Thank you very much. It's a privilege to be here. So this talk is about being a mentor to launch a research career. But before I can define that term, I want to talk a little bit about where it came from and just lay out a summary of the next 12 to 15 minutes. And essentially, what I'm going to share with you were some of the insights that me and Neil Sengupta came up with, largely through trial and error, as we were co-fellows who taught each other methods, data analysis, and how to write a paper. And over the course of our fellowship, we published about 10 papers together. And we learned a method of how to refine our questions, how to find our questions, and how to attract the input of senior clinicians. And if there's one slide that I'd like to share with you, it's this one. But I'm going to, as we start to build up where these ideas come from, I think we first have to agree on a few concepts. And that is that the mentor has the same respect for everyone. And that is the ideas or input that you receive from a co-fellow, co-resident, are often just as good, if not better, than that which you would get from a full professor. The mentor is open to collaboration, tending to say yes within reason to most of the opportunities that are presented to them. Because even as a supporting actor in someone else's project, you will expose yourself to new ideas and approaches that will inform that which comes from your own inspiration and motivation. And you must view others' success as your own success. And that celebration of others will make the whole process a lot more enjoyable. Now, of course, you do need mentors along the way. And nothing can be said that wasn't already said better by Dr. Annie Kardashian last month in Nature Reviews and Gastroenterology in a paper I'd recommend that you download. But what I want to talk about today is how we define what a mentor really is. And I have a problem with the way that it's conventionally conceived. And that is where we hold that the mentor is typically a senior superior with specialized knowledge that they impart upon the mentee to help them grow. But this is problematic for at least two reasons. The first is that it robs the mentee of agency, self-determination, and the responsibility to learn how to extract what they need from the mentor to fulfill their own specific aims. And two, it's grossly oversimplified. Because the reality is that we need multiple mentors. In a field such as ours, we undergo a rapid metamorphosis where on day zero, we hardly know what we're doing. And within a matter of years, we are submitting our own independent grants. And the truth is that there's no one person that knows what it's like to be in your shoes today or tomorrow. And the steps that will be required to get from zero to one or three to four will require insights from people that are markedly different in training and experience. And this creates a tremendous demand for mentoring experiences. But unfortunately, the supply is functionally restricted in what I call a mentorship desert. Even where would-be mentors are numerically plentiful, there are reasons why our access to them may be limited. So there's a tyranny of the RVU, whereby increasing financial pressures have rendered clinical responsibilities more and more important so that we just don't have time for mentoring activities. The senior clinicians around you have gotten where they needed to get. And now they're doing multi-center randomized trials. They're creating their own knockout mouse. But you've got to get on base. You need early hits to establish a reputation and a foothold within your own field. And the knowledge of how to get that kind of stuff done within the context of your residency or fellowship may be lost to time for many of the mentors around you. And not all mentors are created equal. You have to ask around and find out who has been successful in fostering the success of others. And that is not only because of the mentors, but also because not all mentees are created equal. And it is not uncommon for a mentor to be ghosted on the eve of a deadline for a review article that they only agreed to to help out a mentee. And so with those broken hearts, otherwise good mentors begin to hold onto their time and are less open to new experiences. So you need to work on the skills that will set you up for success when you have the opportunity to work with others. You cannot work alone. You do depend on others. But we have to focus on building our own skills. And that is a philosophy that Sengupta and I call menteering, which is the set of skills by which you learn to navigate the research system and become resourceful. By nature, menteers are always curious, scanning the horizon, looking for research questions. And they find them in part by reading constantly about every patient they see, every experience they have. They look through the methods section and ask why it was used for a given paper. They read the introduction and follow the references back to the original description of the condition or procedure so that they understand the gaps in the field and can define where they can have an impact, forming their own research questions. They do not ask for a project. They come up with something that will get them out of bed. And to get it done, they seek out collaboration from friends and from peers. And even if they're not being helped by others, they are learning from others, asking what people did, what worked for them. And they are benefiting from those experiences, as even if they're cheerleaders on the sideline. And they embrace failure. Rejection is an opportunity for introspection about how you could have better phrased the question, the email to a would-be mentor, or the methods that would have helped you get a review at a given journal. Menteers view meeting a deadline as the first and best opportunity to set a reputation