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 I'm so excited to be on the show today because I
have with me a wonderful academic physician, scientist, administrator.
Oh my goodness, she wears so many hats.
Actually, I should add to that changing the world one student at a time.
She's doing so much, Dr. Leonor Corsino.
Leonor, welcome to the show.
Well, thank you so much for having me.
I am so excited to be joining you today for this conversation.
I'm looking forward to talk to you about our journeys.
Yes, the pleasure is absolutely mine.
Leonor, would you introduce yourself to our audience, especially with regard to your path
as a clinician researcher?
Yes.
So I'm Leonor Corsino.
I'm an associate professor with tenure in the Department of Medicine at Duke University.
I'm also an associate professor in the Department of Population Health Science.
As you mentioned earlier, I hold other roles in our school.
I'm the co-director for the CTSI Community Engagement Court, and I also work as an associate
dean for students' affairs.
I also have a small role as the associate director for a master's degree in our school,
which is the master of biomedical sciences.
And I still do a little bit of research too on this side.
Wow.
So Leonor, you do a lot.
Now you didn't start out doing this much.
So tell us a little bit about your journey, because I think when you started, you were
a lot more research intensive.
So how did you kind of come in this direction to where you're still doing research on top
of all these other things that you're still doing?
Yes.
So I actually started my journey at Duke in 2006.
So I joined Duke as an endocrinology fellow with the notion that I wanted to pursue a
career as a physician scientist.
So I was in a T32 grant for my last two years of fellowship.
So I did a three-year endocrine fellowship and simultaneously completed my master of
health science in clinical research.
So my goal was to be a clinician scientist doing mostly research.
And that's what I did from 2009 to 2015 as a junior faculty, I had 75 to 80% of my time
covered by research grants.
And then it was not until 2015 that I got invited to actually join some of these educational
leadership roles.
And that's how I transitioned a little bit from a pure physician scientist to more roles
as a leader and educator.
My research interests are still the same.
My interest is diabetes and diabetes-related comorbidities with a special emphasis in health
disparities and the Hispanic and Latino population.
But also along those lines, I've been trying to do some work in bias, implicit bias in
patient provider communication and patient's outcomes.
Well, that is so awesome.
One of the things you speak to that I do want you to come back to is that you started off
pretty research intensive.
Now many times, I think for junior faculty that are coming in right now, many times they'll
say, well, I just want to be 50-50.
So that's how I want to start out.
Could you speak to the advantages of starting out a lot more intensively research?
Or could you speak to the benefits or the disadvantages of trying to start out kind
of in a 50-50 or more clinical research split type role?
Well, this is my personal opinion.
But I think if you are really committed to be a physician scientist, less than 75% of
research might not get you where you need to be.
We all know that 50-50 is probably like 80 patient care than 20% research because always
your patients will come first.
And the reality is that you really at the beginning of your career, if you're really
serious about it to get your papers, your grants, you really need that protected time.
And I don't think 50% is enough.
But that's my personal opinion.
I have to say I was blessed that I was able to secure that from the beginning to be able
to achieve a lot of this.
I know that it's not possible for a lot of junior faculty to actually secure that amount
of funding for research.
And they have to start with whatever they can until they get to that level of getting
their first K or their first R. But I have seen a lot of my colleagues and friends struggle
with that 50-50 exactly because patient care will take over.
And at the end, your research or your paper gets derailed from timelines because everything
else takes over.
Leonor, thank you so much for that perspective.
And that's something that I think is important for people to know.
I think, and maybe you could speak to this, it's not about giving up patient care.
It's not about saying, well, I'm not seeing patients anymore.
It's recognizing that you don't have the skill set and what it takes to build the skill set.
And so you can always go back to more patient care if that's what you choose.
But it is harder to make the transition the other way around.
If you want to speak to why do you need so much time, what are you doing?
It's just research.
Well, I think once again, I think I mentioned earlier, one thing is you need time to get
those papers out.
And papers, if you're like me, they take long.
They don't, I'm not a natural.
So in order to do it well, you need that time of relaxation where you can put your brain
in a relaxed mode to write your thoughts in paper.
And that's one of the parts.
