Ep. 19 - Research during Training with Dr. Keisha Mulugeta-Gordon

Join us as we chat with a current fellow about the realities of doing research during residency. She shares about choosing projects, finding the right mentor, balancing research with clinical work, and pushing projects across the finish line. We also discuss how research shapes fellowship applications, clinical thinking, and professional identity. Whether you’re excited about research or unsure where to start, this conversation offers practical advice and honest perspective for  navigating research during training.
Audio Editor: Kaylee Morris

Transcript

SPEAKER_01 0:01

Hi, I'm Kyla. And I'm Mary.

SPEAKER_00 0:03

And you're listening to Hello.

SPEAKER_01 0:06

This podcast delves into the complexities, lessons, and triumphs of residency. Through handed conversations, we want to explore how meaning and connection can emerge from the challenges, chaos, and unexpected moments along the way. It's about discovering the purpose and sometimes even magic woven into the everyday work of being a physician.

SPEAKER_00 0:24

Interviews, and opinions of the resident of the podcast are fully our own, and do not reflect the policies or positions of any institution, organization, or employer. The podcast is for informational and reflective purposes only and is not affiliated with an organize or representative of any official entity. And while we are both doctors, we are not your doctors, and we are not providing any medical advice on this podcast.

SPEAKER_01 0:48

We're excited to unpack the massive meaning and magic of residency with you.

SPEAKER_00 0:53

Stay tuned for more. Hello everyone. Welcome to another episode. Today we are very excited to be introducing a fellow who is a recent resident, so wants to impart some of her wisdom for our podcast. We're very grateful she's able to join us today. I'm here with Dr. Keisha Mulugetta Gordon. Hi, Keisha. Hey Mary. Thanks so much for joining us today. Thanks for having me. Do you want to start out telling our audience a bit about yourself?

SPEAKER_02 1:22

Yeah, so I am from outside of Philadelphia, and I have done most of my training in Philadelphia, and I am a third-year gynecologic oncology fellow.

SPEAKER_00 1:34

Wonderful. Well, we're so excited to interview you today. Keisha, my understanding is that you actually have listened to a few episodes of the podcast and you reached out to us with an idea for a topic. Yes, I did. Thank you for doing that. All right, Keisha.

SPEAKER_01 1:49

So I view you as someone who is very much involved in research and a great research mentor. So I'm very curious to know a little bit more about your journey getting into research and how that kind of started off for you in residency.

SPEAKER_02 2:04

Probably at most programs, but where I trained, we were introduced to research pretty early on in our first year to start thinking and brainstorming about a topic of interest and to ideally identify a mentor by the end of your first year. And I knew coming into residency that I wanted to pursue a fellowship in gynecologic oncology and definitely would need to have some projects by the time it came to apply. So I was thinking about it early on when I came in.

SPEAKER_01 2:30

And was it the sort of thing where you always loved research and you were fascinated by a question and finding an answer, or was it more of something you had to kind of grow and develop into as a part of just a necessity for your career?

SPEAKER_02 2:45

I would say it's a mix.

SPEAKER_01 3:13

So you were able to kind of have a little bit more ownership over the whole research process in residency. Exactly. So if you are someone that's really interested in research but you don't have the exposure and you don't know where to start, what should you do?

SPEAKER_02 3:26

If you're a junior resident, you can always ask your senior residents. If you're considering a subspecialty and you have fellows at your program, you can always reach out to fellows. And I would say I know me and my co-fellows or my co-fellows and I am more like, oh, like we should try and get a resident on our project, et cetera, spread the wealth and the knowledge. But if if you feel like you don't have a senior resident you can go to or you don't have a fellow, I think going to your program director who has your best interests at heart and wants you to succeed and just let them know what you're thinking, what your interests are, because they know everyone. So they might be able to be like, oh, this this person's good for you. Why don't you get coffee with this person? And they may be wrong. And if that's okay, just do the process all over again.

SPEAKER_01 4:11

Yeah. And even getting coffee with that person and finding out that isn't a fit, they might know somebody else. Exactly. Exactly. What are some misconceptions that you think people may have about doing research in residency?

SPEAKER_02 4:23

I think the biggest misconception in residency is that you have to say yes to everything. And I definitely felt that way in the beginning as I wanted to make sure I was a strong candidate when it came time to apply for fellowship. And in the beginning, I found myself wanting to be a part of everything, but also realized early on that was not possible. I think a big misconception is that you, in your mind, somehow gonna have time to do all this in addition to learning how to be a really strong OBGYN resident and also to maintain your personal life outside of work.

