The Power of No, the Value of Yes

Brian I. Rini, MD, left Cleveland Clinic to join Vanderbilt-Ingram Cancer Center as its inaugural chief of clinical trials in 2020. The role tasks him with expanding oncology clinical research operations and training opportunities in clinical cancer research. As such, he works closely with the school’s oncology fellows.

Matthew Tucker, MD, was already a fellow at Vanderbilt when Rini came to the program. Tucker, who finishes his fellowship this June, was considering a career in genitourinary oncology, which is Rini’s specialty.

After a few meetings, both virtual and in person, the 2 men developed a relationship. Mentor and protégé sat down to discuss developing a career path and building a résumé, the value of writing review articles early in fellowship, the power of saying no, and the importance of saying yes.

Rini: The key to fellowship and junior faculty is finding a mentor [and] your niche. How did you get into GU [genitourinary]? How did you find projects? How did you ultimately end up choosing a mentorship team?

Tucker: It’s hard [to find a mentor and your niche] when you transition from residency to fellowship, especially if you change institutions. I had done research in GU in residency, so it’s certainly something I was interested in. But coming into fellowship at a new institution, it’s hard at first.

Vanderbilt [University Medical Cen-ter] has what they call research ombudsman assigned to you when you start out. Their job isn’t to be your mentor, but to help you navigate the waters, find potential mentors, [and] help with the early networking to find people you can work and mesh well with.

Rini: The whole key to first-year fellowship is figuring out who you’re going to be [and] which team you’re going to be part of, especially in a new institution. That’s difficult. What are the priorities as you enter that first part of fellowship?

Tucker: Focusing on clinical duties comes first. You may be interested in a particular thing in residency, but fellowship is a whole new world. Keep an open mind. Take a hard look at what’s going on in your clinical duties with different exposures you’re seeing for the first time. You may find a totally different research interest or clinical question that piques your interest.

Meet with multiple people. Just because you’re meeting with them doesn’t mean you’re going to start doing research with them the next day. When you meet with different potential mentors, [it’s important to] talk about what the future may look like [and] what future projects may look like. Get a sense [of whether] that is something that meets your needs and interests moving forward.

Rini: Once you’ve decided, “I want to work with this group or this person,” [or in this case], “I want to be a GU oncologist,” how do you start finding projects? How do you start to build your résumé?

Tucker: Great question. One of the things that helped me early on—and I would strongly recommend it to any first-year fellow or early investigator—is writing a review article. Very early on, one of the first things you did was reach out to me and say, “Let’s work on this together. Let’s look at this particular [review project about] biomarkers in kidney cancer.” As a first-year fellow, you may not know anything about kidney cancer, [for instance, but] coming into it writing that review, you’re going to come out knowing a lot more than you did before.

Going through that process...I’d be looking for X, Y, or Z in the literature and not finding it. That may give you a springboard for what might be some interesting clinical questions, which may lead to future research projects. That helped me a lot early on, just trying to figure out what the framework [is] of what’s already out in the literature to try to get ideas and [think about] potential projects.

Rini: I did a networking lunch at [the American Society of Clinical Oncology Genitourinary Cancers Symposium], and we talked a lot about...expanding [and maintaining] networks. How do you meet people?

Tucker: Twitter is a great resource. I’ve met Twitterers—we get a lot of ideas, see articles pretty quickly, then go to PubMed to delve [deeper]. But [Twitter is a great place] for getting that initial surface of what’s going on.

As far as being active [and posting] on Twitter, you [must] be careful in fellowship and have good mentors to learn from. I have a mentor who’s active on Twitter, and I can learn a lot from that—what can be said, what is too much to say, [and] how to get attention but also be appropriate and educational. There’s a good opportunity to learn a lot from Twitter.

Rini: I remember early on in fellowship and as junior faculty, one of the key skills is being able to say no to projects. Can you talk about that skill? You can get approached by a lot of people to do a lot of things, so how do you decide what to do and what not to do?

Tucker: Early on, people [often] say, “It’s OK to say no,” and it is OK to say no, but it’s also OK to say yes early on. If you have just 1 project going on and it’s all you’re working on, you may hit roadblocks on the way—you may submit it for publication months down the road—so having something else to work on when certain projects may hit slow points is important, too.

[However], once you’re [working on] 2 or 3 projects, this is where it is important to be in close communication with your mentor and meeting regularly because they can tell you, “Hey, it looks like maybe you have too much going on right now.” Or maybe you have room for just 1 more, but [they can] keep you in line. If you start to hit that point where you’re doing too many things, then you just have to do exactly what you said and just say no. You’re going to be approached by [several] different people, different mentors, maybe even different institutions, but you want to make sure [you have time to do, and do well], what you’ve already committed to.

Brian I. Rini, MD, is the chief of Clinical Trials and the Ingram Professor of Cancer Research at Vanderbilt-Ingram Cancer Center. Matthew Tucker, MD, is a clinical fellow in the Department of Hematology/Oncology at Vanderbilt University Medical Center.