The other thing is you also need time without distraction to think about your next ideas.
And to be honest, I don't think I ever had enough time to do that because I was always
writing something or in a meeting or doing the research.
And I think you need to be intentional about blocking those two hours a day, three hours
a day, whatever you can to just generate the ideas for your next grant.
That's the way I learned from mentors that are very successful in this path.
That's how they get to that next big R1 or that next big thing that is going to get their
career into the next level.
And sometimes as junior faculty, we don't incorporate that into our day by day.
And that's where we get overwhelmed because sometimes we have ideas that are not fully
developed and we try to write a grant when we're not ready.
Right?
Or the idea is not ready.
Thank you.
Thank you for sharing that perspective.
Because what you were talking about is thinking as work.
And so sometimes if we're not busy doing something, we feel like, well, we're not doing anything.
And to be honest, we live in an environment or even in academia, we were like, well, what
did you do?
What are you doing?
How many patients are you seeing?
What's your RV use?
But in reality, the ability to sit down and really hash out an idea and create something
that you're going to actually continue to recreate over time, that does take time and
it is work.
And if people are questioning how much time you have available, because people will say,
oh, you clearly have Thursday mornings free.
Why don't you see one or two extra patients?
Thinking is intensive and it needs time to be done well.
Yes.
Yeah.
I felt that pressure because I've never had more than 25% patient care.
Not because I don't love patients.
I love seeing my patients, but I realized my style is someone that wants to get my notes
perfect.
I want to know it all.
I want to have it all done.
And I realized it was taking so much time.
It still takes a lot of time, even though I don't see a lot of patients.
I still have a whole day of patient care where I try to do my notes and have everything ready.
And if you add Cali four clinics a week, there goes your week.
So you really need to actually be protective of time to generate ideas.
Absolutely.
And I think, Leonor, one of the things that people don't know when they're early career
and they're just starting is there's not an awareness about how much time it actually
takes.
And it's one of those unconscious where you just don't know what you don't know.
And to be honest, as you said earlier, there's so many faculty who are starting out without
any protected time.
And it really does make it hard.
I wonder if you could speak about strategies to succeed when you don't start out with that
level of protection.
I think it's extremely hard to achieve anything if you don't have protection.
What I share with my advicees or my mentees before you sign a contract, you actually need
to figure out how to get that protected time because it's like signing for failure.
If you don't do your due diligence ahead of time, it will be really hard.
And I think I'm grateful to my mentor because when I was transitioning from being a fellow
to a faculty, it was clear that my mentor actually helped me negotiate the time that
I needed.
And I can attest as someone that was relatively successful as a physician scientist that without
that advice from my mentor, I don't think I would have been able to do much because I
have seen that happen to some of my colleagues that didn't have the same type of mentorship
that actually signed to do 50-50 or 80% clinical, 20% research.
And then their research career goes downhill because they didn't have that time.
So if research is really what you want to do, I question not to sign any contract that
doesn't have any protective time for research.
Thank you, Leronora, and I'm so happy that you said that because sometimes here's the
thing about us as physicians, we've been doing the impossible from the beginning.
From day one, we've been doing impossible things.
And so there's this idea that we're going to be able to do it.
And to be honest, research is just, it is a skills deficit.
I mean, PhD scientists go to school for six, seven years.
They're just doing research for the most part.
They don't have clinical care responsibilities, all of that.
It's a skillset you're building and it takes time to build skills.
But if you don't even have the time to build a skill, where is it going to come from?
And that's why people are miserable, trying to live life on the margins, taking your nights
and your weekends to accomplish something that is really a full-time daytime job.
So thank you.
Thank you so much for sharing that.
Speaking about the things that you love.
So Leronora, one of the things I know about you is that you have not followed what people
say you should do as much as you followed what you want to do.
Now could you speak about that?
Because that's not a very common perspective in academia.
Yes.
So I'm glad you're asking that question because I feel like a lot of people, when they look
at my trajectory, here I do, especially because that's the only institution I know, they wonder
what happened to this person.
Because to be honest, I never follow a straight line.
I never follow the traditional path.
And it's not that I'm a rebel and I want to do things my way.
That's not how I am.
