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Welcome to the Clinician Researcher podcast, where academic clinicians learn the skills

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to build their own research program, whether or not they have a mentor.

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As clinicians, we spend a decade or more as trainees learning to take care of patients.

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When we finally start our careers, we want to build research programs, but then we find

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that our years of clinical training did not adequately prepare us to lead our research

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program.

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Through no fault of our own, we struggle to find mentors, and when we can't, we quit.

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However, clinicians hold the keys to the greatest research breakthroughs.

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For this reason, the Clinician Researcher podcast exists to give academic clinicians

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the tools to build their own research program, whether or not they have a mentor.

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Now introducing your host, Toyosi Onwuemene.

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Welcome to the Clinician Researcher podcast.

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I'm your host Toyosi Onwuemene, and what an absolute pleasure it is to be talking with

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you today.

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Thank you so much for tuning in.

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I am talking today about how to receive feedback, especially when it feels like it's poison.

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Okay, that's an exceptionally long title.

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By the time I go to edit, I will decide on a better title.

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But right now what I'm talking about is feedback that makes you feel so awful, you feel like

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you could just explode.

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And I want to share this because I do know that in academic medicine there's a lot of

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rejection, whether it is that you're submitting manuscripts to be accepted for publication,

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or you're submitting grants, or you're making proposals.

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You've been met with probably more nos than you've been met with yeses.

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And so to some extent, academic medicine is a process of getting used to getting no without

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wilting under the pressure, right?

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There's so much rejection.

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And many times for any of us going through rejection, there's the feeling of isolation,

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and sometimes the feeling of shame and discouragement.

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And I just want to share that it is actually natural to experience rejection, and it is

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part of your journey.

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And very soon, actually, I will say there's no time you're ever celebrating a rejection

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for the most part, but over time, it ceases to have as much of a sting as it did the first

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time.

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That being said, I'd like to share a story that actually still feels a little bit stingy

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to me.

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I submitted a manuscript for acceptance.

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And actually, this was my first opinion piece, and I really was excited about writing it.

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I had so much fun writing it.

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I submitted this manuscript, and I was so excited to hear the feedback.

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Well, when the feedback came, it was horrendous.

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And when I'm saying horrendous, you know, if somebody tells you that, wow, your paper

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is puke?

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Yes, that's how it felt.

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Now, I'm not saying that's what the reviewer said.

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They certainly didn't say that.

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But when I read the feedback, that was the sense that I got that this paper was so bad,

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it should never have been written, right?

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And I will tell you that when I first read the feedback, I thought, what is this?

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I tell you, I read a lot of rejections.

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And I'm sure that I've never had a rejection where I'm like, thank you so much.

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This was so awesome.

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But this was one especially bad rejection where it almost felt as if the reviewer was

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going out of their way to rub my face in how bad my piece was.

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And I remember reading at the end of it and saying, okay, what do I take out of this?

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And I was struggling.

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I was struggling.

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Because really, what good feedback should do is move you forward.

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And every time you enter into a situation where feedback actually doesn't have a clear

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path forward, it's a sign that it's not really feedback.

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It's poison disguised as feedback.

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Why is that poison disguised as feedback?

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Because you know what?

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In life, there are so many of us that are so super successful.

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We have so many letters to our name, and we've got so much funding, and we've published trillions

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of articles and we're still hurting inside.

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And we're still just inadequate inside.

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Or we feel bad, or we don't feel like we like ourselves or the world.

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And so just because externally there are markers of success does not mean that people don't

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walk around with poison inside them.

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And here's the thing about poison when it lives inside people.

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And when I'm talking about poison, I'm talking about bitterness and anger and just all the

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ugly stuff that lives inside people, unforgiveness, it comes out and it hurts other people.

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You know how people talk about how a hurting person hurts others?

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Yes, that's exactly right.

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Because hey, if you're reading a manuscript, your job is to say, this is how it could be

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made better.

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And even if you think it sucks so bad, you can always find ways to say, this is how it

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could be made better.

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But in a way, insulting someone who's written something is not even a sign of being a bad

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reviewer.

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It's a sign that there's something wrong inside you that maybe you need to address.

