Welcome, everyone, to our webinar on Developing a Career in Clinical Research. Our goal is to encourage and promote clinical research in hepatitis B, especially for our young investigators. We have an exciting program with four faculty in diverse settings, and it is my great privilege to introduce our first speaker, Dr. Anna Lok, Professor of Medicine and Assistant Dean for Clinical Research at University of Michigan. Dr. Lok is one of the pioneers and has been at the forefront of hepatitis B research for well over 30 years, and I look forward to hearing and learning from her journey and experience. Thank you, Dr. Lok. Well, thank you so much, Dr. Nguyen and ASLD, for inviting me to participate in this webinar. So I was asked to talk about why I decided to pick hepatitis B for my research career. These are my disclosures, and I will talk about why I started off with hepatitis B, and after almost 40 years, I still continue to stay with hepatitis B. We start off with whenever we begin a research career, we ask, where should I focus on? We oftentimes either pick a disease or a theme or a methodology, and we have to ask, is this clinically important? And it's important not just now, but would it still be important five or 10 years from now? Because we're talking about long-term career, but it's also important to find out whether we truly are interested in that topic and passionate about it. Because life has its ups and downs, and if we're not really passionate about it, when things don't go well, it's very easy for us to give up. We have to ask ourselves whether we're in the right environment, have the right tools to pursue that topic. We hear oftentimes, right place, right time, right person. For us to be successful, we have to have some unique advantage over our competitors. Either you're in an environment in which you have unique access to patient population, availability of novel technologies or assays, special expertise and reputation of that particular environment in that topic. You also have to ask yourself, your own personal skills, experience, track record, do you have the right mentors, the right collaborators? Because very rarely can we do everything on our own. And what is the likelihood that you can get support financial and otherwise? I started off in the late 70s, early 80s as a resident when I was still in Hong Kong. And at that time, hepatitis B was very common. And I saw a lot of patients with hepatitis B and hepatitis B related to HCC. So my research career really only took off after I went to London for my fellowship. That was late 81 to 83. Remember, that was before we have the diagnosis of hepatitis C. We call it non-A, non-B hepatitis and never was just beginning to be recognized as a clinical entity. So we didn't really have as many choices. It was the early days of molecular diagnostics. I still remember begging the PhD scientists there to teach me how to run the HPV DNA assays. There was no approved antiviral therapy. Actually, the first few clinical trials that I was involved in, those drugs were never approved and never show advocacy. And hepatitis B vaccine was just approved. Association between hepatitis B and HCC was just confirmed in Taiwan. So I was in the right place, the right time. And I had an edge over competitors because the Royal Free in London at that time was booming with techniques to study hepatitis B. But why did I continue? When I moved to the United States, I was advised by a lot of people, give up hepatitis B. It does not exist in the United States. And with the vaccine, hepatitis B would disappear and you have to find a new focus, otherwise you'd be out of job. But I chose hepatitis B because I find it fascinating. It was also a sense of duty knowing that hepatitis B affect Asians disproportionately. I feel a sense of responsibility to get to know more about it, to help my fellow citizens and countrymen. But also by then I've built up knowledge, skills, insights, reputation, and a track record. So if I were to switch, I wouldn't have any advantage. Plus hepatitis B was important, yet not overly crowded. However, forward to 2021, a lot of new problems have cropped up. And why do we still think that hepatitis B is worth pursuing? Well, that's because there's a lot of renewed interest. With the WHO announcing it goes to eliminate hepatitis by 2030, and there's concerted efforts to develop HPV cure, I think this is really a great time. There are a lot of new tools. We have new basic science tools to study virology and immunology, novel animal models that can support hepatitis B replication and even recapitulate human immune responses. For those of us doing clinical research, we know that there are new hepatitis B markers and we have to understand what is the role in diagnosis and management. We also have non-invasive methods to assess liver disease, and there's so many new therapies. So this is really the right time. Hepatitis B is no longer a forgotten disease. But picking a topic is only the beginning. You have to really narrow it down to what are your research questions? How do you design a study that would allow you to address the question? You have to ask whether it is feasible, because for many of us studying, we have limited resources. Do I have the patients? Do I have the methods? Do I have the finances? Do I have the staff to know how to help me with it? So we have to figure out the logistics, and we have to follow things through. It's easy to get started, but it's a hard work to take it to the end. And sometimes when things don't work out, we have to figure out how to adapt. And it is extremely important to pay attention to all the details. We don't know everything. We can't do everything. So it's important to seek advice, to plan well, pay attention to details, work hard, never give up easily, but at the same time, recognize futility. When things truly aren't working, we can't keep banging our heads against a brick wall and we need to recognize when to change course and adapt. And it's very important to collaborate, make friends, they can help you, and you can help each other. So it really brings me to what can ASLD and HPV SIG do? Over the years, we've talked about the role of SIG in fostering collaboration. So should it be collaboration within the U.S., can we do global collaboration? What questions would be of mutual interest? What studies would be feasible? Who's going to fund it? And do we need some infrastructure support and who's going to be controlling the data? And is anyone really interested? We always think of these as being too daunting for us to tackle. But let me share with you my own experience. Back almost 20 years ago, when we just began to understand hepatitis B genotypes and all these variants, I said, I really don't know how common these issues are in the U.S. Can we do a sort of nationwide study? There's no infrastructure. And I used my own discretionary funds. I had a fellow from Taiwan and I asked GSK for a small sum of money. And Annalika at that time gave us some free kits. And we're able to actually get 16 centers to work together. And we publish a paper in Gastro and a paper in Hepatology. And I really were the only person to provide infrastructure support. So I hope that this gives us an example to rethink about the