Actually, I like to follow rules.
But I realized early in my career that I really wanted to do things that bring me joy.
And if it was like being an advisor for the Latino Medical Student Association for free,
I was going to do that because that was something that brought joy to my life.
And I felt like I don't want to be miserable doing this type of work.
Or if it's mentoring undergraduate students or high school students, I was going to go
for it even if it was at the price of sacrificing maybe free time to generate my ideas and writing
my papers.
And I encourage people to do the same because when I was doing this, I got a lot of pushback
from people that I consider traditionalists that felt that by just following my heart
and doing things that I really enjoy, I was not going to be able to make it because I
was not building my niche or I was not getting like my K or I was not getting my R. And the
reality is that not that I didn't care, but I felt like why would I want to pursue that
if I'm going to be unhappy and not making a difference the way I see I want to make a
difference because that's also very personal.
How do you want to make a difference?
It's very individualized.
So I just, every project that I do has to be something that brings me joy.
If I don't see that as part of the process, then I won't do it.
It's not going to be on my list of to do things.
And I don't know if I answered your question correctly, but that's how I see my enrolling
academia.
Just having fun while I go and I work a lot, but I do things that bring me joy.
So it's more like joyful working, not stressful working, if that makes sense.
No, it's, it perfectly is understandable.
I mean, I appreciate you saying that because here's the thing you said, you're working
hard.
So you're not saying I do the things I enjoy in life as a walk in the park.
You're still challenged.
It's still hard.
And so what makes sense to me is that if you're going to work really hard and it's still going
to be a challenging path, then why wouldn't you work in the things that you actually want
to do?
Why would you accept misery on top of how hard it is?
Can you speak to some of that?
Because there's a lot of people around us who do that and somehow they're successful.
Yes.
And they are very successful.
I think we are surrounded by a lot of people like that, right?
That you see them and you're like, Oh my God, they're doing all these wonderful things.
But the reality is that you don't see that joyful person or their face does not reflect
really how much passion they have on the work they do.
I think I got that from my parents.
Both of my parents were hard workers, but they always pursue something that brought
them joy.
So I have good role models and I also have mentors too here at Duke that I saw that are
people that are really enjoying what they do.
And you want to surround yourself with people like that because it's a tough role of things
that we have to do.
I'm sorry, I think I derailed from your question, but it.
No, that's perfect.
That's perfect.
It is.
It is because that is what I'm saying.
It's possible.
The reality is the advice that people give, like follow, maybe they say, follow this one
mentor, just do what they do.
Just keep going until you get the K, the R, everything, and then you can do what you like.
It kind of is a trap because the moment you're successful, people expect that's all you do.
And it's possible to have everything, all the accolades, all the awards and be really
miserable.
And at least for me, and it sounds like for you, Leonor, it's not worth it.
And each person needs to decide whether they just want all the glory or they want to have
joy in the journey.
And I think you can have both if you're strategic.
Yeah.
I want to add to that because I think a lot of everybody's different.
I didn't enter this space because I wanted the glory or the awards.
I know I have received that as recognition of my work, but I never pursue that as my
main goal.
And I think that's where some people get derailed sometimes between the joy and the work because
they focus too much on the awards, the Ks, the recognition.
And believe me, when you do things with passion and love, those recognitions will get, you're
going to get them.
People are going to notice that you're doing it.
And maybe it will take longer because you might be working behind the scenes and people
might not realize all the things you're doing, but it will happen.
So for junior faculty specifically, just do what you love and people will see it.
Maybe not today or tomorrow, but it will happen at one point.
The rewards are going to be there.
Thank you, Lenore.
You point out that it is the harder path.
The path of doing what you enjoy, what brings you joy, what you're passionate about is the
harder path because it's not as well worn, but the rewards are great.
And so it's worth sticking with it.
Yeah.
Let me ask you this, Lenore, you're someone who I think has been very strategic.
And for everyone who's listening, I've known Lenore since I was, I think a med student.
I think she was a fellow med student.
And so I've known her for a long time.
You're giving up on eight.
Well, she's very beautiful, very young looking.
You should watch the video.
She's beautiful.
Yes.
Lenore, you've been very strategic, right?