SPEAKER_01 4:54

Yeah, no, that's I'm really glad that you brought that up because that's something we've talked about in previous episodes of like being able to say no, and that that's also kind of a mark of professionalism, being able to communicate what you are capable of participating in well. And also something we've talked about is kind of like the seasons for things. Like sometimes based on your rotation, different things, you're in a season for being able to do lots of extracurriculars and do research. Exactly. Um, so I think that's a really important skill and the thing to talk about with trainees early on. When it came time for you to say yes to a project when you had the time, what kind of factored into your decision as far as saying, I actually do want to be a part of this project?

SPEAKER_02 5:35

I would say it was a mix of things. I had a very close mentor that ended up leaving to join a different practice during my training, and I was planning on working with her for my project, and things were very slow to get moving. But then when I had brought up an idea that was more med-ed focused, and I was a little hesitant to not pursue more of a GYN oncology project as my at least my resident research project, I had me reached out to one of my mentors, Dr. Diosino Kelly, and brought up this idea that I really wanted to look at the exam under anesthesia consent, because that is just what we do as OBGYNs. The exams we do on the OR are critical to how we plan to proceed in the operating room, and I was very interested in looking into that. I felt enough motivation and that everyone in my research bubble for this project felt it was important that I felt the drive, like, yeah, I could I can do this project.

SPEAKER_01 6:28

Having support makes all the difference for sure, and resources as well. You kind of mentioned just now kind of coming up with an idea on your own, but with other projects that you've been involved in, did you like actively seek those out? Do people just reach out to you?

SPEAKER_02 6:43

I consider myself definitely a go-getter, and when I have an idea or something that I really want to do, I know I'm going to go after it. And I would say I definitely experienced that more so in fellowship during my research year, which every guide on fellowship requires their fellows to do either one or twos, depending on the program. For me, here it was one-year fellowship, but I was able to pursue my master's, and through that program, I was able to meet people that I never thought I was going to meet and completely change my research topic of interest. And through that, I was able to get support to do something that I've never done before, and I would not have been successful without the people that helped me through it.

SPEAKER_01 7:23

And I think something that would be helpful for listeners who are early on in their training is figuring out how to find a research mentor and what qualities or things they should prioritize in choosing a mentor.

SPEAKER_02 7:36

Yeah, no, I I would definitely agree. I one thing I did my research year when I wasn't clinical was I had weekly calendar reminders. And I know weekly sounds like a lot, but but trust me, there are times when you want to to meet weekly, and other times you're like, hey, we can meet in two weeks. But having that time carved out meant I wasn't chasing my mentor, and my mentor wasn't chasing me. I knew every Monday at three o'clock we were going to meet. And if we were just meeting to say, hi, hope you had a great weekend, nothing to add, then we would say that and be done. But it held me accountable and it also held my mentor accountable. I think, especially in academic medicine, and you have talked about this on your podcast, we tend to want to do so much, but then it's hard to actually do all the much that we're taking it. And so I I felt that that's how I was able to expect my mentor to be present for me was to making sure that she was able to show up for me at this time every week.

SPEAKER_01 8:30

For like selecting who you wanted to be your mentor, how do how should people go about that? What are some tips?

SPEAKER_02 8:36

So I think we naturally gravitate toward people of similar interest or for us in medicine, people that are either in the same field. And I will say my I love the mentors I have had with my specific my gynec mentors, but I would say I would not have been able to flourish with my fellowship project, at least without mentors in other departments. And so, you know, I would really encourage the listeners to if you have a project idea, it's okay if someone in your department or division isn't doing that work, or you don't think there's an expert, there is an expert at your institution and they're probably in another department. They may not even be physicians, and then you'll be able to grow and learn from someone who has completely different training. And for me, I know that is why I've been successful.

SPEAKER_01 9:26

I think going back to something you said that um even if you have an idea and you just don't even know where to start, or even if you think it's silly, there's nothing wrong with like reaching out to a mentor or trusted support to just say, hey, I have this idea because you might end up having a brainstorm session and then it turns into something totally different that you didn't even imagine, but that you love even more.

SPEAKER_02 9:49

Exactly. And and honestly, um I'm also you know applying for jobs right now for a big girl job, and I've brought up potential research ideas during my job interviews, and more times than not, they're like, wow, that's a really great question. And I'm like, yes, don't steal it from me. But you know, I'll do it when I come here. And so I I totally agree with that. Like even if you're just bouncing off ideas with someone else, that allows that research idea or topic to grow and flourish. And who knows, whoever you're bouncing ideas off with, they can be your co-collaborator. Or if they're more senior than you, your PI, or can help network and guide you to the next person that can help you.