potential for collaborative studies within the state. And I now would like to pass it on to our next speaker. All right. Now, it's my pleasure to welcome our next speaker, Dr. Kelly Zhou. Dr. Zhou is a transplant hepatologist and assistant professor at Keck School of Medicine, University of Southern California. So she completed a T32 gastroenterology transplant hepatology fellowship at the University of California at San Francisco. So her current research focus is the disparity in liver cancer and utilizing novel jaw special approaches to improve cancer equity and outcomes for multi-ethnic population. And she is the recipient of Fulbright Scholarship and ASLD Early Career Investigator Award in Clinical Translational Science. As a stellar early career investigator, her experience will be helpful for our med students, residents, fellow, and many other early career researchers. Let's welcome Dr. Zhou. Hi, everyone. Good morning. Thank you, Dr. Nguyen and Dr. Yeo for the opportunity to present my winding, often uncertain and still very uncertain career path. So I finished my liver transplant fellowship in 2019. I'm now entering my second year as junior faculty at USC in Los Angeles, and I spend about 75% of my time doing clinical research. So hopefully some of the things I learn will be useful for those of you who are just embarking on this path. Here are my disclosures. So I really wasn't someone who knew from an early age that I wanted to do research. In fact, if you asked me 15 years ago, I would have emphatically told you that I would never be a researcher. My parents both have PhDs in chemistry, and when I was an undergrad, they insisted that I do bench research. So I joined a neurodevelopmental lab, and I spent my nights sacrificing baby chickens. Needless to say, I was very bad at it. So when I entered residency at UCLA, I went in with basically no intention of doing research, and I only did it, like many others, to get into GI fellowship. So I started with this small study of about 40 patients, and this was my very first clinical research project. And unexpectedly, I really enjoyed it. So this was when direct acting agents for hepatitis C had first come out. The field was very exciting, and I felt like I was doing something bigger than clinical medicine, something that might make a difference for many patients instead of just the one that was in front of me. So my lesson from this is that if you're thinking about giving clinical research a try, I definitely recommend taking the leap. So then I came to an impasse. I was a second-year resident applying for GI fellowship. I had one pending publication, and I was facing a decision of whether or not to apply for a T32 research fellowship. It happens to be a little bit easier nowadays here in the US, because most fellowships don't make you declare your research intentions until you're a first-year fellow. But at the time, I did not feel that I was ready. So then I made the best decision I had ever made in my life, and I actually didn't apply for fellowship. Instead, I went outside of the box. I went back to my undergrad, and I asked them, can I apply for a Fulbright scholarship? They said yes. And for some of our international participants today, there are actually opportunities for you through the Fulbright program to do an exchange and work here in the US. So in a very short amount of time, I found a fantastic researcher at UNC doing viral hepatitis research in China. I threw together an application, and next thing I knew, I was in Guangzhou, China. It was an incredible year. I learned a lot. I worked with the World Health Organization, published three papers, one of which was published in Lancet Infectious Disease. And by the end of it, I was hooked. And I have to say that thinking outside of the box and going for this unique experience really shaped my path, but also opened doors for me in the future. So now I had to apply for GIA fellowship. And I say choose wisely, because I do think that where you go for fellowship has a major impact on where you might end up in your first job, but mostly because of regional networks. And I knew geographically that I wanted to stay in California. At the time I applied, there was only one transplant hepatology fellowship in all of California, and now luckily there's three. And I was pretty sure I didn't want to spend three years in one place and then move again for just one year. So that was an easy decision to have UCSF be my top choice. But since I was applying for T32, I had to pick a mentor before I even got in. Now this was a crucial decision that I was definitely not prepared for. So one of the best things I did was actually reach out to several young research faculty at UCSF and talk to them about their experiences as mentees. And they made it very clear to me that there was no point in doing research with anyone other than Nora Turow. And that's how I ended up with the best mentor and role model possible. So if you're in a similar position, having to choose between potential mentors, I highly suggest talking to their mentees and learning more about their experiences to help guide your choice. Now, if you're serious about a career in clinical research, make sure you set yourself up to succeed at it. As clinicians, we are not trained researchers, and there is an entire world of PhD investigators out there who are explicitly trained for years to do this. So get another degree however you can, but make sure that someone else is paying for it. So this can happen at various time points in your training, but fellowship under a T32 is a very good time. And you're not going to be losing a year doing it during that time. Outside of a degree, there are also many opportunities from both GIA societies as well as NIH programs. I attended the AGA ASLB Academic Skills Workshop when I was a fellow. Here I got to meet and I received feedback from Dr. Locke, which was really pretty cool. And I also networked with other researchers and early career investigators, including one at Georgetown, who I'm now collaborating with on a funded HPV project. Now there are a lot of sparkly objects in research, things that we hear are hot, microbiome, artificial intelligence, some of these come to mind. You're sometimes going to feel the urge to reach for them so that your research might seem novel or someone told you that it's more fundable. So I don't necessarily think that's a bad strategy, but ultimately you're going to succeed only if you're passionate about what you're doing. In my path, I felt a lot of pressure to do translational research, but I realized that my heart wasn't in it. What I was interested was in gaps in care and how to fix them. So in one of my studies, we found 50% of foreign born individuals in the United States were still unaware of their HPV infection. And I realized that there are plenty of people out there working on a functional cure for Hep B, but if 50% of patients weren't ever going to get it, that was a true tragedy. So once I realized what I cared about, it was clear what direction I needed to go. And though I knew what I wanted to do, the path wasn't going to be direct. You were going to have to be flexible. You have to adapt to your environment and sometimes adapt to a changing research