Welcome to the Clinician Researcher podcast, where academic clinicians learn the skills
to build their own research program, whether or not they have a mentor.
As clinicians, we spend a decade or more as trainees learning to take care of patients.
When we finally start our careers, we want to build research programs, but then we find
that our years of clinical training did not adequately prepare us to lead our research
program.
Through no fault of our own, we struggle to find mentors, and when we can't, we quit.
However, clinicians hold the keys to the greatest research breakthroughs.
For this reason, the Clinician Researcher podcast exists to give academic clinicians
the tools to build their own research program, whether or not they have a mentor.
Now introducing your host, Toyosi Onwuemene.
Welcome to the Clinician Researcher podcast.
I'm your host, Toyosi Onwuemene and it is an absolute pleasure to be talking with you today.
Thank you for listening.
I am excited to be talking with you today about the 20%.
These are the keys to your 2024, keys to succeeding in 2024.
We are well, well into 2024 now, but you always need keys for success.
Today I'm talking about the 20%.
The 20% comes from the Pareto principle, and that is the principle that 80% of your productivity
or 80% of your benefits or your profits come from 20% of the things that you do.
This principle was highlighted specifically in the book, The 80-20 Rule by Richard Koch,
and it is a really great book.
I totally recommend reading it.
What he talks about is that the 80-20 rule is not really like a number.
It's not really like 80% comes from 20%.
It's really like a ratio.
It's recognizing that of all the things you do, of all the things that move you forward,
very, very few things actually count to enhance your productivity.
Very few things count to move you forward.
Everything is moving you forward potentially, but some are moving you forward more significantly
than others.
If you look back, let's say you look back at your weekly calendar and you look at the
time you spent writing, how much of that time actually produced the manuscript that you
were planning to finish?
You look at it and you recognize that every time you write in the afternoon, you spend
a lot of hours writing, but you don't produce very much content, as opposed to when you
write in the morning, wow, a couple of paragraphs produced or several, several sections were
completed.
You know that your 20% is the morning time that you put into writing because that's the
time that allows you to really move the needle forward in producing as far as writing is
concerned.
I use that example because I am a morning writer, I'm one of those people who's got
to get it done in the morning and I can write at any time of the day, but I am so much slower
in the afternoon, I produce much less in the afternoon.
For that reason, my 20% is to write in the morning.
So that's the example, comes from the Pareto principle and it's really described well in
the 80-20 rule by Richard Koch and it's also described well in the book Essentialism by
McKeon.
So I'm talking about the 20% and how do you succeed in your research program by thinking
about the 20%?
Well, let's talk first about the 20% in your writing.
Now, one of the things I say all the time and I think it's important to recognize that
when you are a clinician researcher, you are a science communicator and that may be one
of your greatest gifts of all time is your ability to communicate your science.
Actually, you communicate not only your science, you communicate other people's science as
well because you are communicating your science in the context of other people's science.
And so your writing is one of your, or at least should be, one of your 20% items.
And by writing, it's like everything that moves you forward from concept, from idea
to your final published work, whether that's your final published manuscript, whether that's
your final presentation, whether that's your finally submitted protocol, whether that's
your finally submitted grant proposal, that all counts as writing.
And no, it's not always fingers on the keyboard typing.
It's also the work that you're doing to read.
It's the work that you're doing to do the research or analyze data.
All of that is what I'm counting as writing in your science communication.
Let's talk a little bit about the science communication.
For one, the most important person you're communicating with is yourself.
You're number one.
You got to understand the work that you're doing.
If you don't understand it, you're going to have a hard time helping other people understand
it.
And this is not so much a challenge as you grow in your research career.
It's more of a challenge when you're first starting out, especially when you're working
on projects that mentors are recommending that you have no clue about, and you're studying
and you're trying to figure it out.
And sometimes there's a sense of, let me just go by faith and believe all that the mentor
told me.
And I'm not saying you shouldn't believe your mentors.
I think mentors are great.
And I think in order to be able to fully own your work, you have to understand it.
And you cannot own what you do not understand.
Now this was highlighted in a recent, actually it's been about a year now, when I was an
interviewer for finalists who were being considered for a grant award.
And so these are finalists who had submitted proposals and we're now showing up to defend
their proposals.
And some of them had amazing, outstanding proposals.
I mean, the proposal was like butter to read if proposals could ever be like butter.
I mean, it was smooth and so beautiful.
