The StoneRounds Success Camp

Maintaining Proper Bit Speed

(and other tips for young clinician scientists)

Edwin M. Stone

One of the many privileges of working in an academic medical center is the opportunity to share career advice from time to time with bright enthusiastic people who will become the medical leaders of the future. The following comments began as a series of after dinner remarks that I made to some MD/PhD students at the University of Iowa in 1998. Someone at the dinner suggested that I write them down. I added a few things in the ensuing years and these fifteen ideas now represent pretty much everything I know about succeeding in academic medicine.

  1. The basics your parents taught you: work hard, obey the golden rule, put some data in your book every day, read the literature, always join or stay at the strongest institution that will accept you, that is well-aligned with your temperament and values, and that your family situation will allow you to accept.

  2. Strive for synergy between medicine and science in your career. Such synergy doesn’t usually happen by accident -- but can almost always be achieved if its importance is recognized. Synergy is the big advantage clinician scientists have over those who pursue science or clinical medicine alone. Without it, the additional training and responsibilities associated with the combination of research and medicine will always be a negative compared to either alone. With it, a clinician scientist can do things that cannot be easily achieved in either sphere alone.

  3. Develop your own internal compass early in your career. Be honest with yourself about things you like and are good at and things you don’t like or are not so good at. There are lots of people around who will have very strong opinions about what type of doctor you should be and what types of projects you should tackle; but, unless they are very much like you -- and/or, unless they know you very well, their opinions will more likely reflect things they wished they had done instead of things that you should really do. Although at any given time, certain subspecialties of medicine, certain laboratory approaches, and certain scientific problems are very “hot”, in the long run, you will do far better by following your own likes and dislikes, interests and lack-of-interests than someone else’s best seller list. The reason for this is that there is tremendous power and joy in doing something that you like and that you do well.

  4. Have some specific goals for your life, both professionally and personally, at all times. Write them down. Periodically get them out and look at them. Use them to help you make major life decisions. It is OK to change your goals, but you should never be without them. And remember:

    Dream no small dreams for they have no power to move the hearts of men – Goethe

  5. Find one or more colleagues to share your scientific life with. You don’t need many, but these people have to meet strict criteria. They have to be a lot like you so that you can understand them and they you. They have to be honest with you when you ask them their advice and you have to have enough self-confidence that when they are honest with you it doesn’t hurt your feelings. You need to support and promote them as you would like them to support and promote you. You need to try to spend at least 50% of the time you have with these colleagues, ideally 99%, talking about exciting new scientific stuff and you should make sure that you talk about unpleasant stuff only when you absolutely have to, i.e. to enlist their support and advice -- never just to whine.

  6. Develop strong relationships with capable, trustworthy collaborators and as you become a more established scientist, strive to share increasing amounts of credit, resources and ideas with them. Sharing valuable resources, credit and ideas with hard working, smart and trustworthy people is almost always a good investment and almost always allows more progress to be made than working alone. Lead the parts of each project that you are most qualified to lead, and allow others to lead the parts of the project for which they are most qualified. Whenever possible, strive to make “a substantive non-duplicative contribution” to an important body of work instead of striving for the more conventional goal of “independence”. Seeking “independence” for its own sake tends to result in intellectual isolation and unnecessarily small projects. In my opinion, it is far better to be a significantly contributing middle author on a 35 author paper reporting major scientific progress than to be the only author of a paper reporting moderate incremental progress. Of course, it is ideal to be the senior author of the important paper. However, with healthy collaborations and shared leadership, you’ll have a bunch of those, too.

  7. Learn to compete against disease and ignorance and waste instead of other people. Compete against yourself, too, by trying to increase your knowledge, mental toughness, physical stamina, and leadership ability every year. Learn to celebrate others’ success, especially when this success truly moves the ball forward for society as a whole. There is and always will be plenty of important work for everyone to do.

  8. Strive for a high completion to work ratio. It is much better to work on three projects and get them all completed and published, than to work on six projects over the same period of time and not complete any of them. Michael Faraday (1791-1867) said this very succinctly: “Work, finish, publish.”

  9. Try to avoid pessimists, especially early in your career. Although there is undoubtedly some value in a pessimist’s point of view, it is usually a poor trade for the emotional pain and lack of momentum they cause. Prolonged contact with pessimists can make one’s scientific pilot light go out -- sometimes permanently.

  10. Maintain your joy of discovery. When you were born, your innate desire for discovery was strong. The practical realities of adult life tend to blunt and weaken that sense of joy. If you start to forget what the joy of discovery is all about, take a compass, a telescope, or a chemistry set to an elementary school class -- the lower grades are best -- and teach the students something. In return, these children will re-educate you about the joy of discovery, and the creative energy that flows from it.