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Anyway, that being said, this is not the story of this reviewer.

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It's a story of me.

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It's a story of how I received that feedback and what I do with it.

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What do I do with feedback, especially when it just doesn't feel like it's right?

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What do I do?

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Number one is to acknowledge that you have been wounded.

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Yes, acknowledge that you've been wounded.

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Now, no matter the feedback, if it's a rejection, it doesn't feel good.

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For some of us, we've had enough rejections where we're not as bothered.

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Sometimes actually you submit something, you're like, if this gets in, it'll be a miracle.

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And then when it comes back, reject it, you're like, yeah, I knew it was a long shot.

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But even when you knew it was a long shot, you knew it was going to be rejected and it

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still comes back rejected.

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You knew it was a long shot and it still comes back rejected.

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You still feel a little bit wounded.

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You do.

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You feel hurt because you wanted them to accept it.

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Even if secretly, even if you openly thought they wouldn't accept it, secretly you did.

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And you would have felt validated by the acceptance, but instead you got a rejection.

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And so I think the first step is just to acknowledge your wounding and say, you know what, that

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sucks.

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It hurts.

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It hurts because it does.

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And it's only human to feel bad at rejection.

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Like whoever wants to be rejected, nobody.

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And so if you're rejected, instead of just grinning and bearing it, acknowledge it.

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If you're someone who gets frustrated and nothing, the tears just come, let them fall.

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Give yourself time to mourn the loss of this particular experience.

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Give yourself time to get over the rejection.

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In reality, it hurts and it's okay to acknowledge the pain and to just mourn that pain or at

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least experience that pain for even a moment.

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But definitely allow yourself to experience the pain and acknowledge that the pain is

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present.

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Hey, this is disappointing.

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Say it to yourself.

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Hey, hey, this is disappointing.

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Okay, great.

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That's the first step.

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Acknowledge that you've been wounded in some way.

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Acknowledge that you've been hurt.

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The second thing we need to do is you need to pause.

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Now what am I saying?

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Am I saying pause and just live in that rejection for three months and say, oh my gosh, woe

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is me.

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I'll never submit another manuscript again.

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I'll never write another grant.

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In fact, I quit medicine.

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No, that's not what I'm talking about.

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Pausing is giving yourself distance between the first time you review the feedback and

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when you have a plan for what to do with the feedback.

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Okay.

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Pausing is to give yourself time to come up with a plan of action.

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Every rejected manuscript is an accepted manuscript waiting to happen.

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It's literally the acceptance is sitting there waiting for you, but only if you move forward.

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But you can't move forward until you have a plan.

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And to be honest, you don't move forward well when you're wounded and still reveling in

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your sorrow.

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Now, I don't want you to revel in sorrow for too long, but you do need to have a gap between

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the first reading and the final decision for a plan.

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And here's the thing.

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As soon as you've read it, your mind has processed it.

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And already you're working through a thinking of like, what do I do now?

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Hopefully you're not thinking, well, I quit.

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That's what.

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Hopefully you're thinking, okay, let me set it aside and then come up with a plan later.

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And the reason it's important to give yourself a gap between the first reading of it and

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when you finally want to come back to it is because your subconscious mind continues to

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work on the problem.

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Your subconscious mind accepts the fact that you've been rejected.

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And then it feels differently the next time you come to the piece of rejection or the

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feedback that you got.

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And so the third thing is to read it, go back and review it.

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Okay.

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So the first thing is that you've acknowledged that this hurt.

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The second thing is you've given yourself space between the first time you read it and

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later.

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And the third time is you come back to it.

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So here you are.

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The third point is that you come back to it.

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So here you are.

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You're finally reading it again.

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And what you'll notice if you've given yourself enough time between the first reading and

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now is that you come at it with a different perspective.

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At first, it actually was kind of like you, the shock of being rejected was so overwhelming

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that you didn't even really have time to think about what were all the benefits or what are

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all the merits of what was brought up in, in whatever the case was against accepting

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your manuscript or accepting your proposal.

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Right.

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And then when you come at it a second time, you come at it with a different perspective.