When it came to discussing it, when it came to defending it, wow, they had no clue what
they had written about.
They were just totally clueless.
And they're like, well, it's my mentor's project.
And it's like, no, no, not okay.
The most important person that you need to communicate with in terms of science, your
science is you.
And so you want to focus on making sure you understand what you're doing.
And if you don't understand it or you don't like it, sometimes when you don't like something,
it doesn't matter how well people explain it, you're like, I just don't like this.
I hate it.
Me that's cell receptor signaling or receptor cell signaling, do you see?
It's just the one project.
It's one of the things I won't do because I can understand it, but I'm like, I just
don't care that much.
I mean, it's good work and thank you to all the scientists who are doing that work, but
just saying that it's not the thing I am primarily interested in.
And so it makes it difficult to communicate with myself if I was doing a project in that
area.
Okay.
So you're a science communicator.
You communicate with yourself first.
You also communicate with funders.
And this is important because funders fund your work, whether those be internal funders,
whether those be funders in the NIH, at the NIH, whether those be funders at foundations,
you are communicating your work to them.
And if they don't get your work, if you don't communicate your science well, and they don't
get moved to fund you, they don't understand the significance of your work, they don't
move to fund you.
But it's the funders, but it's the reviewers that also represent the funders.
So you're in communication with them and you write proposals and submit them so that you
can communicate well.
Right?
So you focus on the 20% of increasing the skill so that you can continue to do that
well.
And then another thing, another channel of your communication, and so the scientific
community is submitting manuscripts all the time.
You're interacting with editors, kind of behind closed doors, because the editors are interacting
with your work and they're not talking to you as they're making decisions as to whether
they move it forward for peer review or not.
And the peer reviewers are certainly not talking with you as they review your work.
So you're communicating with the scientific community every time you submit your work
to be published or you submit abstracts to be reviewed.
You're always communicating with the scientific community.
And then the group that you communicate with, that's also not always fully, you know, front
and center, but is always there and in the background is the lay public.
The lay public who is interpreting your work one way or the other.
So you are a science communicator.
If you're someone who's going to get funded, you're a science communicator.
If you're someone who's going to get invited to give presentations, you are a science
communicator.
If you're somebody who's going to have their work read by the scientific community all
over, you are a science communicator.
And so you want to make sure that when you're prioritizing what your 20% is, especially
as a clinician scientist, you prioritize your ability to enhance, grow, and make space for
and make room for your science communication, which is your writing.
Okay, that's number 120% is your writing.
Number two is your interactions.
And here's what I mean about your interactions.
If you look at all the interactions you've had, tally them over the last four weeks,
and you can look and say, here is where my energy was completely drained, and at the
end of the conversation, it was only five minutes with this person, I was no longer
able to do any work.
And then you can trace the people who you spoke to for even 10 minutes, who totally
transformed your experience, and they helped you see that you could do it.
They helped you see that you absolutely had what it took.
They encouraged you, and you came away from that conversation with a lightheartedness
in your step.
You're like, I can totally do this.
This is not going to hurt me.
I can do this.
Yes, there are those people.
And then there are those people who just make you feel crummy about yourself all the time.
You don't even have to see them for them to affect your experience.
Okay, if you're going to enhance your experience, you're going to want to minimize the 80% that
drain you.
And that may be bathroom conversations, that may be water cooler conversations, it may
be the caucus that forms after the Grand Rounds presentation.
I don't know what it is, you know, but there are environments that keep you from doing
your work.
Now, for me, part of the 80% was asking people how they're doing.
I love people.
And if I see you, I want to know how you're doing.
I want to know how your dog is doing.
I just want to know.
And to some extent, some of that is a people pleasing tendency.
I want people to know that I care about them.
And so sometimes I'm willing to continue to do that to the detriment of my work.
And so part of my people pleasing strategy and my weakness was being at conference physically,
because at the end of conference, I just felt like I needed to talk to everybody.
And I felt like I just needed to, you know, make sure everybody who was there was doing
fine.
And there are some people who when they start talking, wow, they don't stop.
And they don't really care that you have anything else going on.
And so what started as what may have felt to you as a kind gesture becomes a situation
in which you're strategizing in your head, like, how do I end this without seeming rude?
And in focusing on the 20%, what you do is you say, what are the interactions that enhance
me?
What are the interactions that allow me to continue to do my work?
What are the interactions that pull energy from me, drain me or keep me from going to
my work?
And so for me, part of that 80% was going to conference.