landscape. So research in Hep C was not going to be a viable long-term option pretty much as soon as I started doing Hep C research. And when I arrived at USC in 2009, I realized that the institutional environment for research in Hep C simply wasn't here. There were no existing cohorts, no collaborators, and they would need to start from scratch, which isn't easy when you're a young investigator. Nora Turrell always says that you're not going to just do research in one thing over a very long career. And she's the queen of wearing many hats. So we made another pivot to liver cancer. I found a wonderful new mentor, Miles Cockburn, who's an expert in spatial sciences. And we're doing exciting things at the intersection of spatial epidemiology, cancer disparities, and cancer control interventions. So my K award is actually going in in two days, and I'm very much hoping that it's going to be a success. And a huge part of being an early career investigator is not just doing your actual research, but doing research in terms of figuring out what the resources are at your fingertips. And it's often a lot more than you think. Sometimes it's easy to not look beyond your own division or your own field, but transdisciplinary team science is really the way to go. The first thing I recommend is look at all of the other departments in your institution, even the ones outside of medicine. My current work expands about six or seven different centers, departments, and programs here at USC. Ultimately, I think that's what makes my work interesting, innovative, and potentially, in the end, more impactful. Now, these aren't the days where you should only be doing research on nights and weekends. That is not a viable life plan, and you shouldn't be expected to do that anymore. But I've learned that research is also not confined to 9 to 5 p.m. I think if you're willing to be on call and you're willing to have that pager go off, you should also be willing to put in the extra time for research, especially early on. This study in BMJ showed that scientists very often submit manuscripts over weekends and over holidays. So it's definitely going to happen. And because research doesn't just end, like clinic at 5 p.m., I recognize this. I'm flexible with my time when I need to be. Sometimes I put in the extra hours, sometimes less, and I don't ever let it get to me. You'll hear this over and over again, but the most important skill for any researcher is tenacity and persistence. Be prepared to have a thick skin. The majority of your papers are not going to be accepted on your first try. On average, it's three to four tries. I used to have a lot of anxiety about whether or not I was on track with funding for my career. And then I went to an NIH talk and was told that the average age MDs get their first R01 is 45. So you do have time. Expect to not get things on your first try, so keep submitting that manuscript, keep submitting that grant. Do it often and don't give up. So someone once told me in fellowship that they thought the only people who should be doing research were those that were naturally good at it. Now, I do not consider myself naturally good at research, but I am persistent and I'm hardworking. And thus far, that's led to success. And last but not least, make sure you enjoy the ride. So these are the four things that are my current pandemic life, Zoom, Stata, my sit-stand desk, and my very large Mac desktop. So go get yourself a sit-stand desk, get yourself a giant computer. You won't regret it. It's cliche, but life, it's truly too short to be doing something you don't enjoy. So if you do enjoy research, I highly recommend going back to step one and taking the leap. So thank you. My contact is in here. Please email or reach out. I'm happy to connect any time. Thank you, Dr. Kaliju. And I would like to introduce our next speaker, Dr. Hannah Lee, assistant professor and a hepatologist at Virginia Commonwealth University in Virginia. Dr. Hannah Lee has been an active member of our HPV SIG and has been an active member of our HPV research community. And I look forward to hear her perspective and experience in her career. Thank you, Hannah. Hi, everyone. Thank you, Mindy, for the introduction, and thank you for giving me the opportunity of sharing my career journey. I've entitled it A Career Journey of the Unexpected because I have come into the clinical research arena a little bit later in my career. I have no disclosures. So my journey into the world of hepatology was not a planned one. And I remember when I first started medical school, I envisioned myself as a primary care physician practicing out in the community and advocating for my patients in that primary care setting. I had no intentions of going into academia, let alone clinical research, and had no interest in specializing. Fast forward, my third year in med school, I'm starting my inpatient rotations. And the first rotation I started was the GI liver inpatient service. And we were rounding as a team. And I remember walking into our first patient's room, and he had end stage liver disease, refractory ascites, he looked miserable, and he desperately needed a therapeutic paracentesis. And the first thought that came to my mind is, there is no way I am going into GI liver. This is awful. I'm not even going to consider it. So those were my famous last words in med school. And fast forward, I matched for my residency at Tufts New England Medical Center in Boston, Massachusetts. And my priorities at that time for my residency, my intern year was to simply survive. I wanted to survive my intern year, I wanted to survive my training. And I wanted to come out of it clinically strong. I wanted to feel very comfortable taking care of sick patients. And I'm so grateful for my time there, because that's what I accomplished. In the meantime, I did not realize at the time that Tufts New England Medical Center was a very busy liver transplant program. There was a lot of liver disease, a lot of viral hepatitis, a lot of hepatitis B. And ironically, with my famous last words in med school, I was wooed over by liver disease, particularly viral hepatitis and hepatitis B. And despite all of that, I ended up applying for GI fellowship so that I could pursue a career in hepatology. And at that time, we didn't have to do a transplant hepatology fellowship year. I was grandfathered in, but I had a lot of exposure to hepatitis B at the time. During my fellowship, my priorities were the same. I wanted to come out of there as a strong clinician and being comfortable taking care of sick liver patients. I wasn't thinking about a training grant or a clinical research track, just wanted to come out pursuing being a clinician of excellence. I was fortunately invited to stay on faculty after I finished my fellowship time there. And it was during this time as a junior attending, my interest in Hep B continued to grow. My interest in HCC was cultivated there. We were smack dab in Chinatown, Boston. We were surrounded by diverse ethnic immigrant communities within the city limits and outside in the greater Boston area. And I had an opportunity to develop and head our Asian Pacific liver health program at the time. And I had an opportunity to help grow our multidisciplinary liver tumor clinic and