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There's less of the hurt, less of the sting and more of an objectivity, more of a, okay,

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let's see what feedback is useful here that I can use to move this work forward.

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And you know what, for better or for worse, there will always be feedback that you could

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use to move this work forward.

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Now in the particular rejection story I tell you, it did feel pretty scathing.

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It didn't really feel like there was real feedback there.

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You know, when you read something and you're like, you just really hate this paper, don't

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you?

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You hate it so much, you see no good in it.

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And that's fine.

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People are people.

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Sometimes that's the way it is.

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People are just like, this sucks so bad.

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And it, that's how they feel about it.

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And you can't argue how they feel about it.

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Now nothing sucks so bad that it cannot be salvaged, but I'm listening and I'm hearing

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people say, oh yeah, there are things that suck so bad, it cannot be salvaged.

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But one man's meat is another man's poison, which you think sucks so bad and cannot be

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salvaged.

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Nobody else can see the kernel of goodness that can be expanded to grow.

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Okay.

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I say all that to say that no matter how tremendous the feedback was, no matter how much the person

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actually didn't give you feedback, but went off on a diatribe about how you suck and everybody

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from your institution should stop writing manuscripts.

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Somewhere there, there is information.

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Okay.

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That's number four.

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Number four is gather the information.

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Okay.

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What do I mean?

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Number one, the feedback, if it was good feedback should really outline steps for improvement.

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Here is how this manuscript could be improved.

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And if you're a good reviewer and I hope you are, I'm not saying good or bad because that's

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never really useful, but if you're going to be a helpful reviewer, when you review, you

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need to point out places where improvements could be made.

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For example, you could say, hmm, the generic use of language reads like the use of a large

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language model like chat GPT.

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I would recommend that if such a model was used, it not be used for the revisions.

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Do you see?

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Very helpful.

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It's like, instead of saying, holy cow, did you use chat GPT?

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This is awful.

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You're saying, hmm, it reads like you may have used chat GPT to write this paper.

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Maybe you don't use it next time.

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Useful feedback.

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If you're a reviewer, please, please, please, instead of yelling or going off in a diatribe,

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showing what's really inside you, give feedback that's useful.

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Okay.

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So useful feedback helps you move forward.

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You can gather that information.

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That's pretty easy.

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The feedback that says step one, change the way you use these terms or the feedback that

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says step two, do this, do that.

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That's helpful.

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You can easily gather information.

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What about the feedback that is the diatribe?

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The feedback that is the, this sucks so bad, I can't believe you're still writing or that

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you're still alive, right?

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There is that feedback.

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Let's just be real.

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There is that feedback.

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What do you do with that?

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Take the information.

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And you're like, what information?

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The information that that's not where you want to go with your paper.

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You're like, what do you mean?

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There's the New England Journal of Medicine.

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I've always wanted to publish here.

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I am so glad that that's your childhood dream, but it's not the dream from this paper, clearly

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because this paper is not going to be looked at favorably by this particular community.

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And I know in academia, there's a lot of what's a high impact journal, what's the low impact

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journal and where should you try to get your work into and what should you not try to get

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your work into.

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That's a whole conversation for a different podcast.

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But at the bottom of your writing for peer review is that you do excellent work.

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You want feedback so that your excellent work can be presented in the best possible light

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and go out into the world and do good.

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That's at the bottom of all of it.

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For every manuscript, there is a home.

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Some homes look a little bit more appealing than others, but there is a home for every

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manuscript.

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And sometimes the information you take is that, wow, this manuscript could not scale

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the security of or could not get past the security of this particular journal.

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And you decide, do I take it to a journal with a less stringent security team or do

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I say, what will it take to scale the wall of this particular impregnable fortress of

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a journal?

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And it may be that that's what you want to do, but take the information and use it.

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If it's a scathing review, it may be that you say, well, I guess this journal is not

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for me.

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Or you might be like, okay, well, let's go knock on the door again and say, can you help

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me know how I can make this better?

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And sometimes you do that and you succeed.

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For example, I had a manuscript that I once submitted and it was a really interesting

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article idea to me, but I was also writing in an era that was outside of my expertise.

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And I think I recognized that and I thought, oh, I can write in this area.