I don't go physically as much as I used to.
I go, I go virtually or, you know, intermittently in person, because as much as the collaborations
and the connections are critical, one of my flaws is the need to continue to talk to people
and find out how they're doing to the detriment of the work I'm supposed to be doing.
And so you want to understand what interactions you have that keep you from moving forward.
You want to identify the interactions that keep you moving forward.
You want to up those interactions.
You want to up those communities and you want to downgrade the ones that do not move you
forward.
So focus on the 20% in your interactions.
Okay.
The next one is a 20% of the spaces to which you show up.
Now this is really important.
And I want to speak specifically, honestly, in this way to people who are underrepresented
in academia, you know, not every space is a safe space.
And it's important to just acknowledge that.
And I'm just acknowledging that, that not every space is a safe space.
We would hope that academic institutions are bastions of learning and acceptance and tolerance.
And we would love to believe that.
But the experience of many people is different.
And there are spaces to which we show up where we're having to defend ourselves more than
anybody else is, more than we've ever had to.
There are spaces to which we show up where we get up to give a simple presentation and
we're challenged and then we're challenged again.
And then we feel like we need to prove that we were correct.
And there's a lot of energy that goes into showing up in those spaces, preparing for
those spaces, you know, making sure that we recover at the end of being in those spaces.
And I just want to encourage you to think 20%.
What spaces do you show up to?
What really nourish and encourage you?
And what are the spaces you show up to that, frankly, do not?
And it's important because, you know, yeah, you might have to work in all the spaces,
but how could you minimize your time in spaces that do not affirm you?
So okay, everybody has to present at 8 a.m. conference every Monday morning.
But 8 a.m. conference is where there's this tiger of a surgeon who gets mad and starts
yelling at people and telling them that work sucks.
Okay, how many times do you have to present?
What is the bare minimum number of times you need to present in that space?
Mark it, you prepare for it, you coach, you sit with a coach and navigate every time you're
going to that space.
What strategies you're going to use to be calm, cool.
You're going to have a plan for when this person starts to ask the kinds of questions
that get under your skin.
You're going to have a plan.
And then you're going to not show up to that space very much.
And sometimes there's this sense that like, oh no, if I keep showing up, then I'll be
able to get conditioned to the space.
It's like, no, no, there is not enough time.
There is not enough time to try to grow thick skin while someone is trying to hammer and
batter you down.
You got a lot of work to do.
And the work you need to do to move your scholarship program forward is not worth investing, it's
not worth investing that energy in trying to help people love you more and trying to
help people be convinced that you're worthy or that you know what you're doing or that
you are intelligent.
It's not necessary.
People who don't believe you can, don't believe you can because they have evidence.
They don't believe you can because for whatever reason they have a bias.
Because if people are giving you feedback, at the end of feedback, there is a win on
all sides.
If you are left with feedback that leaves you feeling worthless, then I would suggest
that that probably doesn't count as feedback.
And so maybe, maybe you stop asking for feedback from the person who's always tearing you down
in the name of feedback.
I don't know what the answer is for you.
I just know that there are some spaces where you are not affirmed for who you are.
And I'm saying just minimize the number of times you show up in those spaces and maximize
the times that you show up in communities where you are nourished, where you are affirmed,
and where people celebrate you.
Okay, at 20% in the spaces where you show up.
Or maybe there are meetings that you show up to.
And at the end of the meeting, you look at yourself, you look at the time and you're
like, what did we talk about again?
Hmm.
And you're not sure.
You can't really clarify what was accomplished in the meeting.
And this is not a one time event.
This happens over and over and over again.
I want you to mark that meeting and begin to think of ways to negotiate out of it.
It's not a toxic space, but it's not a productive space.
And you, my friend, when you are moving your research program forward, when you're moving
your program of scholarship forward, you are about efficiency and productivity.
And therefore any space that is neither efficient nor productive is space that shouldn't feature
as much on your calendar.
All right.
That's enough about spaces.
But 20% in the spaces to which you show up.
And the 20% in your presentations and grant submissions.
And I grouped these two together because, actually, they could be grouped separately,
but I'm just trying to get the five.
So bear with me.
Okay.
So 20% in your presentations and grant submissions.
What does that mean?
You're a clinician and your field is so broad.
For example, I'm a hematologist and I can do hemostasis, bleeding disorders.
I can do thrombosis, clotting disorders.
I can do hemoglobinopathies, disorders like sickle cell.