learn so much from my colleagues there. In all of this, my curiosity in clinical research started growing, particularly in Hep B. And of course, I didn't start out with a clinical research tract. I didn't have any training in this. But I really wanted to explore this further. And so as a junior attending, I started looking out for mentors within my institution, and I started looking out. And I was so fortunate that Dr. John Wong at Tufts, he was the chief of division of clinical decision-making at the time, and I think he still is, took me under his wing. And we were able to gather a team together. For all of us who had a passion towards Hep B, I was really into the public health part of this, the disparities issues of it. And we were able to get a small NYUB free seed grant looking at elimination of hepatitis B disparities. And this was the stepping stone, the building blocks for me of working with a team, building a database, gathering data, working with a statistician and asking good research questions. I also knew it was important to look outside of my institution. And I was so fortunate to be able to get Anna Locke to come and speak at our divisional grand rounds many years ago, and had a chance to meet with her and perk her brain on Hep B. And she opened doors for me as well, getting me connected with various colleagues and people, getting me involved in the Asian Health Foundation. And that also opened doors for me. So fast forward, 17 years in Boston, I knew that it was time to move on. And if I wanted to continue to grow, not only as a clinician, but also in the clinical research arena that I needed to look out and explore more about what was going outside of New England. And so I took a big leap and left Boston and unexpectedly landed on the shores of Richmond, Virginia at Virginia Commonwealth University. This was not a planned move, but a door opened, an opportunity came that I could not refuse. And my goals in joining VCU was, I wanted to keep growing as a strong transplant hepatologist, taking care of our sick liver patients and advocating for them. But I also wanted the opportunity to keep growing the clinical research side of things. And I'm so fortunate and so thankful for my mentors and seniors there, both Dr. Arun Sanyal and Dr. Richard Sterling, who have helped me continue on this journey of growing those skills. I'm in the process of working on two first author papers through collaboration in our institution and my own database. I'm working with a team and it's a work in progress, but it's been an ongoing journey and so much to learn. And I'm so thankful for the team that I have currently at VCU. So as I think back to my career and I'm not a junior attending anymore, but I'm thinking back and I'm thinking it's okay if you're not sure what you wanna do in the beginning. I think in our interests, our passion, our goals, they develop over time and different seasons of life, we're gonna have different priorities, but once you know what you want, you go after it. And it's so important to surround yourself with inspiring people and people that you wanna be like. The key here, as you're hearing over and over again is finding the right mentors. These are the mentors that are gonna connect you to the right resources and connect you to the right people and to the right team to help you get started. And as mentioned before, seeking out the research resources that you have at your institution. At VCU, we have the CTSA, at TUSC, we have the CTSI. And so utilize those, take advantage of those resources that you have. Again, the importance of networking and boy, collaboration and partnership. Hey, a research project, a poster, a paper, this is not a loner job. This is a lot of hard work. It's a full team effort. And really you gotta work together as a team with a common interest, a common goal to get it done. And how do you get to network and collaborate? Well, you reach out to your colleagues at your institution who have the same interests, get involved in the committees, get involved in HPV SIG, get involved in the nonprofit organizations that you're passionate about. And this will provide open doors to meet people, share ideas and collaborate. I think some of the challenges that I have faced is the lack of time. We are all busy clinicians and I'm a full-time clinician and everything I'm doing in terms of the clinical research side is all on my own free time. And as we all know, no grant, no funding, no protected time. So that is also an important thing to remember. I think sometimes when we're so stuck in the details of life that we have to step back and look at the big picture and ask ourselves the questions. What is our purpose and our passion? What is our mission and calling in all of this? Those are the foundation for our goals and dreams. And it's our passion that's gonna help us pursue our dreams. But you know what? It's gonna take a lot of hard work. It is not instant results. It's not instant gratification. It is the commitment, the perseverance and the focus that it's gonna take to get there. And I think as physicians, we are often, we get stuck in that perfection mentality. And I think it's important for us to remember that it's okay, we're not perfect, we're human beings. And that our journey is gonna be filled with pitfalls, hurdles and setbacks. And the failing part of it, that's a part of the journey of learning and growing. So we learn from the things that didn't work out, the rejected grants. I look at the feedback, I review it with my mentor, we revise it, we try to go back at it again and we keep going. I wanna take just a brief moment to acknowledge all the mentors, teachers, encouragers and inspirers in my career journey. And I'm so thankful for every one of them. Some of them don't know they're on their list. But again, it's so important to find those right people in your lives to help you. And sometimes they don't know they're helping you, but learn from people that you wanna learn from and those that inspire you and you keep going with that. So the journey, the adventure continues. I think it's important to keep moving forward. Don't forget the big picture and just stay focused. Thank you. Right, thank you very much, Dr. Lee. And last but not least, let's welcome our next speaker, Dr. Yaojun Shi. Dr. Shi is an Associate Professor at Yishou University and the Director of the Center of Liver Diseases at Ida Hospital, Taiwan. And he's an active researcher in chronic liver disease, particularly HBV. I remember when I was his med student, I asked him for his advice and he has been always a lighthouse for me. So I'm sure his presentation today can be inspiring for many young researchers today too. So let's welcome Dr. Shi. Thank you, Dr. Yoon for the kind introduction and the invitation. Hello, everyone. Good morning, good afternoon, or good evening. It is my pleasure and honor as well to share with you the experience of my career development in clinical research. I was told to elaborate on how I got started and where I am now. These are my disclosures. So how I got started in clinical research, they can go back all the way to my inquisitive mind. I am not strange for having curiosity, am I? I believe everyone is, or at least was, curious about the world. There are so