 So there was interest. That's good. That's great. I think there's a lot of reason for scientists to or medical doctors to be interested in science. And part of it is exactly what you said, Ariana, that in many ways medicine itself wants itself to scientific inquiry. Could you sign in and then also take some paper? And part of that is because when we think about it, none of the treatments that we have is ideal for our patients. We're always trying to improve on our care. And science provides a method to test ideas and obtain evidence for best patient management. And we cannot experiment on patients. And I'll be driving this home several times. But as soon as you think, gosh, maybe we should look at that and study it, you need to think about getting an institutional review board approval. It's OK to do that, but we always don't ever say, well, we only have three patients. Let's just see what happens. Once you have that question, then you should be thinking about getting IRB approval, so human subjects approval. And there are a lot of things that need to be done in scientific inquiry. And we're going to go through some of the different types today, too. But I want to talk about I'm one of those people that likes to believe that every physician is a clinician scientist of sorts. Like, there are different ways that we can add to the whole to the process. And we already know that science and medicine are so linked. And we do practice evidence-based medicine. So we don't just experiment on patients. We actually go with what's the best approach based on clinical trial evidence. And when we don't have that evidence, then we disclose what we do know to the patient in informed consent. So sometimes we use an off-label drug. For example, acula, right? Catorilac. We use that for sister macular edema after counteract surgery. But it's not FDA approved for that. So that actually requires you to talk to your patient and say, listen, we have a drug that there have been clinical trials or clinical studies that have shown evidence. It's not real strong evidence, probably because there will never be enough patients to be able to do a really strong, adequately powered study. But nonetheless, you have evidence and you want to do something to help your patients. So that would be an example where we do this every day when we see patients. So reasons to approach medicine scientifically, to make a difference, to provide better treatment and care for patients, to be at the cutting edge of what's the best thing we can do for patients and health. But we could also do it to evaluate manuscripts critically. When you're reading the literature and you're wondering, well, I don't know how strong this evidence is. You, by having some background as a clinician scientist, you can evaluate the manuscripts more critically. And you can also meet a need that's on that, like better quality of life for patients, health care workers, physicians. It can be local. It can be global. You can see that there's a problem in the world that you want to make better based on what you already know in locally, for example. It can be in education, patient education and literacy and communication. And it can be in public health. That's sort of an altruistic. Those are altruistic reasons to be a clinician scientist. But there are also other reasons. When you're depending on how much you get into science, there's a certain group on that work of people that you meet. Like, for example, one of my, I mean, National Eye Institute Councilman. So I advise the director of NEI. And that brings together a number of other clinician scientists and scientists. And that's like a group of friends that we have a similar way that we think of things. So collegiality, increased knowledge in our discipline with other non-medical disciplines. Curiosity to understand more than is known. Travel to see other medical practices. We can see how others do. And that's sort of fun. And this is enough reason. Actually, we all know that going through medical school is an internship and residency. And then when you get to fellowship, it's even harder. So you're constantly pushing. And you're always doing your best for your patients. So it keeps you busy throughout those age 20s. And it keeps you busy through your 90s. And it leads to passion and fulfillment. And that's sort of healthy reasons to be a clinician scientist. So anyway, we're going to start out with what a hypothesis is. So Becca, what's a hypothesis? So outing leads to another in a scientific setting. Or you think something happens, and you work based in a support. OK, that's pretty close. So it's basically a question based on observations in nature. And that's key in nature. So it's not like, gosh, I wonder what happens in this model. I've got this interesting animal model that has a genetic knockout to say. And I really want to find out what happens to it. That's not really a hypothesis. That's a name. The hypothesis is my patient, I wonder why this disease causes x, y, z. It could be that simple as a hypothesis. And it can be posed as a statement. And this is what Becca was saying. And that you plan to test it. So you can start out very general. Why does a vein occlusion? Why does a central retinal vein occlusion cause blood vessels to ground the iris? I mean, isn't that sort of