SPEAKER_01 10:28

Yeah. And I think probably at this point the listeners are dying to know what kind of research you're involved in.

SPEAKER_02 10:35

So if you wouldn't mind sharing. So I will say, at least in residency, no surprise, I did a lot of chart reviews. And honestly, that is somewhat easier to do when you have such a crazy work schedule. But in fellowship, I decided to take on learning qualitative research methodology, which, if you know me outside of this, I'm a big talker and a touchy, feely person sometimes. And so I really wanted to, in my field of GUI oncology, learn about the illness experience that our patients with cervical cancer live every single day. And through that work, I've already been able to come up with additional research questions, just learning about these experiences. My residents are interested in doing projects. Even nationally, I've presented this work, and there are residents across the country that have reached out to me and wanting to do work similar to this. And so it was just an idea, and now it's become so much more.

SPEAKER_01 11:33

That's incredible. Would you say doing this work was like harder than you anticipated?

SPEAKER_02 11:38

Oh, absolutely. I find myself feeling a little bit of imposter syndrome with my research because I think we're used to seeing a p-value. And I think every part of medicine is very uh evidence-driven. And in G1 oncology, we we love to see our trials, our GOG trials, we love to see a p-value, what's their overall survival, their progression free survival, and all that's incredibly important. Um, but to me, I think none of that matters if my patient can't tolerate this treatment or if my patient doesn't have access to this treatment. And so I I found qualitative work just for me to interview 21 patients, find them, and this doesn't include my patients that ghosted me after setting up the team's appointment, I know. To do all this work and to code, listen to it, make my my interview guide. All that took me about a year, and I interviewed 21 patients, which an N of 21 doesn't seem like a lot, but it is a lot, and it's the most meaningful work I've I've done.

SPEAKER_01 12:40

Do you feel like it has influenced or changed like how you'll practice clinically?

SPEAKER_02 12:46

Oh, oh, absolutely. One thing that we need to be better at is providing the social support that our patients need, especially our patients with cervical cancer who tend to be much younger than our patients with ovarian or uterine cancer. And I'm I'm speaking specifically within GYN oncology, the three big cancers that we see. But a lot of our patients are dealing with the side effects of either surgery or treatment, whether that's chemo or immunotherapy or radiation, and we don't have the resources to support them in every other way, such as their mental health, the sense of loneliness and isolation that our patients feel. And so from this work, I'm like, wow, I like we are not enough asking the patients how they're doing, aside from like common side effects from treatment.

SPEAKER_01 13:30

And then you were talking about kind of all of the things that it took over that year to like make this project come to fruition. What sorts of skills do you feel like you gained from doing qualitative research specifically?

SPEAKER_02 13:46

So I think most important is just realizing that there are these themes that I thought would be harder to pick up. Um, but when I was working with my my co-coder, which if you do qualitative work, you'll see that you have to have a co-coder ideally to see if you guys share common ground and are interpreting what your patient or whoever you're interviewing, what they're saying, aligns with what someone else who's reading it, if they're thinking the same thing. And so I I thought that was going to be really challenging, but pretty early on I realized we were thinking the same exact thing when we were going through these interviews. And so I thought that was really exciting. You know, I did the interviews, my co-coder didn't do any of the interviews, but she was still able to feel and see what the patient was saying without doing any of that.

SPEAKER_01 14:32

Yeah. That just made me think, I feel like that's a transferable skill clinically. Even if you're like in a room with a patient with a team and you interview one person's interviewing the patient and you all listen to what the patient is saying. And this is making me think about even today, like a clinical encounter with the patient who, after we talked with the patient, I was like, We've seen this patient all week, and I'm now getting to the point where I actually don't think she understands what it's gonna be like when she goes home and the kind of support she needs. And like other people on the team were like, I was thinking the same thing this morning, and like I don't know, taking a moment to actually like process and interpret what how patients are responding to the questions that you ask. Absolutely, absolutely. So, how do you see research in your future? You're applying for jobs, you're like almost done with training. How is research going to be incorporated into your career in the future?

SPEAKER_02 15:28

That's that's a really great question. So, as a geo oncologist, for those who may not know what a geoanycologist is, um, we are a really interesting subspecialty in that we um are surgeons and we're generally in the OR two to three times a week. Some of us also give chemotherapy. Besides that, though, we're mainly surgeons and then we see our patients in the clinic. I, in the long run, would really love to incorporate qualitative work into clinical trials. For a lot of our trials, especially our phase three trials that end up leading to new FDA approvals or really changing the standard of care that we provide for our patients. We are always want to know how toxic is this medication, and and patients will fill out different scales and PROs, which are patient-reported outcomes. Um, but for me, I really would love to somehow incorporate qualitative work into clinical trials, whether that's doing focus groups on a subset of patients. And I I've already put some feelers out with some guy onks who are primarily trialists out there, so I hope they respond to my Facebook message. Um But that, you know, look out for me in 10 years. I'm gonna be on that podium talking about what my patient said to me, getting this experimental drug.