many questions around us. Don't you agree? Of course, some questions are way beyond our reach, like what the mechanism underlying quantum entanglement is. Who knows? But some of the questions appear answerable within our capabilities. I love asking questions and enjoying trying to find an answer. I believe that's the fundamental drive for me to do research. I'm a frontline physician, so I do clinical research. Okay, let's talk about something more concrete. After graduating from the National Taiwan University in Taipei, Taiwan, I received my training in internal medicine and gastroenterology data. Actually, I wasn't born to be a hepatologist. Initially, I followed in the footsteps of my three mentors, Professor Jiu-Tang Lin, Professor Min-Sheng Wu, and Professor Jingying Wu, all of whom are big names in Taiwan for the research of digestive endoscopy, gastric cancer, and helicobacter pylori. So I was more involved in general GI and endoscopy at first. In fact, my very first research article dealt with application of therapeutic endoscopy, and my thesis for master degree tackled the intricate manifestations of functional dyspepsia. I might have just continued to develop my research career in GI or endoscopy. But life is full of crossroads and turns, isn't it? You never know what you are gonna get, just as forest, forest gums, puts it. After finishing my training, I moved back to my hometown, Kaohsiung, which, by the way, is located in the southern part of Taiwan in case you never heard of it. I picked up a job in Yida Hospital and Yishou University, where I'm still working now. I was prompted by my mentor, who was at the time also the Dean of Medical College in Yishou University. He asked me to consider my research focus in a new place. He explained that the field of upper GI was crowded with many senior colleagues and suggested me turn to molecular biology of colorectal cancer or chronic liver disease, because nobody in our group was doing research in either field. Like Kelly, I'm also a believer of being true to yourself. For a gastroenterologist, molecular biology and colorectal cancer sounds fancy and trendy, don't they? But I'm a physician who loves to practice medicine, and I don't think it will work for me to spend hours in the lab doing bench work in view of my clinical duties. I'm sure I won't have any chance to come up with some good research without devotion of time and effort. On the other hand, I know how to take care of patients besides chronic varicotitis, particularly Hep B is big in Taiwan. So like Professor Locke just said, I decided to choose a research focus with which I believe I have some age. So I started to study chronic liver disease, and my PhD thesis dealt with treatment effectiveness on extrahepatic outcomes in patients with chronic Hep C. I totally agree with Hannah that it is hard to plan what may become of our career, let alone to foresee the details of it. Instead of making a delicate plan for the career, I believe it's more important to get prepared. In my opinion, preparation is more important than a fine plan. For an investigator interested in clinical research or any kind of research, I think it's important to know what questions to ask and how it can be answered. So it doesn't matter that much whether my subject was switched, what really matters for me is that through these processes, I gradually learn how to ask a research question correctly. I'm sure everyone agrees that we cannot overemphasize the importance of teamwork in doing research. So we need to build up a team with a shared common goal, and that is to carry out good research. In a team, we have mentors who can advise us the direction, and teammates who closely work with us from nine to five, and actually much more than that. And also there are members who don't stay in the same institute, but work together anyway. And of course, the team should include, well, at least, ideally, our life partners. My wife is very supportive of my dedication to research work. If I had to spend so much time and effort in doing research, and she didn't approve of it, you could imagine what problems we would have. I think what glues the whole team together is mutual trust and enjoyment of being a member in a team. See, what a good time my research coordinator had when we dined together. And I'm also sure that no one here will deny the importance of collaboration in doing research, perhaps especially for clinical research. For that reason, I have to be very grateful because along the way, I have met so many people who are willing to help me with or without formal collaboration. Around the world, there are so many friends, collaborators, advisors, and someone whom I view as mentor for her willingness to travel herself to encourage me and share her insights in various aspects of life. And I think that's a very important part of my research. So I'm very grateful for that. And I'm also very grateful to my wife, who is a very good friend of mine. and I thank my patient enough for their trust in us. For example, this gentleman kindly agreed to be admitted exactly on his birthday according to the schedule in a clinical trial. Patients are really the key components of clinical research. All right, I was asked to talk about where I am now. Well, now very far away from the beginning. So far, I haven't been cited for more than a thousand times per year, and I'm still trying to accomplish some work that can make me a fellow of ASLD someday. Ah, how my research career will be in the future? Who knows? I don't. What I know is together with my team members and collaborators, we will strive to make a difference to the world by doing good clinical research. And I wish when the moments arise and it's my time to leave, I can say to myself without hesitation that I have not lived in vain. Thank you for your attention. Thank you very much, Dr. Xu. And just wanted to ask all the audience that if you have any questions for our speakers today, you are very welcome to leave your question in the Q&A box. It's in the bottom of the window. All right. So I guess I will keep the ball rolling. And so all the speakers have emphasized on the supportive environment and mentors, and Dr. Li and Dr. Xu have shared experience in approaching mentors outside the Institute. I was wondering if Dr. Li and Dr. Xu has any tips in exploring and approaching other mentors, not just in the Institute, because I guess a lot of the audience, they may think that in the Institute, they may not be able to find a mentor which fits their interests. So how would you suggest when, if they want to explore and approach mentors outside the Institute? Can I go first? You know what? It takes courage. It takes courage. You know, when I, with my passion and happy, I was trying to find out who are the experts, the gurus in the field. And attending ASLD and listening to speakers, you just have to find someone that you think could potentially provide you the guidance you need and you reach out. You have to take the courage to take that step and be assertive. And, you know, the mentors are the ones that want to help the younger generation. They are so generous and so gracious and they want to help. So that's all I can say is just take that step of, hey, I see this senior who I think could