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 Teresee Unwemona, and it is a pleasure to be talking with you right now.
Thank you for listening.
For today's episode, I'm bringing you a talk that I delivered at the National Medical Association
meeting in August 2024, and I'm excited to share this talk with you.
Well, hello, everybody.
This is Toyosi Onwuemene.
Thank you so much for listening to me today remotely.
I am so sorry that I could not be at the talk, but I want to thank you so much for the opportunity
to talk with you remotely.
So today, I'm going to be talking about achieving research productivity when you cannot find
a mentor.
We're going to identify barriers to underrepresented faculty leading scholarship, and particularly
speaking about leading research, but this is applicable to leading scholarship in general.
I'm also going to talk about the metrics for academic success and why that's important
for us to understand as we're pursuing mentoring.
And I'll talk about empirical strategies for research productivity if we're not able to
get the mentoring that we need.
So I was a fellow about 10 years ago looking for a position, and people told me that because
I wanted to be a non-malignant or classical hematologist, I was so lucky I was going to
get jobs and I would have no issues.
Well, I said I wanted to research.
I want 75% of my time to be protected for research, but there were none of those jobs
available.
Instead, what was available was full-time clinical jobs, which I did not want to do.
I was so sure that I wanted to lead a program of research.
And so ultimately, I found a job that promised me that I would have time to do research,
but I would first of all need to take an 80% clinical job, which by the way had me seeing
patients five days a week.
And so I found myself doing the work of a full-time clinician.
And so over the course of my career though, I finally figured out that, wow, a transformation
is really needed for a clinician who wants to succeed as a researcher and that the metrics
for research productivity are actually kind of clear and that it's possible to achieve
them even when you don't have the optimal mentoring that you would like to have.
The first point that I want to make is that clinical training is not equal to research
training.
Clinical training is not equal to research training.
In fact, by the time you get to your fellowship and your early faculty career, you've actually
barely done any research so that you are truly not qualified to lead a research program.
If anything, you are qualified to begin to learn to lead research.
Okay.
So most of our medical school was dedicated to learning how to understand the basic science
so that we could actually start to take care of patients.
And then we became interns and we mastered the art of taking care of the patient.
And then we become residents and now we are leading other interns who are taking care
of the patient.
And so there's this graduated leadership journey along the pathway to becoming a clinician,
but nowhere in the framework for clinical training is there research training.
So what are the challenges for clinicians in leading research?
This is an older graph, but what I want you to notice is that it is sharing with us that
while research and teaching have stayed about flat over the course of years, patient care
for academic clinicians continues to rise.
And this is an ongoing trend.
So what are some barriers to physicians and research?
Well, the reality is that their financial and time demands of clinical practice is increasing
complexity of patients.
There is not a supportive infrastructure for many of us to be able to optimally deliver
patient care.
We also don't have the research training and I want to focus right now on inadequate research
training.
There is a significant difference in the training for MDs who are becoming clinicians and PhDs
who are becoming researchers.
Let's go through now the PhD pathway to research.
So PhD will do maybe a pre-doc, they might do some research as they're figuring out
whether they wanted to do research, not very much, but about maybe at the end of the day
at most two years worth.
When they go into their doctoral program, they are doing research, primarily leading
research that the graduate student on the senior graduate students project, and then
they continue until they become the senior graduate student having other graduate students
be on their project.
And then they finish and they go on to do a postdoc.
And many people will do a first postdoc, some people will actually do a senior postdoc,
and then finally they get to their early career faculty period and they say, you know what,
I need a career development award so I can learn to lead a research program.
PhD researchers have had a lot of investment doing research, but they still get to the
beginning of their faculty careers realizing that more training is needed.
Okay, well let's look at the MD pathway to research.
Well, you know, for those of us trying to get into med school, we might do a research
training program, perhaps a summer elective, but by the end of the time you add it all
up, it's about no more than a year of research.