SPEAKER_01 16:42

Yeah, I love that. I think that's excellent. I feel like that's also kind of like applicable to contraception, right? Like how many times has a patient said, like, well, I have this side effect, and my friend does too. And then we're like, well, the research shows that that's not true.

SPEAKER_02 16:56

Exactly. It's not on the FDA label, or it's not, you know, it's not at least for us in in oncology, you know, the myelusuppression, the anemia, you know, other toxicities, and it's like all that is incredibly important. But like, if that's not what's like making or breaking their day, it's not that I don't care. I just like want to hear what the patient is saying.

SPEAKER_01 17:17

Right, a hundred percent. So we've kind of looked to the future, but kind of looking back to the past, if you had any advice for an intern, what would you tell them as they kind of start to get involved with research?

SPEAKER_02 17:32

Well, I would go back to what I said in the beginning, is it will be super intimidating to say no, but if you're feeling too overwhelmed, you don't have to accept a project. You can always say, not now, maybe in a few months, or let me get through this rotation. I'm still very interested. But if you are going to run forward with a project, know that it's okay to have speed bumps along the way, whether that's getting your IRB in, if it gets rejected, having to make changes or modifications and get it back in. And then I would say once your project is there, don't be afraid that it's not going to get accepted if you try to publish it or that you have to make all these changes. Because I will say for me, I've had plenty of papers rejected, and the comments are so helpful. And I will say, just yesterday I found out a project I worked on in my masters after being rejected from three journals was accepted into its fourth journal. And we're so grateful, but we're like, okay, like that's perseverance. We kept saying, like, and it's on DEI, and we're like, this is not gonna make it right now. Um, and it's qualitative, so look out for it. But I was like, okay, this feels so good, all this work that we did, and now it's it's gonna get out there, even though it took us a year and a half to to get it accepted. Wow.

SPEAKER_01 18:54

Yeah, I think that's important for people to know. The research process is very long. Uh huh. Um, even after you submit something, right? Like someone has to read it and it goes through all these different it is a lot.

SPEAKER_02 19:07

And being on the other side, I've have done some, I for a few journals will like go through papers and see if they should be accepted versus, you know, make some changes. And even then, like I know I'll get like three email reminders before I go in and like read the paper. And so just knowing the it is a very time consuming and for people that are impatient, uh impatient like myself, it's a humbling experience because it from submission to acceptance could be like six months, and that's that's just how it is.

SPEAKER_01 19:37

Yeah. But I think it's important for people to know too, like if they are trying to apply for fellowship, things like knowing like what's the timeline and when should you kind of start being a little bit more serious about finalizing projects or coming up with an idea and moving forward in next steps. If someone doesn't love research, is there a reason to still do it?

SPEAKER_02 19:59

To be honest, I don't think so. Unless, and and I would say if you go into academic medicine, there you know, most institutions will have different tracks. You don't have to be on a track where your promotion is dependent on how much you publish. There are, you know, teaching tracks, more so clinical tracks. And of course, if you don't have research, you know, do your thing. But you have to know as part of being a trainee, you will have to do some type of research. But you can make it fun. You can do implementation science, you can do something innovative, you can create something, simulation. You don't have to come up with this insane research question and then pursue that as your project. It really should be something that you're interested in. And then if it doesn't make you happy and doesn't serve you, then you shouldn't have to do it, don't feel like you have to do it.

SPEAKER_01 20:46

Yeah. Don't overcommit. I think this is a bit of a hot topic, and I think maybe more so when I was a medical student. But how do you handle the conversation around authorship?

SPEAKER_02 20:59

Ugh, that's a that's a really tough question. I will say I've been in a few situations where I may have done a lot of the work in one end, but maybe didn't do a lot of the work on the other end. And I think most important when it comes to authorship, you just have to have an honest conversation. If you think you deserve to be first author, then you say that, even if it's uncomfortable. I think the senior author discussion is also can be a bit uncomfortable, especially when you have multiple senior people working on different aspects of your project. But I think ultimately you have to be true to yourself. And and when you're submitting a paper, you want to be truthful. So if you feel that you did the majority of the work or if you feel like this person did not, then you should feel empowered to to put what you think is correct.