help me. I'm going to reach out to them. I agree with Hannah that it takes courage to introduce myself to some guru or some experts in the field. But I think also we need to find out a common interest. For example, I know these experts, I know this master is, you know, is as good as I have been, particularly in terms of some research that I can contribute in. Then I, perhaps I can say, for example, years ago, we tried to study the predictive models for patients who stopped nuke. We tried to predict who will develop clinical relapse and who will not. And the new biomarkers, hepatitis B correlated antigen, CRIG comes up. So I introduced my, well, through Professor Nguyen's introduction, I collaborated with Professor Tanaka in Nagoya City University. So we can work together to accomplish some work. But I agree with Hannah that the first step is courage. And the second step is to know what field or what common interest you and the collaborators or the experts can do together. So I'd like to chime in also as a more sort of senior or older researcher. And I completely agree with what Hannah and Holden have been talking about. So you have to do your homework so that you are reaching the right person. Someone who really is, has the expertise or experience and working in the area that you're interested in. So you're not knocking on the wrong door and you should be prepared. So you don't just go knock on the door and say, hey, I need some help, give me some help. You have to specify what type of help you need so that some people can figure out, am I able to help you? Or you're asking for something that I can't do anything. And the senior people are also very busy. So they have to, when people now, I get a lot of people knock on my door and I sort of say, yeah, I want to help some people, but I don't have enough time to help a million people. So who should I help? I want to help people who would be helping themselves. So you have to convince me that you're serious, you're prepared, you know what you need, and you're going to do your part because I don't expect that you give me anything in return. But if I give you my time and my energy and my expertise, I expect that you do your part. And you're not just sitting there waiting for someone to give you stuff. You have to give something back and that would encourage that relationship. Now you talk about courage. Yes, I mean, some people might say that, well, Mindy and I might be sort of very intimidating. How dare I sort of reach out to them? If you don't have the courage, you might actually ask someone that you know, someone in your institute to make that introduction. And I do that a lot of times because I have junior faculty and fellows who need help from other people. They don't know them. And I sort of I'm sending introductory message, arrange an introductory meeting. And once that's connected, then of course you have to do the rest yourself. Thanks, Dr. Lok. So courage, I totally agree with Hannah and like Dr. Lok just also confirmed, it takes courage. And in my case, I can share that. It took me many years to talk to Dr. Lok. So better late than ever. That would be what I would like to share. We have several questions from the audience now. I like to start with the next one. So one is from Dr. Rachel Chan from Taiwan. And her question is a very relevant one and probably affect all of us is how to strike a balance between research work, clinical work and being a mom of young kids or a father of young kids, et cetera. So this I would like to open to all the faculty, but I just want to share briefly so that everyone can also share their experience. So I have two kids and it's a constant thing that you need to deal with every single day, drop them off at school, pack lunch, you know. So I think for me, the key is organization. You just have to be very organized and learn how to compartmentalize, you know, like this is what, so I actually have like list, to-do list, so this list for my patients, you know, today I need to call this person, check this lab, book this doctor for my patient. And then this list is, you know, I have a deadline, you know, to turn in my lecture slides, you know, and this list is I need to do for my kids, I need to call the cello rental place to change it to a bigger size because she's growing up. So I think compartmentalization and also staying organized and I think that's the key and I wouldn't know how to do it any other way, at least for me. Any tips from you, Hannah? Well, I don't have children, but still balancing the life of personal life and work life is still a challenge for sure. And I think maybe you hit it on in terms of just organization and really it's a fine balance. And sometimes you just have to say no, you know, sometimes we wanna say yes to every opportunity, every project, every whatever. And as I get older and as I learn that time is so limited and so precious that we really have to prioritize the things that we really, that are important for us. And so learning to say no to things that really are not our priority and it's okay to say no. I also don't yet have children, although hopefully in the future, but I think the one piece of advice that I've previously heard that I think is very important is balance is false. It is not actually possible to achieve balance. You're not gonna have 30% in your bucket of research, 30% in clinic, 30% with your children. So I think you have to sort of not, you have to do away with this idea that you're going to achieve balance and really pick the things that matter to you and spend the amount of time appropriate to how much they matter to you. And then you'll just feel, I think you'll feel better about the whole situation. Well, I also don't have children, but I mentor a lot of people who have children and you can't do everything. So hopefully you have a partner that really is truly a partner and share with them some of the work, because if you end up having to do everything yourself, it becomes very difficult. And sometimes you have to give up the ideas. Okay, well, you're supposed to clean the bedrooms or whatever. When there are other deadlines, you just have to say, well, you know, this can be pushed back to next week. As Kelly mentioned, I mean, at that moment, prioritization, but being organized. And everyone has mentioned that to be successful, none of us can do so with working 40 hours a week and not working weekends, not working evenings and taking six, eight weeks of vacation. It's just not possible. I do most of the work over the weekend because during the week, I can have eight Zoom meetings in a day. And I do the rest of the work in the evening or weekend. Every Friday evening, I drop a to-do list and I circle in red the ones in which the deadline is within the next one or two weeks. Because I know that I'm usually overly ambitious because I say yes to too many things. The to-do list would actually take four weekends to finish. And even though I decide to give up on everything, there's no way I can finish, but I pay attention to the ones where the deadline is really coming up. And I take great satisfaction when I cross each item off. That's really very, very rewarding. But you have to really figure out what are the things that you need to do. And Mindy mentioned the