Can you talk about some of the strategic moves you've made in this process?
Yes, I am very strategic.
My students will say that I always use that word when I'm advising my medical students
and I'm very organized.
Some thing that I encourage everybody to do is know what is expected from you.
So I knew that I wanted to do things that brought me joy, but I also knew that I have
to fulfill certain expectations to be able to move up the ladder.
So I started as a medical instructor.
And from the first day I signed my contract as a junior faculty, I already knew what was
expected from me to be able to move to assistant professor.
So I knew I had to get whatever number of papers, whatever grants I had to do.
I put it on a place where I can revisit on a regular basis to make sure I was on track
of achieving those expectations.
The same when I was trying to get tenure.
I knew that my career has shifted to a different direction, but I was very clear that the expectations
for the institution that I worked at were like I had to get my papers, I have to get
my grants, I have to get my national, international reputation.
So I work in parallel while I was doing my joyful work, I was also working on the things
that were expected, which was getting all my papers out and getting certain presentations
and stuff like that.
And I think that's the only way you can actually be successful and not get derailed.
Because it is very easy to just follow your path and do everything you find joyful and
then not pay attention to the things that are going to really count towards your success
and moving up.
And I, of course, people, I actually print out the promotion and tenure documents for
my institution.
I have it in a folder in my office.
And once in a while, I will look it up, I'll make sure am I on track?
What am I missing?
What are the things I need to do?
I also reach out to the individuals at my department that are responsible for promotion
and tenure.
Once in a while, I ask them, can you look at my CV and I'm on track?
What am I missing?
What are the things I need to do?
And that's being very strategic on my part because I know I can get very distracted,
something that I have to share.
I cannot do one the same thing all the time, so I can be very distracted.
But I also know myself that that will be a downside if I don't keep an eye on the long-term
goal, which is getting full professor with tenure.
That is awesome and thank you so much for sharing that, Leonor.
I feel like you just gave a master class.
That was just so perfect because the key is that in the academy, there are things that
are valued and those things don't change going from institution to institution.
People value publications and they value grants.
And for many faculty, as you look through your appointment and promotions and tenure
documents, those are things that feature quite consistently and not just those things.
You talk about international reputation, national reputation, giving talks, that kind of thing.
They're all pretty well detailed.
And so as you're doing the things you love, yes, you want to make sure that you are layering
your interest over what the institution values so that at the end, it double counts.
It counts for your joy and it counts to give you credit that you've been doing work well.
So that was fantastic.
Thank you so much for laying that out.
Well, that requires intentionality.
It doesn't happen.
You have to be strategic.
Yes, yes.
And you talk about involving people too.
So it's not just you saying, I'm meeting the metrics.
It's you asking other people objectively and saying, hey, how does this working?
You gave me that advice and that really helps me because early on I was having meetings
with a person who's in charge just saying, hey, here's my CV.
What do you think?
Here's my statement.
What do you think?
And that really helps me start being intentional about shaping what the statement is going
to look like looking forward rather than trying to look backwards and make it all fit.
Yes.
And that's also an advice I give to junior faculty all the time because we want to have
resistance against assistance.
Right?
We're like, why do I have to do it this way?
Well, you nicely alluded to the fact that academic institutions have rules of what is
expected and I don't see that changing much.
It's not our institution thing.
It's institutions that have the same expectations.
And the earlier you know that and the earlier you have your allies and people that are going
to advise you how to fulfill them in a proactive way, the easier the journey will be.
I think sometimes it's like we want to resist until we get to the point, oh, I want to go
to associate professor and then you look back, you're like, oh, but I don't have all the
papers I'm supposed to have.
Or I didn't do all the talks that I was supposed to do.
And then that's where the frustration comes because you feel like you wasted your time.
But if you do it early, then you know what you're aiming for, what your goal is.
So it's not as hard.
I'm not saying it's going to be easier, but it's less stressful.
Thank you.
I love the way you put it.
It's like we want to be resistant.
We want to resist, you know, the powers that be.
But as long as we're in a system, it is worth knowing all the rules and then you can decide
strategically which ones you follow, which ones you don't, but you got to know them.