And then we go to med school, if we're lucky, we might get a couple of months elective doing
research during med school.
Some of us actually gave up a year of med school so that we could do research throughout
that year.
But at the end of the day, it's probably no more than a year, maybe two years of research
during med school.
Then you go on to residency.
Residency is pretty busy.
Maybe you have elective time where you're able to do a couple of weeks of research.
And then for many of you that are in ACGME accredited fellowships, you finish your ACGME
accredited fellowship and you're lucky if you've had a full 1.5 years of uninterrupted
time to do research.
And then you get to your early faculty career and you're like, well, I need a career development
award as well.
And the challenge is that when we compare you to the PhD faculty member, that's eight
to 12 years in a PhD researcher's trajectory versus 1.5 to three and a half years in the
MD's trajectory.
Honestly, as an MD, by the time you come to your faculty position, you're like a research
baby.
You have no idea what you're doing.
You totally clueless, but then you're a faculty member and you're saying, I want a career
development award.
But when other people are evaluating your application against PhD researchers, you really
have no experience at all.
All right.
So the challenge then is how is this gap going to be bridged?
Well, currently the way we try to bridge that gap is with mentoring.
Mentoring is an insurmountable task.
When you think about the fact that a physician who's not really had any research training
doesn't only need research mentorship, they need mentorship in scientific writing.
They do need mentoring in research methodology.
They do need to understand leadership because when you're in research, you're not actually
trying to do everything yourself.
You're leading a program.
You're leading other people to do the research.
So you need training in leadership.
You obviously need to know how to write grants.
People always talk about grantsmanship.
Well, that's something that is a skill that can be built.
And then team management as well, right?
Because you're building teams to move the research forward and also mentoring as well.
As the person who is mentoring is being mentored, you're also mentoring as well.
And so there's so many things that are needed for the physician.
And the whole idea that a mentor is going to do all of it is actually quite challenging.
For this reason and for many other reasons, many early career faculty actually struggle
to find mentors.
And when we look at prior studies, including this systematic review, unfortunately, it
is a challenge even for medical students of whom less than 50% felt that they had a mentor,
for faculty members of whom less than 20% felt like they had a mentor.
And then women perceive that they had more difficulty finding mentors compared to men.
But mentorship was so important to success, yet such a big chunk of faculty members, medical
students and trainees feel like they're missing mentors.
So they're not really able to advance in their career because of this huge gap.
What are some mentoring challenges in academia?
Well, the reality is that an excellent scientist does not equal a great mentor.
And sometimes faculty need different things from different mentors.
One person who's a great mentor to one may not be a great mentor to another.
Secondarily, seniority and success, while we always applaud those who are successful
and we say, well, you should have more people in your lab, the reality is that it does not
always lead to a great mentor.
If you're going to be a mentor, it is hard work.
It is patience, it's dedication, it's pouring into the life of another person.
It takes investment and it's usually not funded.
It's often associated with administrative duty.
Hey, this is your job.
This is what you're supposed to do.
Unfortunately, it's often uncompensated.
And I'm not just talking about financial remuneration.
I'm really talking about its time.
That time is often not compensated.
And so faculty are borrowing from the fringes of their experience to try to mentor other
faculty, which means that it's going to be a variable experience for many faculties being
mentored.
Mentoring is a skill and skills can be acquired and they can be grown.
And so it's a skill that needs to be taught.
Many faculty are actually not trained to be mentors.
And when mentees have poor mentoring experiences, well, they can quit early, but if they become
mentors themselves, then they continue to perpetuate that cycle of poor mentoring.
Underrepresented faculty also may have greater challenges in mentoring.
When you now compare faculty and advancement of faculty by race and ethnicity, well, you
realize that many, many underrepresented faculty stay at the instructor and assistant professor
level and few of them go on to the associate professor and professor level.
And in general, these numbers are very small relative to the number of trainees that are
coming through the pipeline as well.