art of saying no, which for a lot of young people find it very, very difficult because you worry that once you say no, people would cut you off. Well, if you're asked to review a paper, you don't dare to say no. A senior person asking you to serve on a committee, you don't dare to say no. At some stage, yes, I mean, the first time you're ever asked to do anything, try to say yes, because this is the first time. But if this is the 10th time and you're already doing eight different things, you have to start making decisions. And some of that, you have to say no, but learn how to say no very diplomatically so that some people won't feel hurt. You remember when we used to have the face-to-face meetings whenever people come up to the mic and ask a question? They always say, this is a fantastic talk and blah, blah, blah, and then, but, okay. So you don't start by saying, no, I can't do this. You always thank people for the honor, for recognizing you and for inviting you to do something. However, due to the fact that you're already over-committed, I cannot. So oftentimes I would say, I would really love to do this, but I don't think I'm able to deliver quality work within the timeframe that you expect. So therefore I have to politely decline, and I hope that there'll be opportunity of working together again in the future. So people really then say, oh, all right, this is okay. All right, yeah. Thank you very much for the very important response. I mean, yeah, we have next few questions and the second and third question are from the same person. So I will just say them together. So what are some initial grants you would recommend for young investigator to begin with? And do you think that the knowledge of basic statistic is important for clinical researchers? Any programs you recommend, or little knowledge is dangerous thing and just stick with a seasoned statistician? I will pass this question to Kali because she has a very updated experience in grant application. And also she mentioned about some of the statistical programs. So yeah, Kali, please. Sure. Yeah, I think that's a great question. It's really tough when you're applying for your very, very first grant. You do wanna start small because grant writing is a beast. Let me tell you, it's a credible amount of work. So the very first grant that I ever applied for was actually a American College of Gastroenterology pilot grant. So these are small pools of money, usually between 10 and $30,000 to support a very small and focused project. And most of the foundations have one, although I will say the ACG is probably the most robust of the GI societies that provide these types of grants. And then the second place that you should really be looking is inside your institution. So here at USC, I have pilot feasibility grants from our liver center. So we have a liver center that has these small pots of money for researchers. There's also sort of institution-wide pilot grants and things like that. So that's definitely where I would look first, those two places. In terms of statistics, so it really depends on what you're doing. So if you're doing, let's say clinical trials, yeah, you probably don't, other than a basic understanding of the most foundational pieces, you probably don't need any deeper knowledge, maybe some translational work you might not need it. But for what I do, for example, where I take large databases and I'm doing complex regression and modeling of predictors and outcomes, I think you want to have some deeper knowledge for two main reasons. The one is to really understand your output and be able to interpret it to the best you can. And the second thing is you'll see a lot when you're, say, reviewing papers or reading other papers, having just a little bit more deeper understanding of the methodology, I think really takes you a long way. So that's what I would say. I would say it depends on what type of research you're doing in terms of how much statistics you should have very well. Thanks, Kylie. And I think that to follow this up, maybe we could discuss after this, maybe we could collate a list of potential grants that residents may be eligible, fellows may be eligible, and maybe post it or make it available, at least for our sake, so we can follow this up. And thanks for bringing up this question. So the next question, I would like to bring it up for everyone for discussion, is a question from Dr. Chow Wu from Nanjing, China. And this is a great question because he's asking that, you know, how young scholars from mainland China can participate in the training programs of ASOD? And this is a great question, not just from mainland China, but HPV is a really global disease. So I would like to expand the question to even be beyond that, is how do investigators, young scholars from outside of U.S. in different areas could be more involved? So I would like to ask Dr. Lok, could you help with this question? Well, there's one silver lining from the pandemic, which is a lot of meetings and courses are now online that it doesn't matter which part of the world you're in, you can have access to. For example, the LIBER meeting in November of 2020, if you registered for the meeting, all the talks were online until, like actually it will still be online and available for the next few days. And so that makes it very easy. And the ASOD meeting include career research workshop and all these other research training sessions. ASOD also has a number of connect programs. We recently did one with mainland China. Hopefully you attended that one. And we did one with Taiwan. We did one with Turkey. Some of them are really updates from the ASOD meeting. Some of them focus on clinical research training. So there are a lot of these sessions that are available online that you are able to attend or there are recordings that you can subsequently attend. And I think that these are some of the things that we can, if we're interested in more health related, we can certainly plan some of these in the future. Thank you, Dr. Lok. And another venue to get involved, not just for training, but in general to participate and contribute is to join a SIG. So if you're interested in HEPDI, I hope you are because you are joining this webinar, please come and join our HPV SIG meeting. We have this at every ASOD, whether in-person or webinar, if we are Zoom meeting because of COVID. And we hope to see more people from North America and from mainland China, from all over the world. It's really a global disease that we all need to work together to make it. And Dr. Yihui will bring the next question. Yeah. So next question is from an anonymous attendee. So some of us are currently doing research and a master or PhD in university surrounded by professors, mentors, and research opportunities. However, when we finish our training, we might be going back to areas which lack researchers or opportunities. So how can we make sure we can maintain or continue research when we're back in these areas? Well, once a trainee, always a trainee. So all my fellows continue to be my children. I don't disown them. They would have to do something really bad for me to sort of kick them out of the family. And over time, I actually get to know their own trainees because some of my early trainees are now mentors. So