    Knowledge leads to confidence, confidence to enthusiasm, enthusiasm to success. Success builds on itself. – M.D. Stone, Jr. (1969)

  11. Maintain an awareness of the privileges you enjoy and the societal responsibilities associated with them. Few humans who have ever lived are as privileged as clinician scientists in the 21st century. An average first year medical student has much more money than an entire family in most parts of the world. But, in addition, he or she has the very real potential of eventually managing millions of dollars of public resources contributed by all levels of society and using these resources to pursue scientific questions they find interesting and important. An insecure unhappy pessimist wandering loose in a research institution can make a whole roomful of young clinician scientists lose their awareness of this tremendous privilege -- and worse -- make them feel that all of the minimum wage earners working in un-air-conditioned factories actually owe them something more than a net worth in the upper 1% of the population of their country and freedom to pursue their own scientific interests. As a result, people who are actually among the most privileged people in the world fail to appreciate and enjoy their privilege and also fail to feel any need to give anything back to the society that has given them such wonderful opportunities.

    I feel that the greatest reward for doing, is the opportunity to do more – Jonas Salk

  12. Strive to maintain the optimum bit speed throughout your career. When drilling holes, there are at least two ways to fail. First, one can fail to press against the work and let the drill just spin freely in the air. While easy on the motor, the driller will ultimately be dissatisfied because of a lack of any meaningful achievement in his or her career. At the other extreme, one can load up a large diameter bit and put a ton of pressure against dense wood and amid the smell of burning sawdust and ozone, the motor will fail, permanently. In medical science, the board changes density every day, the bit changes diameter and sharpness every day, and even the line voltage to the drill varies. One must be constantly vigilant to make sure that permanent injury to the drill doesn’t occur, while still striving to drill a lot of pretty big holes. One must recognize the signs of dissatisfaction at either extreme, spinning in the air or excessive coil amperage, and respond appropriately. Good self-awareness, a close relationship with your family, and a close honest colleague are essential to be able to do this well. It is especially important to realize that people more distant than your family or close colleague, e.g., your immediate supervisor, the NIH, the journal you review for, etc., are useless in helping you determine proper bit speed and such individuals will frequently encourage you to apply unsafe levels of pressure to the drill.

  13. NEVER feel sorry for yourself. There is no time. You have been chosen by society to help people. There is too much important work to do to waste even a single hour feeling sorry for yourself. Go take a nap or a shower – get on some clean clothes or scrubs -- and shake off whatever personal injury, insult or disappointment you just experienced. Get back in the game.

    Even if your grant doesn’t get funded, or your paper doesn’t get accepted or you are sitting alone in a hotel room with no room service, no one to join you for dinner, ten inches of snow outside OR all of these at the same time, you are still one of the most privileged people who has ever lived. You have had more attention and more resources devoted to you in the past year than most people on earth have devoted to them in their lifetimes.

    If these altruistic reasons aren’t enough for you, how about this: do you want to succeed? Your reading of this document suggests that you do. You are more likely to succeed with your paper or grant next time if you can maintain your good attitude, enthusiasm and your overall sense of well being – while someone else applying to the same grant agency or submitting a paper to the same journal spends part of his or her time being “down”. Distributed across your whole organization, your smile and your optimistic attitude create more smiles, more focus, more security and more happiness for your folks. Your self-confidence breeds more self-confidence while the other person’s whining slows his colleagues down.

  14. When under duress, seek advice from people with more power, more resources and more experience than you have -- not solace from people with less power, resources and experience. Be prepared to have these powerful people tell you things that you don’t want to hear (e.g., the duress may be of your own making to some degree). They may not be right in this case (you will be the final judge of that), but their power, resources and experience suggests that you should listen carefully to what they say and consider it very seriously.

  15. Finally, be very wary -- almost fearful -- of personal recognition.

    Personal ambition for fame is perhaps the greatest single threat to a scientist’s career. It clouds his thinking and confuses his emotions. It makes him say “I” when the truth is “we” and “we” when the truth is “they”. It upsets him when some other scientist has a breakthrough when he should be happy that society has moved 100 yards further out of the wilderness regardless of who was wielding the compass and map when the movement occurred. He becomes preoccupied with being “first” instead of being preoccupied with contributing to a comprehensive solution to an important problem.

    Having said that, a person with no ambition at all is a lousy leader and is unlikely to persevere in the face of large obstacles. A person with little or no ambition and no track record of success is unlikely to inspire people who control important resources -- which are absolutely necessary for developing a lasting solution to an important problem -- to put those resources into his or her hands.

    So, ambition is an essential, powerful, and dangerous tool. Like a chainsaw, if its power is respected, it can be an important contributor to the solution of a large problem. If it becomes an end in itself, it will probably end up killing one or more people who are the closest to it. So, I try to keep the chainsaw gassed up and sharp, but I also try to keep it in the case most of the time, I always wear safety glasses and gloves when using it, and I NEVER forget that it is just a tool.