unusual? Why does that happen? So it could be a general question. And then once the question is posed, then there are next steps. So this is where you become the investigator, right? So research the literature, find out, how do you do that? I do it. I initially, it sort of depends. If it's a question that I know nothing about, for example, I got recently interested in Schlem canal cells. Because I study angiogenesis and blood vessel growth. And they kind of are endothelial cells, sort of. But they're not quite. And so I wanted to understand this whole issue of why do patients develop glaucoma? And is it related to certain growth factors, say, in the eye? And so I didn't know anything about Schlem. Trabecular muscle excels, I didn't know. So I actually started through Google. And Google has its benefit. At least it's not up to date. You get everything out there. But sometimes it at least gives you some starters to be able to then do a more refined search through PubMed, where you can go through the library, as we saw in Grand Rounds, and go through the librarians. Also asking colleagues for their experience. And I will also put in their mentors. Like if you have a mentor who works in the area, definitely talk with them. And then be aware of patient's thoughts too about the condition. Like if you're interested in glaucoma, whatever. And sometimes we're trained to that this is the way you do it in medicine. And this is how it happens. And yet that's not always a hypothesis. But we're not taught that as medical students and residents and fellows. We're taught that that's gospel. But it may just be hypothesis. So sometimes you can get information from your patients as well. It's incremental learning. So first you have to do that background, you learn. Then you can then, as you're gathering information, and you may find out that there's very little on it, you have to be also aware of bias. And what I mean by that is if you get a bunch of case series, an example would be somebody tests. Well, let's see what happens when we give a steroid injection in the eye in somebody with macular edema from vein occlusion. So we're going to take 10 patients. We give them a steroid, and we see what happens. And they find out, oh my gosh, in a month they're better. But that doesn't necessarily mean that steroids, that's not really testing a hypothesis. Our steroid's helping macular edema. You have to be able to go further and go further into this. And that's the anecdotal finder. Yes. The other thing to think about when you're doing a hypothesis, like when you're designing your study, is it possible? You have this great idea like, oh, let's see what happens if we follow patients who have glaucoma, and we want to see what happens to their visual field and compare it to, say, their optic nerve findings or their neurofiber layer on OCT? Well, it may be something that takes thousands of patients to be able to find a difference. So it's helpful in those cases to meet with a biostatistician and to be able to break down your question. You may need to make it more possible, or you may need to collaborate with others in a multi-center trial. So that's sort of a general thing about hypothesis. And I want you all now to write down a question of a hypothesis that you want to do. So you've got to, I think most of you have a hypothesis, and the next part you can think about is how you're going to test it. So how do you test your hypothesis? And what I'll start by saying is it kind of depends on the area of science. If it's clinical, then we don't have as much harder to get really strong evidence in clinical. We can't experiment on patients. The best we can do is maybe a clinical trial to test if something works compared to a control. But so it depends on that. And I think it's important to break the question down. Based on literature search, as I said, and your initial research, but also work with mentors. And determine if your mentors may be based on others. Basic science are clinical. And many times you need mentors in both rounds. And if it's developed, does it involve lots of patients? Is it something where you're going to need a population-based study? And then in that case, and I would say probably in every case it's helpful to get biostatistician. So let's just go around the room. Let me hear some of the hypotheses that people have developed. Yeah, do you want to start? My question is, how effective are contact precautions at preventing the actual transmission of clinical async? Oh, that's a good question. When I'm sweating and I have a full gown and everything, that's the first question that always comes to me. So that's a good question. That's a very good question. And so that's probably clinical, right? And so it would have to be, so let's see how you would do that. And so think about some of the ways that you could actually test that hypothesis. What would be your experimental, what would be the experiment? So think of it that way. Can you have contact precautions and not contact precautions? Or could you test between two different types of contact precautions, for example? Those might be some of the things to think about. Because if you just say, well, let's just see how people do when we do this implementation, you don't have really a control group. That's a good question. And