00:32:28,300 --> 00:32:32,340 So take a minute right now and share it. 519 00:32:32,340 --> 00:32:37,820 As you share this episode, you become part of our mission to help launch a new generation 520 00:32:37,820 --> 00:32:43,460 of clinician researchers who make transformative discoveries that change the way we do health 521 00:32:43,460 --> 00:32:44,460 care. 522 00:32:44,460 --> 00:33:04,940 Let's get started!