And then you've got to be strategic.
You can't just pick and choose.
And then you might get to the point where you're like, well, you can't move forward
in the way you want to.
So I really appreciate you saying that.
Thanks, Leonor.
You're welcome.
So we're kind of getting closer to the end.
And I have two more questions for you.
Hopefully we can get to those.
But one question is that at some point you decided to make that transition away from
research.
Could you tell me about what that transition looked like and how you set yourself up to
be where you are today and still keep some of that research?
Yeah, it was a very serendipitous situation for me.
In 2015, I was actually on a, I don't want to call a gap, but I took three months off
to deal with a lot of personal challenges I was facing.
And during that time, I received an email from a colleague who invited me to join the
Duke Master of Biomedical Science as one of the executive team members and an advisor.
And it was funny because I got the email and it was like, you know, this sounds great,
but right now I'm going to leave and I will be back in January.
Is this an opportunity that can wait until I get back so we can see it and talk about
and see if this is really in alignment with what I want to do as I move forward?
So that person was kind enough to say, you know what, there's no rush.
Whenever you're ready, when you get back here in January, we'll meet in person, we'll talk
about it and see.
And then that's how it happened.
We met, I interviewed with the rest of the members of the executive team and it was a
match.
We actually, I think I found my tribe of people that I actually love to work with that are
extremely supportive, very interprofessional and collaborative environment.
And I was like, yeah, I'll take the job.
That's great.
And that's how I actually started taking some of the leadership educational roles.
And I've been in this role for 10 years and it's been the best thing.
I learned from the best in our school in education, I have to say.
And that's where I realized, you know what, this brings me more joy than submitting my
next K or getting rejected for my next paper.
And I started that transition.
So as part of that role, in addition to being a member of the executive team, I also advise
students that are doing the post-bacc or the master's degree to get to medical school.
And I realized that that worked very well with my personality, like helping others achieve
their goals and helping people identify resource and all of that.
And then when the opportunity was open to submit applications to be an associate for
students affairs, to be honest, I felt like I was not ready.
That was four years ago.
And I got so many emails from older people here saying, Leonor, you need to apply, Miss
Royce for you.
And I was like, oh, I don't know.
Sometimes we are like that as junior faculty, we are like, oh, I don't deserve it or I'm
not ready.
But because I got at least 10 emails from senior individuals saying like, go for it.
Well, I submitted my application.
I went to all the eight panels of the interviews, which was the most intense interview process
I've done in my life.
And then when I got the call from our vice dean of education saying, well, Leonor, everybody
seems to like you.
I want to offer you the job.
I accepted the job without asking, which is, remember my first advice to all of you, you
not sign anything without knowing what you're getting into.
But I say yes.
And I don't regret it.
It was the best decision I made.
And then my other leadership role being the CTSI came from works that I was doing with
one of our colleagues here.
I was the director for one of her projects, a population health mapping project.
And then that project went very well.
It was for her and the chancellor.
And then when the opportunity came for the CTSI, she was like, oh, Leonor, do you want
to join the CTSI as the associate director of the community engagement core?
And I say yes.
And then that's how I ended transitioning to leadership and education versus fully research
work.
That is so awesome.
You know, one of the things that comes up in your story, Leonor, is that you saw, well,
actually, you were in the right place at the right time.
So you're connecting with the right people, doing the right things.
And then when an opportunity comes up, somebody invites you to it and you are paying attention
to opportunity and recognizing a good opportunity when it comes.
And I think I appreciate that you share that because to be honest, that's how many of our
careers are serendipity.
But it's not just luck.
It's that because I'm showing up, because I'm clear about what I value, what I'm interested
in, the moment I'm showing up so people are able to offer me opportunities, but also when
the opportunity comes, I recognize it as an opportunity because I've been doing the work
of clarifying what I want to do.
And so it's beautifully said, because I think sometimes there's frustration from those of
us who are early career looking ahead saying, but how did you figure it out?
How did you get here?
And there's not necessarily like a puzzle that you're putting together to get here.
You're literally just taking one step at a time and the road is becoming clear in front
of you.
I wonder if that's fair to say.
Yes, I think you nicely summarize exactly how I feel about my journey.