think about that. So continue to work on that. And maybe the infectious infection, or those people, the infection control police or whatever, or infectious disease may also be able to be diagnosed. That's good. I like that. Theresa. So mine was does refractive area effect learning in Navajo School? It showed about this because so younger children tend to have high degrees of astigmatism in glasses. And so I was wondering if you could have glasses or not having glasses to be able to learn in school. So your question is actually, is it valuable to correct refractive area for teaching, or for learning? For learning, right? So how would you then, that's good. How would you learn, how would you test the outcome of learning, for example? So I mean, you could see where their grades are at in school if you had access to it. Or mom's a teacher, and she always can tell me. She's like, I know which kids are having trouble learning and which ones aren't. So work with teachers. I think that's very good, yeah. And actually, as teachers, well, we'll kind of outcome what you look at, right? I think that's very good. And how long, the other thing to think about when you're doing designing your hypothesis and studies is think about how long it would take, right? How long would it take to do this study? So you may want to say, I'm going to give it a certain time period, like six months or something. And so you want to get an outcome measure that you think you could actually find a difference in that period of time. And so that's where teachers and educators can also be valuable, because they look at those outcomes. I think that's great. Good, good. What did you find? What is the difference in outcome in varying levels of aggressive versus conservative treatment of a small carotid dissection? So of a small carotid dissection. So what are the differences in outcomes between a more aggressive approach versus conservative? And so what would your more aggressive approach be? Or a sister-in-law approach versus, I don't know. As opposed, and then conservative would be medical or observation. OK, so one approach could be just to retrospectively look into the data. So you find data, assuming that patients have conservative versus more aggressive approaches and define that. And you could sort of do a case control kind of study and be able to determine that. Again, working with a biostatistician, that gives you the evidence to see whether or not it's worthwhile to proceed with a prospective study. So that would be very good. And I'm sure that, and that's a very good question. And I'm sure that other people who understand that area more than I do would be able to work with you and help you refine the question and maybe the approach. So I gave you one example, but they may say, oh, no, we have retrospective studies already, so let's go right to a prospective study. It's good. Thank you. But what was your question? My question was, will iris neovascularization develop if all the posterior angiogenic factors are blocked? OK. All right, so that's a good study. So first of all, so think of a couple of things with that, because you may refine it. How are you going to determine what all the angiogenic factors are? I think that we probably don't know, but we could narrow it down. OK. That's good. One or two. And if you were going to narrow it down, is there one that you would or two that you would really? VEGF and HIF. What? Well, yeah, HIF. So this is where going through the literature is good, because HIF is a transcription factor that can be stabilized. It's usually not secreted in the vitreous. But VEGF is. So you could potentially, based on the studies done, be able to say, is VEGF affected in patients? We know it is, right? And then if you want, were you thinking experimental? Or were you thinking clinical? OK. Good. And what kind of, like, do you have an idea of a model? Well, this came up because we mentioned with neovascularization, considering whether PRP will kind of solve that problem. So what I imagine, and I don't know if this exists, would be, say, a diabetic retinopathy animal model, where a test group gets a total PRP in the back, laser out to hold back, have to measure VEGF levels that are still secreted, and then measure aris neovascularization. Yeah. OK. So I'm going to suggest another model. I think it's a good question. I would start with animal. And I would look in the literature, because in the past, like, there have been studies where they use roasts. I don't know if it's Rootsbengal. They use various types of dye. And then with laser, all the vessels around the optic nerve. And I think they use pig models, but there are other animal models as well. And that induced neovascularization. So if you can find a mouse model, you might be able to, there's not a, you can't knock out HIF or, but there are ways that you can affect the expression of HIF. And you can look at those genetic models and then really test the effect on aris neovascularization. You could also use drugs that stabilize HIF or inhibit HIF, right, if that's a concern. So that may be an approach. And the reason that I'm suggesting that, and I also say I don't totally understand it, don't get discouraged, talk to other people, too. But the reason I'm suggesting that is that there's so much variability in how