I have grandchildren. And recently I was introduced to my great-grandchildren as well. I am old, but not all that old. But the thing about academic family is you don't need to create a next generation in five to seven years. You don't need 20, 30 years to create a next generation. And hopefully, if you have actually developed a good relationship with your mentor, that relationship lasts for life. And your mentor can also introduce you to other mentors back in your home country or in your local institute. We talk about collaborating or seeking advice from people outside your institute. Sometimes it is true that due to circumstances, you go back to a smaller place where there may not be expertise in your area, but the world is so connected nowadays. Everyone is just one click away. Yeah, I would like to second everything Dr. Locke said. And I have also had the privilege of having similar relationship with my mentees. So I keep in touch with almost all of my mentees, even the one who become dermatologists or become anesthesiologists. I still hear from them. And sometimes I'm asked to review their employment contract, even for anesthesiologists. So it's like you become part of the family. And I don't have great-grandchildren yet, but I have grandchildren now too, that now I'm seeing their children, the children of my mentees are now working with me. So it's really, so you can have a research mentor that is just a project. And after you're done, you're done with each other. And that is one type of relationship. But I think that the one that is most meaningful for all of us is a long-term relationship, someone who cares not just about getting the paper done or the project done, but about your career, and not just your career, but your life overall, because we cannot be a happy person if we have a successful academic career, but a completely messed up or unhappy personal life, right? So it's everything is together. And there's one question that is not directly on Hep B, but there's a question on translational research in HCC from Dr. Daniel Millian. So what is the most important translational research topic in HCC, possibly related to HPV or similar? So anyone has, I thought that biomarkers is one of the key things, because one of the major problems with HCC now is that we diagnose too late. So whatever treatment we have would be limited. So Kelly, you're working on HCC now. I am, I am. I'm not translational, but I think biomarkers too, Mindy, but I do also think not just diagnostic, but also prognostic. And also using biomarkers to differentiate those that are gonna respond to different kinds of treatment. Because our treatment for advanced HCC is just incredible now, right? We have so many more new options, we don't really know which ones work in which types of HCC patients. So I think that's gonna be one of the next challenges. And then combination therapies. Oh, I guess maybe that's not translational, it's more therapeutic. But I think that's part of it, figuring out which patients are gonna benefit from combination therapies, so local as well as systemic, and how we're going to best fit the treatment to the patient. It's really personalized approach. So that you don't just say, okay, we have some three options, and you're gonna get A, you're gonna get B. You really characterize the patient, and then you sort of choose the right approach. But there's also a lot of interest in applying AI, artificial intelligence. And we've been involved in a couple of projects where you mine a lot of data. In addition to the clinical data, imaging, because this is a very rapidly growing field. We now rely on the radiologists using a human brain and a human eye, and say, yes, I see something. I don't see something. What is RL4, it's not RL5. But a different radiologist might see something a little differently. And there are all these subtleties that we can actually mine them and put into computer algorithm, which for one thing can be much more consistent. So you're not relying on, well, who is the radiologist reading your scan? And whether it's reading on a good day or a bad day. But there are also so many features in each scan that the human brain cannot process. The human brain focuses on five, six, or seven features, but there may be hundreds of features, which when you combine them together would allow you to differentiate them. So we have a project using AI technology to circumcise whether indeterminate nodules can be declared as HCC earlier instead of wait for three more MRIs before we can be certain. Right. Thank you very much for the answers. And yeah, I see that we have last questions for the day and it's from an anonymous attendee. Are you passionate in research all the time? Have you ever questioned yourself? Why do research? Why not just do practice? I'll start. Like many of you, I did not start thinking that I would do research. During my training in Hong Kong, I thought I'd done well. I mean, there weren't too many people doing research. I thought I'd just be a good clinical doctor. And in fact, when I went to London for my fellowship, I thought I'll just learn from the queen of liver disease, how to take care of liver patients. But because I had two years there, I thought I would like to sort of learn and work on a research project. And some of you have heard of that story. My first meeting with my potential research mentor was, what do you want to study? How do you tackle it? And what do you expect the output will be? I had just finished my residency training. I had just arrived at a foreign country. I was not able to answer any of those questions. So I said, I don't know. I'm just here to learn. And I was told to go home and think about it. And I basically got rejected a few times. And the more I got rejected, the more determined I was to prove that I wasn't a piece of garbage, that I could be trained, and I could get something done. So actually that strengthened my determination. And once I got started, you get the positive reinforcement, but life is always full of ups and downs. We all have papers rejected, rights rejected, things that didn't turn out the way we want it to be. And ultimately, it's really your passion. So that's why picking a topic that you're interested in. And we also have physicians taking care of patients. And sometimes you go back to your patients. Why did you get involved in research? You want to help your patients. You want the next patient that you see to have a better outcome. And they remind you why you shouldn't just give up. Thank you very much, Dr. La. That is really inspiring. And so, yeah, that comes to an end to our webinar today. We are so grateful to our exceptional speakers today for their motivations, sharing, and tips on important questions, such as research topic selection, how to stay in specific areas, how to juggle, and so on. So I thank you very much to all the audience for your participation. And I hope our webinar today is helpful for all the audience. Hope you have a great rest of your day slash night and early happy Lunar New Year to all our audience from Asia and stay safe, everyone.

clinical research

career development

hepatitis B

personal journeys

young investigators

passion

mentors

supportive network

patient populations

collaboration