Charting the Course: The Journey to Becoming a Physician-Scientist

(pensive music) - This is "Lab Medicine Rounds," a curated podcast for physicians, the laboratory professionals, and students. I'm your host, Justin Kreuter, a transfusion medicine pathologist and assistant professor of laboratory medicine and pathology at Mayo Clinic. Today, we're rounding with a true pioneer in his field. He's a professor of neurosurgery, division chair of neurosurgery at Mayo Clinic's Jacksonville Campus, Dr. Alfredo Quinones-Hinojosa.

Dr. Q, as he's known by all of his students and mentees, his journey is nothing short of extraordinary, from humble beginnings as a migrant worker to becoming a renowned neurosurgeon and scientist. His story is really one of resilience, determination, and, of course, a relentless pursuit of knowledge. Throughout his career, he has not only made groundbreaking contributions to neuroscience, but has also inspired countless individuals with his compelling narrative.

And I really appreciate you for joining us today, Dr. Q. I think our audience is excited to hear from you. - Well, my dear Dr. Kreuter, thank you, my dear Justin, for allowing me to be here with you, with your audience, and hopefully for allowing me to share some experiences, and anecdotes, and ways of thinking. And thank you for that kind introduction. I don't deserve it.

I remind everybody that behind people like myself, there are hundreds, if not thousands, of unsung heroes that allows us to do what we do every day and allows us to care for patients in advanced science. And it is a great honor and a privilege, so I thank you for that kind introduction. - That's why we're talking with you is to tap into these insights

and your mentorship for our audience. Let's kick off with: What are your thoughts? I always like to kind of start with a why question, and why should listeners invest their time listening to our conversation today. Why do you think it's important for physicians to play a role in science? - Well, Justin, I think often about this.

I think that as physicians, as scientists, as physician scientists, as clinician scientists, we are perfectly positioned because we see human disease from a different perspective. We are right there with the patient. Many times with other clinicians, with nurses, doesn't matter in which discipline you are, you are somehow either directly interacting with the patient or only one or two degrees of separation with the patient, and that puts us in an amazing position already.

Our clinical insight and our firsthand experience is second to none. I would say also that we are perfectly positioned to implement not only new preventive measures depending on the discipline for diseases that we care for, but also we can detect them early on. Anything that threatens human health, whether it is one case or millions of cases, and of course we're constantly thinking not only of the patient and the disease, but also we are thinking: How can we treat them better?

So we have that connection to the patient that allows us to communicate well with them, and many times we have the ability also to relay that information back to the public. And many times also, across many other disciplines, that allows us to be good communicators, and of course, continue to move the patient forward.

And I think ultimately, what makes us really, really special is the fact that we can lead multidisciplinary teams where we get to interact with basic scientists, clinicians, clinician scientists, nurses, but most importantly, we get to bring the patient as part of that team as well. And then we can pivot and figure out how to make our patients part of a scientific team, so we can then, together, find cures for their diseases in ways that makes sense to them as well.

So for all these reasons, I think ultimately, we can determine policy and be great advocates for our patients. - Wow, I really love that answer. It really, I think, has hooked all of our different audiences that we're connecting with. 'Cause I love how you start with the idea of position, right? So to not only know what is important, but as you're saying, important to the patient.

And I like that your answer also is opening us up to understand: What are the ways that we can actually have that effect on patients? And that you're also talking about with prevention specifically, it's not only the patient in front of us, but your answer, you're talking about highlighting the importance of connecting with the public. I think that's a fascinating thing that probably every one of our listeners can really kind of key into.

So I'm curious about: How did you get started earlier in your career? I've seen interviews with you before, and I know that there is a lot of work and effort, and certainly not to shortcut anything, but how did you set up kind of early in your career, kind of set yourself up for success? - Beautiful question, Justin. I would say that we are all born scientists. Our minds are inquisitive.

Since the moment that we are born, we're trying to bring things to our mouth, experience with our hands, trying to get all that information. Somewhere along the line, some of us get encouraged to do a little bit more science than others. And some of us get exposed to the scientific method, maybe early in our careers or later in our careers. But I would like to believe that we're all scientists at heart and we're born as such.

But how do you do it in such a way that is a little bit more methodical, in a way that will assure that you run laboratories, like the one that we run, which is federally funded with tons of grants, and innovation, and patents, and leading up to companies and things like that? I would say that the first thing that you have to continue to develop. Whether it's early in your life or late in your life, doesn't matter.