patients present with neovascularization and who presents. And there isn't, we don't see that much now. So it may actually be very difficult to get the patient population, and maybe not even ethically possible anymore, right, because we use anti-veg up in that. So the study becomes harder. But I encourage you to look at some of the models and to work on that. I think that that's a very good question. Becca, what did you get? So I was wondering if a telerepnal screening program could improve visual outcomes in patients with diabetes, especially patients with limited resources. I know there's a lot of work that's been put into developing these telerepnal models. And I don't know as much about what's been done on the other end as far as, are we actually improving outcomes? And so I think that would be interesting. It could start as retrospective, looking into the models that are out there and seeing if they're actually doing anything good. And then if they are, then do a build a prospective model. But we're actually actually actively getting the same measures before and after screening. OK, good. That's a good question. And are you thinking maybe even population-based? Yeah, population-based. So that would be something. I mean, if you were here, we have a whole population, right, department. So Rachel Hess and Angie Fagerling. And so a number of people can help in the green and all that. Building all the cohorts that you want to. Exactly. And that probably would be something collaborative as well. And so I think that, yeah, so that's very good. And that's very, that's kind of, you know, we're getting a variety. This is great. How about your question? What did you come up with? I guess my overall question was, what causes natural generation some people from the hundreds? Obviously, that's been worked out a lot. One thing I was wondering was whether, like, whether NAD Plus, which has been sort of like a victim of mine, has been associated with other signs of aging in New York generalities. She's an initiative. That was decreased in a patient's speculative generation compared to an age-matched population. It's very interesting. And so how would you measure NAD Plus in the patients that you have? So I think classically they do it. They've done it now, so they've looked at levels of tissues. But I believe it can also be measured in blood. So they're human based, you know, in the generation. And does it correlate with, like, if you measure in blood is it the same as what it would be in the tissue in the eye? That would measure it. So it may, so let's see. And do you have to measure it in live people, or could you look at IVAN guys just to get a sense? Probably look at IVAN guys, you know? Because they usually measure it post-mortem. Yeah. And you're looking at the protein, is that right? Or the enzyme activity? I guess it's the molecule. Yeah, so if that's a real interest. So like if you're looking at activities and you have these enzymes that do things really quickly, sometimes it's hard to catch them at the right time. But I mean, one way is to look at a downstream product from the enzymatic reaction. And if you're looking at expression, you could also look at genes or mRNA. And that would be something to talk to Greg Hagen about, like if you had interest in that. So I would encourage you to continue to look in the literature on that and think more about that. But I think that's very interesting. I like that. OK, Chris, what did you want to ask? So my question is, in people who are women musicians, are there higher rates of glaucoma? Should we be thinking about retreating these people? Because we know that. We know that. That's a really good idea. People would, you know, play women instruments. I'm a trumpet player myself, but we have, there's higher, you know, when you're playing, there's, you have increased, you have increased the pressure, but, you know, is that significant? And over time, you know, is there a cumulative effect that can lead to glaucoma damage? Wow, yeah. That is a reason, that's a really neat question. How are you going to start? Is there any evidence out there? No, I think it's really important. I mean, you know the studies, I mean, look at Bob Weinberg. He has the whole sleep stuff, right? That people who are lying flat have higher incidence of glaucoma, I think. But he just, he has a whole lab where he has people like sleeping and not sleeping on that. So, and it started from an observation. I think this is interesting. So, I mean, there's been a lot of work done that shows that, you know, playing women instruments increase your track of their pressure. And I don't know, this has just kind of popped into my head. I was thinking about it over the past couple days, actually, but I don't know if there's a lot of evidence I've never been so sure as to see if there's been people looking at glaucoma and its damage over time. But that'd be the next step. And it's something like this, you might, I think you might have to start doing a retrospective review. Because I mean, you know, you're talking about years of playing in cumulative science. You're talking about prospective. Yeah, so let me just give you, throw this out if you're interested in it. So in, I don't know if it still exists. So this was pre-Katrina, I was at LSU. And they used to have