I feel that I'm very open to change.
I'm not afraid of change, which is something you have to embrace in academia because change
is inevitable, especially in the times we live where things are changing constantly
and embracing change with joy.
I think all our conversation today, joy will be the word and the feeling that I hope everybody
take and I put all my energy and effort and a hundred percent to it.
And people notice, I also share that with my students.
So I have done so many free things here at this institution that people were like, why
are you giving your free labor here?
And the reality was because I enjoy it.
And that free labor actually opens a lot of doors for me.
And I know as junior faculty, sometimes you will get the advice of learning how to say
no, but I actually changed that advice a little bit and say, learning how to say yes to the
right opportunities that are right for your values that are aligned with what you want
to do.
Because even when they are for free at the beginning, they will open a lot of doors that
will co-work effort and salary support, but you have to be open to embrace them.
I'm not asking every junior people that are listening to the podcast to just do free comedies,
every comedian.
That's not what I'm saying.
What I'm saying is that if an opportunity comes your way that is in alignment with what
brings you that joy that I keep talking about, take it because at the end you're going to
do a good job and people are going to notice.
And then when opportunities come with salary support and effort, you will be the first
name in their head.
And that's my whole story.
People knew I was doing things and when opportunity came, they were like, oh, Leonor will be great.
And then I will say, okay, now I need effort.
Do you have money to pay for my effort?
And they will say yes.
But if I haven't done the other free things before, I don't think people will have their
mind and their minds to consider.
That is so beautifully said, Leonor, and again, you speak to showing up and however you show
up and showing up joyfully and that helps people know that I like to work with Leonor.
How can I make it?
I got to make this more concrete and that those are opportunities that have come.
That's so awesome.
Wow.
We are at the end of this episode and to be honest, I wish we could keep going because
you've got so many amazing gems that you've just been dropping all along the way.
I have to go back and reflect on this episode.
But I do want to ask though, if there's anything you feel like we've left unsaid over the course
of the episode, what would you like to share with our audience as we close?
Yes, I can believe that time went so fast.
I also enjoyed this conversation a lot.
I want to make sure people don't misinterpret my joyfulness with not having faced struggles
because I think that's also really important.
It hasn't been an easy journey.
I had to work a lot.
I have neglected a lot of my personal life in a lot of ways, which I regret.
But if I go back, I don't regret it.
I think I'm being able to achieve a lot.
But at the end, you will have to sacrifice.
There's always this journey, no matter if we sing a cadena or whatever journey you pursue,
you will have to make sacrifice.
And what is important to think is, are the sacrifices are making worth making for what
I'm going to get at the end?
Because I don't want this episode to be all like Leona is joyful.
She does whatever you enjoy.
It's true, but I have challenges.
It hasn't been an easy journey for me as an individual from a minority background with
a big accent in an institution where I was very the minority when I got here.
I don't want to say I've been lucky, but I've been blessed to have good mentors that actually
helped me.
So this journey, but every day I encounter challenges.
It's not that I don't.
And I don't want to make sure I want to make sure people realize that.
You can still embrace the challenge and enjoy it.
Recognizing that it's part of life.
It's not only at the beginning.
Living comes with challenges.
You just need to learn what to do with them and keep going.
So I don't know if that's the end you wanted to get for your.
It absolutely is.
It's beautifully said.
It's beautifully said because it's like, it's going to be challenging no matter what you
choose.
So if you choose a challenge that you actually will feel at the end, you're like, okay, that
was a challenge I worked through.
I feel good about that rather than a challenge where you're like, what was the point of that?
I think in retrospect, you want to look back and say, okay, it was a hard journey, but
I feel proud of myself that I was able to overcome any challenge and I feel joyful and
didn't lose myself in the process, which is actually what I hope for everybody pursuing
this career in academic medicine.
And that is the last word.
I want to thank everybody for listening.
That was such a powerful episode.
Please share this with others who want to live joyfully within the academy while also
navigating challenges.
Leonor, thank you so much for being on the show.
Thank you for having me.
Have a wonderful rest of your day.
I will you too.
All right, everyone.
I'll see you again next time on the Clinician Researcher Podcast.
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