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So I was writing kind of in hematology, but I was also writing in a genre that, oh gosh,

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what was it?

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It may have been medical decision-making, which it's hematology and I make medical decisions

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all the time, but people are very specific about their specific kind of expertise, a

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specific kind of language they used.

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Anyway, I got rejected.

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But what was interesting is that the journal said, you know what?

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We can't accept this manuscript in its current format.

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If you significantly revised it, maybe we could reconsider it.

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So they kind of opened a little bit of door and I was like, okay, well, let's go at it

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again.

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And we revised it, revised it, revised it.

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We sent it back.

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And they sent it back again.

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And I was like, you know what?

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Wow, this is a great case, but oh my gosh, your attempts are just, they're just, they're

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awful.

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Like, I mean, they didn't say it in that way.

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They were actually very, very helpful in just saying, this is how, if you were going to

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revise the paper, you would need to do this, but holy cow, that's a great undertaking.

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I'm not sure you're going to be able to do this.

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And so what we finally did was we went and we found somebody who had very specific expertise

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in this kind of writing.

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I know I'm calling it medical decision-making.

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I'm now blanking on what it actually was, but it's, anyway, the point I'm making is

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I got someone who was an expert in writing these kinds of papers and that I asked the

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editor.

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I said, Hey, we really think this is a great case and we think that people are going to

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learn from it, but we are not well versed in writing in this way.

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Who do you know who might work with us?

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I asked the editor that.

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And to be honest, the first time I sent a letter to the editor, I got no response.

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And then I went and looked at other people who had been associate editors or other people

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who had in some way, shape or form been associated with a journal.

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You could say I was stalking the journal.

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Maybe I was because I was like, no, this journal, this article is getting in here.

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And finally, finally they turn around and say, okay, I have nothing to do with this,

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but you should reach out to this person who frequently writes these kinds of articles.

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Great.

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And then they made the introduction.

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It was so awesome because now we had an expert in our field, in our, in our, in our court,

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right?

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In 2019.

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And that expert really helped us.

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It really, he really helped us shape the article.

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And when we finally submitted, we got another revision, but this time it was that this is

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a great article.

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Here's how you make it better.

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And so sometimes the information you receive is that, oh, wow, it sucks so bad.

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Well, how can I make it not suck so bad?

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And you go after that information and you don't stop until you get it.

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Or sometimes you say, you know what?

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I don't have time to be chasing or trying to knock down this wall.

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How about I just take it somewhere else that doesn't have a security system that's so,

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so intense, right?

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Information.

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You can use the information to your advantage.

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What you don't want to do is to be overwhelmed, but you do want to use the information to

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your advantage.

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And even when it's a scathing review, it is helpful information.

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And you have to ask yourself, what do you want to do about it?

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And that is the next thing.

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I think it's number five now.

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I'm not counting now, but not the number five is, is what is your plan?

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Like formulate a plan.

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Now, to be honest, formulate a plan should have been at the very beginning when you first

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submitted your manuscript.

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You should have had a list of three journals that you were going to submit to tier one,

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tier two, tier three.

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And as soon as you knew that tier one was rejecting your work, you would be like, oops,

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sucks for you tier one.

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You'll go to tier two.

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And then tier two is like, yeah, we hate this work too.

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You're like, sucks for you tier two.

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And then you go to tier three, right?

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That's kind of the pre-planning you do at the beginning of any, every manuscript.

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We don't always do that.

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And to be honest, in this particular manuscript I'm referencing, did not do that.

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So now I'm like, oh, I don't know where else I want to send it.

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I haven't really done this work.

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Well, whatever, no matter when you decide to have a plan, just have a plan and it's

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okay.

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And what is your plan?

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Your plan is, well, what am I going to do with this paper?

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Where do I want to send it to?

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How do I want to revise it?

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So it's meets that other audience's criteria.

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What do I want to do with this paper?

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Have a plan.

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And then of course, the last thing is execute on that plan.

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Execute on that plan.

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You know, and it seems a little bit obvious, but in reality, many of us stop at like number

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one, where we're just so wounded.

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We're like, you know what?

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00:19:01,440 --> 00:19:02,440
Academia sucks.