SPEAKER_01 21:49

Yeah. That's so interesting because I've actually never thought about the perspective of the senior authorship. Like you just get the email and you see all the names at the end, and then you never think about that there might be conversations that are happening.

SPEAKER_02 22:00

And no, oh no. And what's also interesting is like being corresponding author is also something that is like a hot take. If you're sharing co-first author, which some journals allow you to do, and you put an asterisk next to their names, one person be the first first author, the other person be the corresponding author. There's a way to make it so that the academic recognition, and I hate to say that, but that's kind of what it is, is still there, but in different ways.

SPEAKER_01 22:27

I think from my experience, especially can remember as a medical student, because oftentimes you are the person who's doing the chart review or the data collection or like reviewing the paper for any typos, that sort of thing. I found it really helpful when residents at the very beginning, like first one, two meetings, is like, this is the project, these are the tasks that need to be done. If you complete this work, this will be your authorship position. Like I feel like for 90% of the projects that I was in, going into it, I knew where I was gonna fall in the list, which is helpful. And I think it avoids like having those awkward conversations where you're like, oh, actually, I just did 50% of all of this by myself.

SPEAKER_02 23:10

And I think you bring up and you've also but like setting expectations, and I know we've worked together c clinically. I know you see my expectation email. I'm I'm not trying to be too much, I'm just trying to keep it real, like these are my expectations, every part of our clinical experience together. And so I think when doing research, it's also the same, like, hey, like I want you to write the introduction, three paragraphs, this is how I want you to do it. This is where, like, that's all I need you to do. If you don't set expectations, then I kind of feel like you're set up for failure in a way. And you're set up for not confrontation, but if not everyone's on the same page, then it makes for a uncomfortable experience. And that happens a lot when we're, I feel, trying to get something published or we all want to contribute in one way or another. But I mean, I think goes with anything in life, and even personally, you have to set expectations.

SPEAKER_01 24:00

I guess going off of expectations and thinking, I guess, more like systematically or structurally, are there ways that residency programs can like improve residents' research experience or things that you've seen that have maybe been harmful for the rest residents?

SPEAKER_02 24:17

I I will say where I trained, I liked that early on we were told to start thinking about a project, maybe start trying to identify a mentor. If you can't, we can help find one. I would say where programs can improve is making sure that residents have appropriate resources, whether that's statisticians or access to the software or how to maybe if they if the residents want to take additional initiative to learn how to use certain software like Stata or N vivo if you're doing qualitative work. And I would say in my experience, I found it okay to work with the our statistician, but I know they're doing, they're working on multiple projects, and so I think ensuring that your residents have access to all the potential resources that they may need because they're also working insane hours and it's what they need to graduate too. And you want to make sure they graduate feeling fulfilled with the project that they chose to do.

SPEAKER_01 25:15

100%. Well, thank you so much for joining us. Thank you for having me. You have been a fountain of wisdom, and I know everyone's really gonna benefit from hearing about your experience in research, and that also you're kind of doing something that's a little bit less traditional with pursuing a career in qualitative research, which I think is awesome. So I think it's time for us to talk about our magical moments. So for me, I'm still currently chief of a service, um, and so now an added responsibility is to be much more involved in teaching medical students and making sure that they feel really well integrated into the rotation. And the service has been quite busy the last two weeks. Um, and a medical student was her very first actual like clinical rotation, first week of her clinical year before she left for the weekend, told me that she really appreciated all of the behind-the-scenes work I was doing. You could tell that I was working really hard to make her feel like a part of the team and that she had like a role and responsibility, and she was very appreciative of that.

SPEAKER_02 26:18

Love that. I feel that my magical moment will build on that, but I would say my magical moment is that this evening I was highlighted for one of clinical teaching awards, which is just an incredible honor. And I received this award as a resident as well, so I'm just happy in my mind to feel that even though the days are long, the the hours sometimes just feel crazy that I'm still able to keep it together when it comes to working with our students because they are our future, and I'm just so honored by that.

SPEAKER_00 26:52

That's awesome. Congratulations. Thanks, Kyla, for that great interview. It was so great to hear from Keisha and hear your perspective on it as well. So we do have a little bit of news that we wanted to share.

SPEAKER_01 27:05

Yes, given this busy season in both of our lives, we are planning to move the long haul to every other Monday releases. So you will still be hearing from us, but just twice a month instead of four times a month.

SPEAKER_00 27:22

There's only so much wisdom we can impart at the end of the day. Thanks for listening. If you have comments, questions, or ideas for a future episode, please reach out to us via email at longcallpodcast at gmail.com.