Whenever you sense that there's something that you wanna do, you have to continue to develop an inquisitive mind. And I would say that since I was a little boy, I continued to develop that inquisitive mind. By the time I was at UC Berkeley, what I think I realized is I needed to join a laboratory where I was going to learn the basics.

And I gotta tell you, the first lab that I joined after leaving the farms, working as a farm labor as part of my background, I joined a community college and then I went to UC Berkeley, and I joined a lab that allowed me to clean dishes. I always tell people, "You gotta start... You gotta understand the nuances of a laboratory, how it's run. So that way, when you given an opportunity to do science, you can take care of those resources and exploit those resources even better."

So the next thing that I did is I found a great mentor, and a great mentor doesn't have to be a great mentor all the time. He can also cross the line between a mentor and a tormentor. And I got to learn a lot from that mentor, as I found that person who challenged me. I joined the scientific team that was open.

He was open to hear from me labs that allow you to hear from anybody else without distinction based on rank or experience, but a team that allows you and treats you like every member is an incubator. Every member is a source of information, of new ideas. That is the place that I wanted to be, and I was lucky enough to find that place. And of course, in science, just like many other disciplines, you cannot give up because sometimes, you gonna do an experiment. And you're not gonna find an answer.

Or sometimes, you're gonna find the complete opposite answer of what you were expecting to find. And you have to have that kind of mind that is imaginative and creative in such a way that when that moment arises, it may actually lead to new discoveries, new ideas, and new ways of looking at a scientific answer that no one else has seen before. And I would say that those are the kind of things that ultimately lead you to never stop asking questions.

And many times, it is okay to doubt your own answers because that leads to much more precise science and eventually much better answers and much better therapies for our patients. - Wow, I really appreciate this kind of... In your answer, I'm thinking about the interprofessional nature of our practice. The way you're talking about starting off cleaning the dishware in the laboratory as a way to really kind of understand how that process is done.

And as you work your way up, you really have a better understanding how to work with different colleagues. That's certainly kind of a microcosm of clinical medicine these days. I'm curious, when you talk about an inquisitive mind,

I'm really kind of curious to kind of dive into a little bit for our listeners, what does that look like for you? And the reason why I ask this is because I think for a lot of people, when they hear that, it resonates. But to somebody, how do I kind of develop these practices? Or what is the habit? What does that look like for you?

I've kind of heard maybe other people, maybe that's habits in your personal life, maybe that's habits with your research meeting, but just to kind of give the audience a little bit of a flavor for what does that look like for you? - It's very simple for me, Justin. I read a lot, I write a lot. My papers, I always tell people that by the time I publish a paper, I probably have gone over 100 different drafts and versions.

I read something, I let it percolate in my mind, I let my neurons activate new synapses. I look at a figure, I dream about it, I think about it on the weekends when I am with my family, I comment, I talk to my fellows, I allow them to challenge me.

And ultimately, of course, we have our formal lab meetings, but we also have a lot of informal lab meetings, and the lab meetings are broken down in different parts of the lab meetings where we present the paper, where we present data, where we talk about troubleshooting, and all that creates a chaos in your brain, in your mind. 'Cause imagine this. Our brains have over 100 billion neurons. And right now, I mean, your brain is over 160 to 600 trillion synapses ongoing.

More synapses going on in our brains right now than there are stars in the Milky Way in our galaxy. So when you have that kind of chaos, but in a way that is organized, in a way that it makes sense for you, because everybody's a little bit different, some people like to wake up in the morning and read, some people like to do it at night, find what is good for you.

What I found for myself is I am the most creative early in the morning when I have my feet up on the table, when I'm just daydreaming and thinking about it, having a cup of coffee, or when I go for a run with my fellows, or my lab, or my colleagues, and we get to talk about something that new idea is for. That's how I sort of structured myself. - Wow. I need to join your lab so I get better about my running habit.

(Justin and Dr. Q laughing) Something that kind of your answer there reminds me of, I remember talking to a colleague that made a major discovery recently, and it was one of these things, when you look back at it, it kind of was staring in the face, right? But he was the one that asked the question. I remember asking him: How is he able to recognize this thing that's right in front of everybody's faces?