a musician's clinic, iClinic. And it was free. So it was for, you know, like wooden Marsalis and a lot of different jazz musicians who, you know, they're like incredible, they're incredible, right? With their music, their celebrities. But many times they don't make a lot of money and they don't have insurance and their healthcare isn't that great. So we had a free clinic form at LSU. And so you might be able to find different clusters where you could take, say, you could just, I mean, just get some evidence to even help to support the hypothesis. And, you know, look at people who have been playing, maybe, you know, say you have to be playing this amount of time or something. Maybe you want to find any confounding factors that might, you know, that you might wanna look at as well. And then have a control group, right? And compare. So that's very interesting, I like that. What did you come up with? I said, what is the rate of Canada endothelitis and corioritinitis of patients with systemic cannabemia without visual complaints? And what about patients who are unable to describe visual symptoms? Okay, so what was the first part? What is the rate of Canada endothelitis? Okay, so this sounds like an important question for, because residents get all those consults, right? Yeah, yeah. So there is some evidence in the literature, right? People have published on that and you probably, are you aware of some of that? Yeah, mm-hmm. So how would you design your study? I think it's good. So we have a amount of volume for it. It would be something where there's like a humming here. I would probably study it right now. So for people who have a Canada or other fund at seeing the fundus and so each patient, like a cell phone, camera kind of thing, we have a fundus and then have it looked at in terms of does the resident think there's anything there and then does the retin fellow stepping it, see over the course of like two years where people actually had disease that weren't treatment and were any of them. So it would be, you're seeing, it's just more like a series, which is find a prospective series and then when you get your, you'll end up with your cohorts, I guess, ones who did have Canada findings, ones who didn't. And then you could compare them potentially because maybe you could find risk factors, right? That well, when you have XYZ, now that's a big study. I mean, it's probably gonna take a lot, but if you did, you might find that if they have these parameters, we found that they were more likely. So I think that's really good. The other thing I would just have you think about too, because I don't know that anyone's done working it, but is there like a biomarker that could be measured that is associated with infection with Canada? You know what I mean? Not doing PCR on the aqueous fate at every patient because that's a little invasive, but is there something that you might be able to find? So very good and very important. Like, you know, kind of manpower and personal power. What was your? Yeah, so this actually came up yesterday after Manila's Pathorones, but so two questions, what is the effect on endothelial cell count in deep treatment of corneal cross-linking? Oh, okay. So that's kind of, yeah, okay. So what is the effect on endothelial cell count after deep treatment of cross-linking? So, okay. And then the second question would be, what effect on tensile strength does deep corneal cross-linking have on grafts, such as de-sec? Okay. So do you have like a broader, so what, what- What question am I trying to figure out? Yeah, what was the overall? Does deep, does deep linking do something to the endothelial? Yeah, so basically, if you could strengthen either a PK or a de-sec or a de-mech through corneal cross-linking, then you'd have a therapeutic kind of information. So basically my, I guess my big picture question is, can't we strengthen these grafts through cross-linking like we do for catagons? Okay, so even bigger, like going up, right? Is it that we wanna figure out a way to reduce the graft failure or the long-term graft failure or something like that? And then your aims would be, let's test whether or not this effect has an effect. That's great. I think that's a relief. And then that could be doable. Now, what would be your comparison? So you have the deep versus just- There's just standard. And I was looking up a little bit yesterday. You can measure how deep your treatment is through excision of tissue, and then there's a demarcation line, but they've also recently done like confocal microscopy so you can do it in vivo. So you'd have to have an animal model basically where you treated standard depth and then where you went deeper, closer to the endothelium. You probably have to do some testing to see how deep you are and kind of your standard deviation of your treatment depth. Yeah, okay, good. And it sounds like you could do this with minimalists, right? So I think that's great. And you could do the animal model. They have a way of doing the cross-linked. Are probably rabbits? Rabbits would probably be where you're at. Yeah, because they're corneas. Is that right? They're corneas that kind of likes the farthest ones. Ish, ish, but more than, and they're a little easier than mice. Yes, they're very good. I like that. Good luck. And what did you