And that is evidence that there is not adequate mentoring for underrepresented minority faculty
compared to majority faculty.
What are some barriers to effective mentoring of URM faculty benign neglect, faculty reported
feeling uninformed and unsupported.
Many faculty are having to patch their mentoring experiences together.
There is a perception that so the work that underrepresented faculty want to do is not
necessarily widely accepted.
Why is mentoring needed?
Mentoring is needed because for academic faculty to advance, there are some very clear metrics
for success.
Let's talk about some of those metrics.
So this is from the National Center for Faculty Development and Diversity, which I think is
a little bit more geared towards PhD faculty.
So I want to say that where you see teaching, I want to substitute clinical medicine for
those of us who are MD faculty.
I mean, you look at the criteria for tenure and promotion.
In general, research scholarship drives promotion and tenure, research and scholarship.
Everything else is a little bit smaller, right?
But the average faculty member is spending so much time doing teaching the service work
for clinicians, you can just translate that into patient care.
There is very little time for scholarship, the thing that actually allows academic faculty
to be promoted.
Let's look at a different set of metrics.
Now this actually comes from the University of Maryland School of Medicine, and they're
very clear about, okay, so there's a tenure track and there's a non-tenure track.
And I want you to pay attention, even when you look at the non-tenure track, publications
are still relevant in advancement, right?
Contributions to knowledge.
That means seeing patients in advancement at any academic medical center is usually
not enough.
There is an element of contribution to scholarly work that's required, right?
It's very important.
And so here's the challenge.
If you don't even have time to do any scholarship because you're so busy, how can you contribute
to the scholarship that actually facilitates your promotion?
It's challenging.
And many faculty, many early career faculty, found themselves in this space, and so do
many underrepresented faculty as well.
And so then what are faculty members to do?
Especially if they have no mentor.
Okay, so it's important to recognize that faculty have many needs.
We talked about the need for research skills, there's also career development is needed,
intellectual development as a scholar, professional development as a professional, needed a role
model, someone who can give them substantive feedback on manuscripts and grants, faculty
need accountability so that they can meet their goals.
They also need safe spaces as well.
You need sponsorship, they need emotional support.
So the current model of mentorship is a myth of a guru type mentor.
And again, this comes from the National Center for Faculty Development and Diversity.
But the idea that there is one mentor that can meet a faculty member's needs in every
way.
Now it sounds a little bit ridiculous to you, doesn't it?
That, oh yeah, one person can't meet all these needs.
And so what ultimately happens is that as the guru mentor is struggling, the mentees
become abandoned.
And there are many abandoned mentees out there whose careers have been affected because they
can't find the adequate mentoring.
And so I think it's important for us to think about how do we reimagine the paradigm?
How do we support faculty to succeed when they cannot find a mentor, when they cannot
find the one and be all guru mentor that can support all of their needs?
Well, first of all, consider the faculty have many needs.
And there's this idea that there's one person who's going to be able to solve all these
problems.
But if we take away the guru mentor from the center and we put the faculty member at the
center and recognize that, well, the faculty member is the one who has all these needs.
So where can the faculty member go to get these needs met?
Well, so if we take away the idea of the guru mentor, what we really have is that faculty
members need mentoring networks.
If there's an issue of elderly care as my parents are aging, I need a mentoring network
that's separate from my research mentor at work.
Or if I'm dealing with issues of family planning, pregnancy, I want to talk to somebody who's
not a primary mentor.
And so faculty actually need mentoring networks so they can advance their career.
And so empowering faculty members can occur through coaching.
So faculty members are taking ownership of their own careers as they move forward, rather
than being totally dependent on one person.
It's great when you have a great mentor, but if you don't, you still need to be able to
move forward.
You still want to succeed in scholarship.
And so empowering faculty through coaching is helpful so that faculty members can really
take ownership of their careers and use their mentors in their networks to their advantage.