as a doer and a task completer, and never over-promise and under-deliver. Menteers make their research questions clear. There are two main methods by which I'd like to leave you today for you to develop in order to help clarify your research questions for sharing with others. The first is the one pager. You write an email to a friend or a possible mentor, and it goes like this. This is the field that I'm interested in. It is meaningful and important for these reasons. This is the research that has been done. This is the gap that I would like to address. Here is my testable hypothesis, my research question that specifies exactly what we need to do with a data source that I understand where it could be accessible, and a plan that potentially has the specific types of variables that you'll need, and I'll describe that later on. The second way that we have for clarifying our ideas is to give a talk. As an academician, as a resident or fellow, you're always being asked to give a talk. So I'll give you an example. When I was a second-year fellow, I was asked to give a talk to a hepatology conference about something controversial, and I noticed that everybody was poo-pooing the ED's use of ammonia levels. So everybody's doing it, but we didn't trust it. What was the deal with ammonia levels? This required a tremendous amount of reading between the lines to figure out that ammonia is associated with the development of encephalopathy, but it's confounded by many other factors. In order to refine your ideas, you must build a team. When you are giving that talk, you will get feedback from others about what could be done, what could have been clarified better, and you'll have a better sense of what resonates with others, potential readers, editors, and reviewers. Just as a side note, menteers always make things count twice, so I published that PowerPoint as a Twitter tutorial five years later. It was just literally cutting and pasting PowerPoint slides onto Twitter. But when I was giving that talk, I noticed that I had co-fellows that were also interested in the topic, and thought we could maybe write a review article. You might like the sound of your own voice like I do, but you need people to critically revise your concepts so that they're going to land well with reviewers. And this could be someone who's a senior clinician, or it could be your friend Gordon, who's a resident, and your co-fellow Vilas, who is an excellent editor. And we were able to take what we talked about and publish a review article about what was missing with ammonia levels that would explain their lack of clinical utility. Menteers are also always curious, and seeking to extend their research with the next potential question. If ammonia reflects not only portal hypertension, cirrhosis, but also CKD, sarcopenia, and the comorbidity of bleeding, it was hypothesized by my co-fellow that potentially this was a biomarker of risk. That we could do this as a retrospective cohort study, looking at everybody who had an ammonia level and to see what happened to them. If you're about to do a study, a menteer always anticipates and overcomes rate-limiting steps. The two of which I'd like to discuss right now are the IRB and data collection. Everybody gets worried, oh, the IRB's gonna take so long. Ask a friend who just had something approved. Someone's already done the work for you. All that boilerplate that the IRB needs to see can be done for every study. I don't recommend copying and pasting clinical notes, but for IRBs, please go ahead. You're already writing the review article, that's your protocol. Everything you need to say about HIPAA waivers and so forth, someone else has already written for you. You rely on your friends. They can be co-authors. Data collection requires an organization of your thoughts so that every time you open up a chart, you know exactly what you're going to get. So the best way to think this through is to create shell tables. You create a table one and you say, I'm going to describe the population in the following ways. Well, what do people want to know? Well, I can tell you as a second-year fellow, I didn't know what people wanted to know. So I read as many papers as I could. I learned we needed to know child class, we needed to know MELD score, etiology of liver disease, and acute on chronic liver failure, whatever that was. It told us exactly what variables we had to extract from the chart so that we knew what we were going to do before we did it. And the result was a paper of which we were proud, but was in truth a celebration of the teamwork that we had solidified. Mentors have fun. This is about learning. This is about growing a career and helping to grow others' careers. And when you, like I did with Vilas or Neil Sengupta, when you get together and you both benefit from something and you watch your careers grow, you will make friends for life. You are building a family. And this is true in figurative and literal ways. This is a bonding experience that you will never forget. Here's me actually building a family. This is a picture of me submitting my K award. You can tell this, I have work-life balance, but it requires ingenuity. And finally, mentors give credit. You can't do this on your own, and people should know who helped you. And one of the ways you do that is through co-authorship and supporting other people's projects. People like to talk about the most famous mentor, but the most important mentors that I ever had, the foundation on which I built my research career, are people who, at the time, were at my same level, peer mentors. And after that, you could start to build up to the people that might be more widely recognizable. But the most important thing are the friends that you built it with and the future that lies thereafter. Thank you very much.

mentorship

research career

collaboration

resourcefulness

teamwork