do? Well, something I've been talking to a number of people about is what is the relative efficacy of trapeculatumia versus various mixed devices for control of IVP disease progression? Okay, okay, so that's good. And that seems like, so that kind of lends itself to a comparison like retrospective case control type of study, possibly. But do, I guess the questions that you might think of going forward. You know, it's, when we think about the clinical studies when we're comparing them, it's really good to compare to the age match, gender match, but also sort of time match. Do you know what I mean? Time in medicine. Like, if you're taking historical data and comparing it to data now, there may have been things back then that are very different than what we do now. Sure, it just seems like, I've been talking with a lot of people, it seems like there's sort of a, I was talking with Dr. Roscoe there's almost a push from some people to go back towards trabeculatomy and two-chent devices, and there's some ongoing studies actually testing some newer mixed devices and versus trabeculatomy, but really in order to get good data, it seems like it would have to be prospective and that might be difficult to actually do and get higher approval for. Okay. Well, I think with Dr. Roscoe, you've got a great mentor there. She's very scientifically going in and she'd be able to work on ways to be a letescent, so I encourage you to think that's really good. So that was great. I mean, you guys all have great questions and you've got this down. You know, I'm gonna kind of skip through, I didn't know each year it's a little different and I never know the interest level, but it seems like I've got a really interested group. This is great. So I'm kind of gonna skip through some of the other information kind of quickly because I think you may know this, so. Okay, so what's going on here? Let me just see if I can figure it out. PRK increases the performance of interns in ophthalmology because Sean is up here. You know, that's for sure. It doesn't appear to me. It does not. Initial rots. Initial rots, not at all. So all you said, that might be anecdotal. So I'm just gonna briefly go through. These are all good. So I kind of said you couldn't be mechanistic as much in clinical and that's because ethically we can't experiment on patients. We can do clinical trials, but we want to have a lot of evidence going forward with that before we do it. So exploratory or hypothesis generating is fine and that would be something where a case control study, right? You refine your hypothesis. You get evidence to be able to understand it and it's always good to go to a biostatistician so you don't get, you know, when we're scientists, we want our hypothesis to be true. But the most exciting thing is if you get information that actually goes against your hypothesis because then it makes you rethink and go deeper into what might be going on. So, and then the mechanistic studies are where you actually test the hypothesis. So that, and let me see if I, so an example that would be, you know, see for example, let me think, what would be an example of the mechanistic study? Say we want to know whether VEGF signaling through VEGF receptor two is important in blood vessel growth into the vitreous in a model. Okay, so what we would do in that case is we would try to inhibit VEGF receptor two. So first, you know, you might first just look, okay, if we give VEGF, we measure, this is an animal model, we give VEGF, we measure VEGF receptor two. So VEGF could be given by ischemia, okay? You increase the expression. You measure it in the animal model, make sure it's increased, make sure the receptor is activated and you look for the outcome, right? Blood vessels into the vitreous. But then to test a hypothesis, you have to knock out or knock down or reduce the VEGF receptor two activation and then see the outcome. That's how you test it. Now you can't do that in person, right? But you can do it in an animal model or in cells and there are various ways you can do it. Pharmacologically, you can use receptor tyrosine kinase inhibitors. You can do it by gene therapy and introducing a short hairpin RNA to VEGF receptor two and thereby reducing that. So there are different ways like that. So that would be more of a mechanistic study. And this is, so this is what, this is a little bit of that ethics I wanted to go through. You know, there are differences in medical questions and science inquiry and also just in science rigor. So in medicine, we're trained to observe outcomes based on intervention, like how a patient does when we give them antibiotics. I just had antibiotics for pneumonia but I probably had viral pneumonia and the reason they gave me antibiotics is they can't distinguish viral and bacterial more than 30% of the time. So it's like, I'm not gonna wait around and get worse and say, oh, I guess it's bacterial. You know what I mean? So you do things like that but in science, we have to really be rigorous and test our observations. So in a model, if you were trying to figure out is it bacterial or viral, you might actually wait till the outcome happened and see what the effect is. You can't do that in patients. And when you do the, when you test the hypothesis and you're really rigorous about it, especially in basic science