And he kind of answered is like, it's kind of like they're like a high-end luxury watchmaker was his answer to me, was it's not doing anything that other people aren't necessarily doing, but it is that methodical focus. and that's what I'm hearing in your answer, right, is it's being deliberate about things. And also, I kind of hear the beauty of the informal lab meeting as a way to kind of deepen our curiosity.

- 100%, I always tell people that every single lab member in my lab is much smarter than I am in their subject. They know a lot more than I know in their subject. What I do know is that I know a little bit about forming connections. I hear someone presenting this data, and I know someone else has this data in my lab, and I try to make sure that I connect the dots, and then I say, "Why don't we meet and we talk about this?" And that's how new ideas are born.

More than anything, my role, I serve as a matchmaker more than anything. So instead of a watchmaker, I'm a matchmaker. (Justin and Dr. Q laughing) - So this is a perfect segue, and I really wanna explore, and this is why I really asked you for this podcast, is:

How do you mentor younger physician scientists, right? And this is something I think that our audience, by large, can really key into because we have a number of physicians in practice that are maybe early in their career setting up a laboratory, trying to figure out how can they mentor new trainees authentically. And of course, we have trainees and students that are looking for laboratories and are trying to figure out how to navigate that process.

So from your standpoint, how do you mentor younger physician scientists? - Well, this is what I think, Justin. So from my sense of view, the first thing that you have to do is you gotta give them the resources. You gotta empower them to change the world. So how do you give them the resources? As a PI, as a lead, you have to get grants, you have to convince philanthropy, you have to convince the government, the foundations, to give you money.

So you have to come up with some ideas to establish a laboratory, to make sure that you have monies to run a laboratory, whether it's a startup package from an institution or a grant or two grants. So that's the first thing. So that's your duty is, "I have to figure out how to convince my peers, my other scientists, to also give us resources for our lab, because that will give them the resources that would allow them to grow." And you have to allow them to do experiments and fail.

And many times, as you empower them to change the world, you have to listen to them. You have to challenge them when appropriate and support them above all else, even when you think they may be wrong. Why is that? Because at the end of the day, it's what is called the scientific method. As long as they have a rationale, how they gonna test the hypothesis that it makes sense to you as well, then you have to let them experiment. It may be that you as a mentor are wrong.

So you always have to keep that open mind overall. And I would say that as you are supporting them and they have this very rigorous scientific rationale, you will continue to also grow as a mentor and as a scientist. So you have to allow them to be part of your DNA. They're almost become those proteins that allow you to shift your DNA and produce different ideas. And I would say that that's one of the secrets as a mentor that people don't realize, or we don't talk too much about it.

The way that you stay young and active is you surround yourself by younger people who are also much brighter than you, and they keep you sharp. - They also keep the running pace up, I imagine. - [Dr. Q] That's true. (Justin laughing) - So I'm really fascinated, I'm really glad you brought up the idea of that it's okay to fail, right?

The key thing is that you have a reason and a rationale, and you're really talking, at least in your answer, I hear you're really coaching somebody to be strong in their thought process. And I'm curious about: Do you have thoughts on how to mentor somebody through that, maybe their first failure?

As we know, you might have somebody that's working with you, they're just getting into this, you're probably something of a minor deity to them in this lab and they want to come out with amazing, gorgeous data. Maybe they saw the postdoc come out with amazing stuff and they want to do that, but then that research failed. How do you mentor them through that and how do you help them achieve that perspective that this is what science is? - Beautiful.

You just reminded me my own experience with one of my early mentors when I was in medical school. Ed Kravitz, he is an amazing... He discovered GABA, he's a full professor at Harvard Medical School. So as a matter of fact, he still holds being the most senior faculty member at any institution that still has federal funding from the government.

Now, it reminds me of a quote that he gave me from Winston Churchill that said that success is going from failure to failure without the loss of enthusiasm. And you could brought me back to an experience where I thought that I had already discovered a gene that was manipulating aggressive behavior in Drosophila melanogaster back in 1994 when I was first young in the laboratory, in his laboratory. And I was so excited. Exactly what you said, all the book stocks were producing amazing data.

So I come to him to show him this. He looked at it carefully, he had a very kind and gentle voice, and then made a few adjustments. He goes, "This is a great start, I'm so proud of you," he said to me, "because you're clearly thinking the right way. Your interpretation of the data is incorrect and you are wrong, but you are in a great trajectory. Keep going, and eventually you will make that discovery."