Coaching is helpful for helping faculty play at a higher level.
So what are some strategies to enhance research leadership?
Now, we measure success in different ways, retention, publications, funding, reputation,
promotion.
And so mentors need support.
And so we need mentoring support systems.
We also need resources for mentors in terms of time and funding.
And then for the baby, too, the mentee, if they had other sources of nourishment and
were not fully dependent on the mentor, perhaps they could do well, even if they ultimately
were abandoned.
And so is it possible that mentees can have their own networks so they can be successful
as well, rather than being dependent on a stressed out faculty member?
And finally, can faculty also benefit from peer mentoring networks?
And I think the answer is definitely yes.
How can we also encourage skills development in mentees?
Because being a good mentee is actually a skill that can be developed.
And then acquiring all the skills of a successful researcher also can be developed as well.
So how do we help faculty create their vision for their research?
All right.
So I want to go back to my story, the case study.
So I started out with no resources for research.
Honestly, I didn't even have resources for clinical care.
So I had a double whammy there.
But one of the things that I really needed was research training.
I actually didn't have much research training.
Now by the time I came to my faculty position, I had a master's in clinical investigation.
But I certainly needed a lot more training than that.
Again, compared to my PhD colleagues who were doing research training or doing post-docs,
I had barely really had much by way of research training.
That's one thing I needed.
The other thing I needed was protected time.
I needed to be able to do research during my work hours rather than trying to stuff
research training and the research into my off hours, which means that there's so much
less that's going to get done if I'm trying to do it by burning the candle and not sleeping
at night.
Now, the other thing that's needed is salary support.
So well, if you're a clinician, make a lot of money generating RVUs and now you're not
generating RVUs because you're doing research, who's supporting your salary?
And that's an important question that faculty have to think about even when they don't want
to as they're trying to lead research, as they're trying to do more scholarship.
It's like, well, who is paying your salary?
And that becomes a really important question.
So I will tell you that throughout my process, I was very stressed trying to keep up with
my full-time clinical load, seeing patients five days a week, also writing grants at nights
and on weekends, also taking care of at the time, two children under three.
It was a really stressful time.
I found myself spending a lot of time sleeping in my office.
And I finally got to a point where I was like, I cannot do this.
It is impossible.
I will quit.
And I was fortunate because actually I found a way out.
And so my first step towards growing my scholarship was that I was awarded a diversity supplement
to one of my mentors, R01 Grants.
Following the diversity supplement, I was selected to be part of an institutional K-12
award and I started moving projects forward.
I ended up getting an HTRS Mentored Research Award.
I also got the Harold Amos AMFDP Career Development Award, supported by the American Society of
Hematology.
And currently I have a number of funding sources as well and continue to move my research forward,
continue to collaborate to answer questions in classical hematology.
Now I just want to share a little bit about what I think about when I advise faculty who
feel like they don't have adequate mentoring.
And so the most important thing is to recognize that there does need to be a shift in identity.
There are two shifts that I think are important to recognize.
Number one is a shift from trainee to faculty member.
And you may be in that transition period or you may have already transitioned, but it's
important to recognize that you're no longer looking for people to tell you who you are,
to tell you what to do, but now you're the person who's driving your own career.
In the same way as you're the one who the buck now stops with when it comes to patient
care, that is your career as well.
And so I know we look to mentors to drive our careers and I'm so glad that mentors are
so helpful, but at the end of the day, if the mentor doesn't take care of you, you are
still responsible for moving your career forward.
And so no matter what stage you are in, even if you're a trainee right now, it's important
to say, wait, I'm the one driving my career.
What do I want my career to look like?
And it's not too early to start to ask that question, to shift from, okay, everybody tell
me what to do, tell me how to advance to say, well, what do I need so I can have the kind
of career success I actually want?
And so first of all, a shift of identity is needed.
The second thing is that you know what?
Protected time is essential.
You cannot succeed in research without protected time.