or in translational research, science always says exploration is part of it but you still want the rigor of testing the hypothesis. So let me see. I wanna spend a little time on mentors and so, you know, exploratory research so it can be qualitative studies like assessing barriers to diabetic eye care from focus groups, maybe a little bit of the telemedicine approach that's a little bit of an outcome study, adherence, compliance, OCT features associated. So association studies are really kind of exploratory. They're not really testing anything. You see, is a reduced easy line associated with risk-to-vision after renal attachment repair, you know, in a macula off detachment. So it doesn't prove anything, right? It just gives you evidence to support it. Exploratory research in basic science could be metabolomics, you know, amino acid localization, genetic association studies, even when you have genetic association studies and they say this gene variant is associated with AMD versus people without AMD. It's an association, it's not causal. Whereas in mechanistic studies, you know, again, you're not really doing mechanism with clinical trials even. You're doing either the medicine versus placebo or the medicine versus comparison and to an outcome but you're not necessarily looking at how that medicine affects the disease but you are at least, that's a gold standard that's important and maybe beyond that is a meta-analysis of a number of clinical trials to see how generalizable the findings are. But in basic science, you can actually test a hypothesis. And then in population research, I'm not even gonna go into this. I think if you do want population research, talk to someone who knows more than I do. Okay, so mentorship. I do wanna touch a little bit on mentors. How do you get involved in research? Find someone that you sort of like. I mean, you can have multiple mentors at different times in your life. You like how they do things or what they're doing. You wanna learn more about them. They might have an area of interest that you have a mutual benefit like incornia and cross-linking with mammalists. Make sure it's feasible. So if you meet with somebody and you say I wanna do a project and they say, oh, great. Well, I've got this five-year study that's going on and I want you to do something in it and be involved. I mean, if that's what you wanna do, that's fine but there are questions you can ask. Like, you know, I wanna be involved throughout it. Can I take a little bit of it? Because I'm only here for two years. Also be realistic. If you go in and say, I've got two months off, I wanna do a research project. It's probably unlikely that you're gonna be able to complete a research project in two months. But you can get started and that's not a reason not to do it. It's just, you know, these are questions to think about. So, you know, probably you've gotten your soul. The initial question you have, like, my first was, well, my first research was in cancer but when I was in ophthalmology, my first research was in RK healing of acornium. So totally different. I ended up in retina. But it was a research process. It was that discovery. It was finding things out. It was being involved in the actual experiments that really hooked me. And actually I was hooked in high school. So it was more like, how do I get involved in ophthalmology to be able to do research when I started out wanting to do cancer research? So how did I make that transition? So you follow your gut and your soul but, you know, it's gonna come a time when you're at a point that you can say, okay, I'm ready to do the research. And there are gonna be questions that just drive you. And they may be from your patients. They're gonna be, what drives your passion? So don't worry if that doesn't happen right away. It will happen. And anyway, you know, that's how you would get started. So mentors are multiple throughout your life. They can be more or less prominent during different phases of your career. And that's okay. You can be really involved with someone in residency and then you go to your fellowship and you're not really as much involved. And they may come back later on. That certainly has happened to me. Trust is essential. So you want someone that you believe you can talk to. And if you're, it doesn't happen that often but it does happen where you have an idea and you talk to somebody and you say, I really wanna work in your lab. And that person says, I'm sorry, I don't have space for you and then they take your idea. I mean, it's not that common here. It happened to me in Boston. But it's not, I don't think it's that common but you wanna make sure that the person that you're talking to, you trust. And most of the time, I think like in Utah, I don't think, I think you can trust people. So if you're an MD and you're working with PhDs, that's great but I would also encourage you to have an MD as a mentor. So you can have a mentoring team but the reason I say that is as an MD, you're gonna have clinical responsibilities. And it's very helpful to work with an MD who has figured out how to increase their cushion of time to be able to get research done. Like I plan way in advance. When I have to do an NIH renewal, I start a year early. If you talk to some PhDs, they're like, oh, three months. But I can't