So he gave me the positive feedback that I needed at the same time as my world was collapsing in front of me. So I always say that as, and eventually he's sensitive, and that's when he gave me that quote from Winston Churchill, the success and about failure. And I have to admit it, that it's played in my own life with my own mentees, is it served me well throughout the years.

- I'm curious about that as you see your mentees go on, is there a way that you're able to kind of keep in touch with them? I imagine that just like you're saying, the gene that you were involved in probably is from a different clinical discipline and maybe you don't interact with them. How do you keep in touch with your mentees as they go on in life? - Beautiful, I always tell them that they're always connected to me.

Many of them ended up going into the neuroscience and some ended up going into radiologist. Someone goes into industry. My latest graduate student, she's amazing. Rawan Al-Kharboosh, she was a graduate student here with us at Mayo. She's now started a company in Washington, D.C., and my role with them is always I am here. Anytime that you wanna call about anything, life, professional, science, doesn't matter. I'm here for you.

Of course, I always try to be thorough with them and making sure that we finish our papers or manuscripts, the things that we needed to do. But overall, I think that I touched base with them from time to time, try to send them, they're all in my speed dial, and my phone, and my texts, and my WhatsApp. Doesn't matter where they are in the world. I think it is our role as mentors-slash-tormentors to continue to make sure that they know that we are here for them.

And I would say that especially when things are failing or not going well, that's when they need us the most. And we also need them. Many times, I go back to them and I say, "What do you think about this idea?" That's how I've done it. I don't have a better way of doing it, but that's been my modus operandi for decades. And I gotta tell you, I'm proud of them. I'm proud, very proud of all of them and the things that they're doing in all different disciplines. I'm also not in the...

I'm not one of those people that I believe everybody needs to be a physician scientist, or everybody needs to be a neurosurgeon, or everybody needs to be whatever. But I am in the philosophy that I am... My role as a mentor is to help them find happiness in whatever field they go to. - That's wonderful. I think that's something that I need to take away. I'm often trying to... As I'm kind of known in my area for trying to share my enthusiasm and get people to go into transfusion medicine.

And I think as you highlight, of course, my wishes for them to find what makes them happy. And I really appreciate how you really kind of set that sense of home, right? "I am here," and that's a wonderful touch point. Well, I'm really...

I wanna close out our conversation today by really looking forward into the future. I think your answers, the conversation so far, I think that our audience can probably feel your enthusiasm. So what are you most excited for in 2024? - Well, we have embarked, as you know, at the Mayo Clinic in the next frontier. Ball forward, we're excited about the future. We continue to invest in people, space, and technology.

One of these that just crosses all these disciplines is the use of artificial intelligence and machine learning. We just went through the process of recruiting Dr. Tao, Swee Tao, who is coming from Texas to lead artificial intelligence research from our site. As you know, I'm the dean of research here at the Mayo Clinic in Florida.

I would say the things, the future, the use of artificial intelligence, machine learning, and discovering and using the technology to allow us to better discover new therapies, new ways of treating cancer, which is my field. I get excited about it, but I gotta tell you, also, the world is evolving.

The latest set of grants that I put together, we have really gone out of our way and engaging the patients not just as support, but engaging them in the conceptualization of science and the experiments that we are doing and the therapies that we're trying to find. All the way from artificial intelligence to implantables in the brain and asking them, "Does this make sense to you? Are we communicating our science?" And I think that that engagement with our patients, it really reenergized me.

And I can sense that the world, the future grants from the federal government are going to incorporate the patient experience and knowledge much better. And I'm excited about this in 2024. - Wow. Awesome way to finish.

Amazing advice. Closing the loop, really, with Dr. Q and how to keep that motivation up through science and research. We've been rounding with Dr. Q. Thank you so much for joining us today. - Well, thank you Justin. Thanks everybody for listening to this nonsense, and I'm really appreciative and very honored and humbled by all of you. - It's wonderful, from another bow tie wear. So the next time we have you on Dr. Q, we'll both be on our bow ties. - Promise.

(Dr. Q laughs) - To all of our listeners, thank you for joining us today. We invite you to share your thoughts and suggestions via email to [email protected]. If you've enjoyed this podcast, please subscribe. Until our next rounds together, we encourage you to continue to connect "Lab Medicine" in the clinical practice through educational conversations. (pensive music)