Any thought that doing research at nights and on weekends is going to help you advance
and make up for that gap between a PhD researcher's training and yours is not realistic.
Protected time is needed because there's a gap, there's a skills gap.
Research and leading research is a skill that is built over time.
And if you focused all your training on clinical training, that's good.
But if you're going to lead scholarship, if you're going to lead research, you do need
to go back, walk back the steps and get the training that you need.
And you got to do that as part of your work day, not as something you do overnight.
And so for those of you who are exploring new positions, you really got to think about how
do you get the protected time you need so that you can be successful?
For those of you who are already in positions where you don't have the protected time, how
can you partner with your division chief, division director, your dean to figure out
how you get the protected time to move research forward?
And then if you are going to be given the protected time, if you receive the protected
time, how do you actually get accountability so you're not just wasting time?
So you're not just saying, well, I have all this protected time and now I have all this
free time, how about I just try to finish all my notes during this protected time?
It's creating structures for accountability so that you can be productive.
And there are very specific metrics and strategies to be productive that don't necessarily have
to come from a mentor, but can help you really succeed.
So one of the things that's important is that if you are a scientist, if you are a researcher,
if you are a scholar, it means you are a writer.
It means that writing is part of your daily job.
And so one of the things that you think about for productivity is how do you create space
for continued daily writing so that you can move research and writing forward?
Now writing is so critical because as a researcher, you're a communicator.
You communicate with funding agencies so you can get money to move your work forward.
You communicate with the scientific community by putting out manuscripts and abstracts or
giving talks.
You communicate with the lay community or with the public as your projects are funded
and you're disseminating your work.
And so communication is such a critical part of what you do.
You've got to create the structure and accountability to write consistently.
Another thing you want to do is to be clear about where you're going with your research.
And part of that work is to make sure that you have a clear strategic plan and a weekly
plan that helps you get there.
These are things again that mentors are able to provide you, but you can get on your own
in many programs that support you doing that so that you can be productive even as you
continue to pursue the skills in research training as you need.
And so creating structures for productivity is so important if you're going to succeed
in scholarship, if you're going to advance in the academy.
So I want you to think about your own career and I want you to think about what do you
wish for your career?
What do you see ahead of you?
And I want to encourage you to think about how can you create what you want?
What do you need?
Who are the mentors?
Remember I noticed I said mentor with an S. You don't need one mentor.
You need multiple mentors for your career, for your research, for your academic advancement.
You need sponsors.
There are many people you need.
You need help with your writing.
You're a great writer, but scientific writing is different from what you've done.
And even more important is grant writing.
Grant writing is a different skill.
Who are the people who can support you, especially early on, give you the intense mentoring that
you need?
And it may not be the people that you think because they're so far ahead.
They don't really have enough time to invest in you, but there may be peers that wouldn't
mind doing that.
There may be instructors in writing programs that may be able to help us do that.
So reimagine your career.
Where is it you want to go?
And who is it that already is around you that can help you get there?
And as you begin to be more, think more critically and take the driver's seat of your career,
you're able to create fireworks literally in your career because now you're not waiting
for someone to show you where to go.
And then if you have no mentor, you're stuck.
But now you're saying, well, who do I need and how can I go get them?
And then you realize that you don't have to be focused on just the faculty within your
academic institution.
Who are the connections you already have outside your academic institution that can help you
create the vision you have for your own career?
I want to thank you so much for listening.
It's been a pleasure talking with you.
Again, I wish I could have been there with you in person, but I want to thank you for
listening.
And I hope that any questions that you have can be directed at me.
I'm at tonyasidardonwemina.edu.
I would love to hear from you.
And I want to thank you so much for listening.
Have a great rest of your sessions.
Thank you for listening.
I look forward to talking with you again next time on the Clean Ocean Researcher podcast.
Thanks for listening to this episode of the Clinician Researcher podcast, where academic
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