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00:19:02,440 --> 00:19:03,440
I am no good at it.

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I'm really horrible at writing.

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00:19:04,880 --> 00:19:06,160
I don't know how to write grants.

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00:19:06,160 --> 00:19:08,720
I just am not going to do this anymore.

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And I just want to say, please don't let that be you.

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Don't be the person who allows obstacles to throw them off course.

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Now here's the thing about obstacles.

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Obstacles are actually kind of clarifying because when an obstacle comes in front of

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you, you have to decide to do something about it, right?

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You're on your way.

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You're in motion.

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All of a sudden this big boulder drops out of the sky, narrowly misses you, lands in

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front of you, blocks the path.

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Okay.

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You have to do something about it.

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The question is, are you going to find a way through the boulder?

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Like are you going to try to blast it out of your way?

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Are you going to try to find a way over the boulder?

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Are you going to see if you can dig a tunnel and go under the boulder or are you going

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to walk away from the boulder?

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Are you going to say, you know what, this boulder?

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I know, but it's clarifying, but don't let an obstacle stop you because the question

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is should you be on this path?

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And it's really a question you ask before the obstacle comes because obstacles don't

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define you.

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They don't define where you're going.

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They don't define who you are.

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They clarify for you.

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Is this the path you actually want to be on?

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And if it is the path, then don't let the obstacle stop you.

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Let the obstacle be your jumping off point.

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So it's like, okay, well, here you are, big bad boulder in the middle of my path.

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How about I build a bridge or a ramp and ride a really fast motorcycle and use you to catapult

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to the next level?

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Absolutely could do that.

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But that's only if you have clarity that the path you're on is the path you want to be.

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Don't let obstacles make decisions for you.

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00:20:51,800 --> 00:20:55,480
Don't let negative feedback make decisions for you.

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00:20:55,480 --> 00:20:57,320
Make decisions for yourself.

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00:20:57,320 --> 00:21:03,000
Make decisions regarding your purpose and why you want to do what you're doing.

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00:21:03,000 --> 00:21:09,200
And if this is the field for you, one horrible feedback from one or two reviewers should

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00:21:09,200 --> 00:21:12,480
not make you change off that path.

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00:21:12,480 --> 00:21:15,640
So in summary, please don't quit.

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00:21:15,640 --> 00:21:18,160
Don't quit because you got a horrible review.

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00:21:18,160 --> 00:21:22,680
You know, unfortunately, there are many more where those came from and it's okay.

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00:21:22,680 --> 00:21:26,840
The important thing is, are you doing work that matters to you?

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00:21:26,840 --> 00:21:28,800
Are you doing work that resonates with you?

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Are you doing work that makes you proud of the work you do?

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And if the answer is no, then why are you doing this work?

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If you're like, well, I'm just looking because, you know, at my institution, they say we're

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supposed to submit manuscripts and I just want to, I just want to check the boxes.

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00:21:44,960 --> 00:21:47,280
I want to say, please stop checking boxes.

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00:21:47,280 --> 00:21:51,320
Life is just not, it's about so much more than just checking boxes.

415
00:21:51,320 --> 00:21:56,500
And I know you succeeded getting through med school and residency and fellowship by checking

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boxes.

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00:21:57,500 --> 00:22:00,560
I know because I checked those boxes too.

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But there comes a point in life when we decide that checking boxes is not the way to live.

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And I'm thinking that's now.

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This is the moment.

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00:22:09,400 --> 00:22:12,080
Like if you're listening to me, it's now.

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00:22:12,080 --> 00:22:17,600
Because checking boxes, when there's a big obstacle that comes or a really huge rejection

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00:22:17,600 --> 00:22:23,440
or a huge disappointment, then you find out that checking boxes doesn't satisfy and it's

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not enough to move you forward.

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00:22:25,880 --> 00:22:30,440
So I want to encourage you that if for whatever reason you are a box checking person and there's

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00:22:30,440 --> 00:22:32,760
no shame, I love box checking.

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00:22:32,760 --> 00:22:36,640
I still think a good box checking gets me through my day.