I can also do red cell disorders.
Sickle cell is part of that, but also anemias or hemolytic anemias, all the anemias.
And then there are white cell disorders.
Remember the patient has leukocytosis.
That's not cancer.
There are a lot of areas in which you could call me to give a talk and I could absolutely
pull the talk together.
But here's what happens.
You know, over time, there are maybe 20% of topics that you keep getting called to present
on and there are 80% of topics that you present on maybe once every three years.
And so when they call you to do the once every three year presentation and you have to dust
up your slides, it takes a long time to catch up again on all the things you haven't read
in the last three years because that's not your area of focus.
So what you want to do is you want to make sure there's just a narrow area of focus that
you present in so that every time someone says, hey, come present, you're not starting
a new presentation from scratch.
You're ready to go.
I mean, yeah, no presentation is without the need for, you know, dusting up every once
in a while, but what you don't want to do is to be creating a presentation every time.
So define your field, define it.
And if you're a clinician researcher, you're moving scholarly program forward in one specific
area.
And it can be a broad area, but it's just got to have a theme.
And if you find yourself creating a new presentation every time you're invited to speak, that may
be a sign that maybe it's too broad or maybe your criteria are not narrow enough.
What you want to do is go back to all your presentations.
Pick the ones you love the most, pick the ones that are most interesting to you and
the ones that people continue to invite you back to speak about.
And you want to move those ones forward.
In your grant submissions, the same thing.
You know, you have a big program, you have funding from this person and funding from
that person.
And there are just some of the programs or some of the grant funding agencies that really
give you a big bang for your buck.
And so maybe you submit 12 proposals, only one or two really gave you the big payday.
You want to spend 20%...
The 20% is to spend time on the grants that give you the biggest payoff.
You could apply for many, many, many, many, many, many, many, many, many, many small grants
that you're competitive for, you're able to move forward.
But at the end of the day, you collate them together and it's like, oh, wow, I got $50,000
from this, you know, these 20 applications that I sent out.
And maybe you could have maybe invested more time in one big application that could have
given you a bigger payday and less time involvement over time.
And so those are the kinds of things to think about.
I think I'm not saying don't submit grants or don't submit as many as possible, but think
about what is the threshold of money that will get me out of bed to submit this grant?
I think it's important.
When you start, you know, you do start small because it gives you momentum, it builds your
momentum.
And so I'm not saying don't apply for monies that are considered small, but as you progress,
especially as you begin to have a bigger research program and you have more needs to your research
program, you start asking the question, what more, what more can I get from the same amount
of time, the same amount of effort?
And as you start to build your team, you start to ask the question, how much more of my team
can support me in this really big thing so that I'm not trying to do it all by myself?
I want to just pause there and say, hey, if you are writing grants all by yourself, there's
opportunity to invite people to be part of the process with you.
And if you have people in your program who have expertise, say in biostatistics, so they
have expertise in a certain methodology, they should be helping you write the grant.
Absolutely should be helping you write the grant.
They can't write the whole grant for you because that's why you're the leader.
That's why you're the person with foresight and oversight of the team.
But they really can help you so that you're really coming to the grant or coming to the
proposal as a master, as a master, what's the word, the master, the lead researcher,
you know, the lead, the PI.
The word I'm looking for is PI.
You are the PI.
You're the one who thinks about the direction of the research program.
And so to the extent to which your community, the community that you lead, the community
that depends on you to find funding, to the extent to which they can help you, you want
to take them up on that offer so that they can help you think critically about components
of the grant or at least give you first drafts for you to really, really shape.
So you want to think about that as you're doing presentations and doing grant submissions
as well.
OK.
Number five is the 20% in your productive time.
Now I alluded to this earlier when I talked about being a morning person.
I'm the person who rises early, early, early.
I'm the person who's writing before people wake up because it's just my best time of
day.
When I look at my productivity, I see that in the morning I get the most done.
I have the most ideas.
It's so beautiful, so awesome.
And I get to go right in the afternoon because I'm able to do all things.
But I don't get as much out of it when I write in the afternoon.
And so for that reason, it's really important that you recognize what is your peak productivity
time.
And you want to give that time, you know, you want to make sure that you put in that
peak productivity time the most important things.
And there are some things that, you know, are not as important.
For example, checking email.
Yeah, you do need to communicate with people.
You don't need to spend all day on it.
And if you spend the best, most productive time checking your email in which, you know,
that inbox is a hot bed of stuff, right?