428
00:22:36,640 --> 00:22:40,440
But I want you to think about how do you do your career differently?

429
00:22:40,440 --> 00:22:42,020
How do you do it differently?

430
00:22:42,020 --> 00:22:44,760
How do you stop doing what everybody else says you should do?

431
00:22:44,760 --> 00:22:50,280
How do you stop living like everybody else says you should live and begin to really live

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00:22:50,280 --> 00:22:55,840
for your purpose, for something that resonates with the deepest core of who you are and that

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00:22:55,840 --> 00:22:58,600
moves you to where you're supposed to be?

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00:22:58,600 --> 00:23:02,120
If you don't know that, I invite you to come work with me as your coach.

435
00:23:02,120 --> 00:23:07,600
So you'll see on Wemina, I am available on Instagram, most especially LinkedIn, also

436
00:23:07,600 --> 00:23:08,600
on Facebook.

437
00:23:08,600 --> 00:23:13,820
Reach out to me and let's set up a 30 minute conversation just to talk about what you need

438
00:23:13,820 --> 00:23:16,200
and how you're going to move forward in your academic career.

439
00:23:16,200 --> 00:23:23,760
But if you're miserable in any way, if you are overwhelmed or tired or burned out, I

440
00:23:23,760 --> 00:23:26,520
want to say it doesn't have to be that way.

441
00:23:26,520 --> 00:23:27,920
Don't accept it.

442
00:23:27,920 --> 00:23:30,960
Okay, so I'm going to summarize.

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00:23:30,960 --> 00:23:34,600
First of all, you got it when you get bad feedback, something that's so horrible.

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00:23:34,600 --> 00:23:37,120
Number one, you just got to acknowledge the hurt.

445
00:23:37,120 --> 00:23:39,480
You've got to acknowledge that you've been wounded.

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00:23:39,480 --> 00:23:41,120
Number two, you've got to separate yourself.

447
00:23:41,120 --> 00:23:44,520
Just give yourself a gap between your first reading and your next reading.

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00:23:44,520 --> 00:23:47,860
Number three, you do have to come back to it and give it another look and you'll find

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00:23:47,860 --> 00:23:50,440
that you're seeing it with a new perspective.

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00:23:50,440 --> 00:23:56,120
Number four, you want to draw out the information of this particular piece of feedback, no matter

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00:23:56,120 --> 00:23:57,560
how bad it's giving you.

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00:23:57,560 --> 00:24:00,000
Number five, you want to come up with a plan.

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00:24:00,000 --> 00:24:02,960
Number six, you actually want to act on that plan.

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00:24:02,960 --> 00:24:07,920
Number seven, you want to make sure that you know what to do with this obstacle and that

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00:24:07,920 --> 00:24:13,360
it doesn't derail you or keep you from having the career that you were meant to have.

456
00:24:13,360 --> 00:24:15,880
All right, it's been a pleasure talking with you today.

457
00:24:15,880 --> 00:24:17,400
Thank you so much for paying attention.

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00:24:17,400 --> 00:24:21,200
Please, please, please, please share this episode with somebody else who's just been

459
00:24:21,200 --> 00:24:24,040
rejected and needs this encouragement.

460
00:24:24,040 --> 00:24:25,040
Thanks for listening.

461
00:24:25,040 --> 00:24:35,720
I look forward to seeing you again next time on the Clinician Researcher Podcast.

462
00:24:35,720 --> 00:24:41,080
Thanks for listening to this episode of the Clinician Researcher Podcast, where academic

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00:24:41,080 --> 00:24:46,560
clinicians learn the skills to build their own research program, whether or not they

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00:24:46,560 --> 00:24:47,840
are a mentor.

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00:24:47,840 --> 00:24:53,800
If you found the information in this episode to be helpful, don't keep it all to yourself.

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00:24:53,800 --> 00:24:55,680
Someone else needs to hear it.

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00:24:55,680 --> 00:24:59,720
So take a minute right now and share it.

468
00:24:59,720 --> 00:25:05,200
As you share this episode, you become part of our mission to help launch a new generation

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00:25:05,200 --> 00:25:18,080
of clinician researchers who make transformative discoveries that change the way we do healthcare.