There are things in there that you have to respond to.
There are emails in there that make you so mad.
Take away your energy, waste your time.
And then you come away from that and you're like, wow, I don't even have the energy to
write I'm so mad.
Exactly.
So what you want to do is you want to reserve those activities for later in the day.
When you're like, you know what, okay, that's fine.
Okay.
And you know, you're just more tired and you can read the email and respond, or you can
just let things go.
But you don't want to use your peak productive time to do the things that you could do at
any time of the day.
For example, putting your desk together.
I hope you have somebody else help you put your desk together.
But let's say you have to do it.
Don't do it in the time when you should be writing.
Don't do it in the time that's most important.
Okay, so that's the 20%.
I want to share one more thing with you.
This is the way I think about the 20% in my research program.
I think about my 20% in one making offers, and that's really submitting grants.
I make as many offers as I can, because the more proposals I submit, the more opportunities
I have to have funding to move my research program forward.
So I do prioritize submitting proposals.
The second thing I prioritize is really maintaining my own platform.
Nobody knows what you're doing until you publish it.
You may look busy.
You may be like, oh my goodness, it was so tough in the lab yesterday, or oh my gosh,
this program of research is so crazy.
But until it is out there in the public domain, people don't know what they're doing.
That's why people talk about manuscripts as the currency of academic medicine.
And so what you want to do is prioritize getting those manuscripts out.
We're doing all these projects, but the manuscripts are piled up.
It's like, I'll get to it, I'll get to it.
Don't be the bottleneck.
I have been the bottleneck for my research program.
Until recently, I started finding first authors who would finish my manuscripts for me.
And they get a manuscript, a first author manuscript publication, and I get my work
finished.
And so it's really important that I prioritize that, getting the manuscripts out, because
they are the evidence for the work that I'm doing.
So those are two things.
The third thing I also prioritize is getting on other people's platforms, meaning going
and presenting my work.
And the more work you have out there, the more people invite you.
But some of it also is the more they see your work, the more they think of you.
And so sometimes what you want to do is to reach out to someone and say, hey, I'm growing
my expertise in XYZ.
May I come and give grand rounds at your institution?
Yes, invite yourself if they don't invite you.
There are some of us, especially those of us who are underrepresented in the academy,
and people just don't think about us because we're not part of the large networks where
people maybe meet each other all the time.
And so you just have to think strategically about doing things differently.
If you're not invited, look around at institutions, find people you know and say, hey, I would
really love to come give a talk about XYZ.
And here's how I think it will provide value to your faculty.
Would you care to have me?
People are always looking for grand round speakers to fill the schedule.
Of course they would love to have you.
They've never thought of you because they didn't know.
And that was your area of expertise.
And I know that every time you submit manuscript, you're like, by now people should know me.
And they don't.
And it's OK.
It'll take time for them to know you.
And until then, you're going to ask them if you can come and present.
And so one of the things I want to invite you to do as we are closing this episode out
is to make a list of 10 institutions at which you want to give a talk this year, 10 institutions.
And don't tell me, oh, I'm not really an expert yet.
You're a physician.
You can read.
You can write.
You are an expert as long as you start doing the work and giving the presentations.
And of course, you're leading a program of studies.
So of course you're the expert.
OK.
So you're going to write a list.
I'm asking you to write a list of 10 institutions at which you want to give a talk this year.
Then I invite you to name 10 people who are at the institute, or not 10 people, but just
for each institution, one person per institution.
And you're going to end up with a list of 10 names of people that you know, either directly
or peripherally.
So remember, six degrees of separation.
There's always someone who knows someone who knows someone.
And then I want you to reach out to just one person this week and say, hey, I'm building
my reputation in this area.
Here is a paper I've published in the field.
Or if you haven't published anything, that's OK, too.
Say, may I come and give a Grand Rounds talk on XYZ?
And I think it's a great thing.
And you can do that and see what happens.
And you know what?
Come tell me about it.
Come tell me about it on Instagram, on LinkedIn, and on Facebook as well.
Or you can just come to our podcast website, clinicianresearcherpodcast.com, and leave
a voicemail for me.
Would love to share your voicemail with the audience.
All right.
That's all.
It's been a pleasure talking with you today.
I look forward to talking with you again the next week.
Thanks for listening to this episode of the Clinician Researcher Podcast, where academic
clinicians learn the skills to build their own research program, whether or not they
have a mentor.
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