do that because if I'm on call and a patient has a problem, I have to take care of the patient. So if I plan to work on something during a period of time and I have a clinical responsibility, I've got to take care of the clinical responsibility. So it's helpful to work with an MD as well. And they talk about this concept. I like this, the board of trustees. These are people that you trust. And sometimes when you say, oh, will you be my mentor? In the mentor's mind, they're thinking, oh my gosh, I don't have enough time. How could I be a mentor? What's your project? And they in their mind think that it's a lot of work. But you can just say, hey, do you have time to go out for coffee? Or could we just go and talk for a little while? I wanna pick your brain. I wanna get your ideas on this. And you just talk to them. It's free. And most of the time people, especially, there's clinician scientists who are like a network. You can find them everywhere. But most of the time, people are gonna be very happy to have you as their advice. So don't forget that. You can do that. And those are people that you just pick up the phone and periodically talk to. Or you have to do it in a way that it's easy for them. So I have a board of trustees. And some of them are now people who mentored me during the time that I was an early faculty member. And so I try to meet up with them at meetings. We're in different cities. I mean, if I really needed their help, I could set up a phone meeting. But I just try to talk to them periodically. And I use the time to be able to get career advice. And don't forget your mentors. So when they talk about their preside, they have all these names, right? I guess I'm talking about people that you can trust that you can talk to about your career and about your science and about your clinical, what you wanna do. When they talk about mentorship, there is supposed to be that at some point in your life, you're gonna, your mentors, there's like a mutual interaction. And there may be, it doesn't have to be, you know? But on the other hand, don't forget your mentors. I mean, I think people who teach are often who are really dedicated to teaching are often like, you know, they feel unappreciated. It's getting better now because academic institutes are actually recognizing that teaching is important and there are promotions and all that stuff for teaching. But for a long time, it wasn't always like that. There, you know, some of the programs will talk about the difference between a mentor and a sponsor. So, and I'm not sure I quite understand that. I don't know that I've had sponsors, but sponsors are supposed to be people that you can go to and say, hey, could you support me for some award or some course or some promotion? I mean, I guess I've been a sponsor to people because I get asked a lot of times to write promotion letters, for example. But it's not, it's more that I've been asked through academic institutes and not necessarily from that person. But that's another thing that, think about moving forward in your career. Okay, let me see here. I think we're just about done. Let me go through pearls. Yeah, so, you know, the pearls I would say, you know, as you develop your career as a clinician scientist, and you may also say, you know what, I don't wanna do basic science, but that's okay. You can still be evidence-based, right, for your patients. But a couple things, timelines vary. So, you know, you're a resident or say you're a resident or a fellow, and you're really busy clinically. And you wanna be involved in research, but you don't have the time. That's okay. Your goal now is really to be clinical, to learn everything you can clinically. But if you can get involved in research or you can continue thinking of scientific rigor during journal clubs or as you read the literature in that, you know, you can always look in PubMed when you've got a patient that has some kind of strange disease or like I don't know what this is. Why is this happening? You can do that research and start to be more, is to get together more information about it. So you don't have to necessarily be thinking about a KOA grant when you're a resident or a fellow. So timelines different. You can't do everything all at once. You may be focused on your family for example, that's important. You should enjoy that as part of what you do. You know, it's like, I don't know, maybe I don't quite understand the work-life balance thing because so many times I have people say, oh, well I've gotta make sure that I have time here to be able to spend with my family. And I've got this time and it's like, well it's, if you can, it's so stressful, right? If you can think of it that this is a, this is part of who you are as a physician, right? Who you are in trying to provide the best evidence-based care for your patients, right? So this is part of you. This is part of life and how you approach life. So you don't, you know, don't worry about segmenting. If your children need your attention and give them your attention, but you can still be involved in research. You can still do it through your mentality and the day-to-day. Help them do a science project. You're involved in research, right, designing. Enjoy what you do. And remember though, timelines, time does move rapidly. So it's very helpful to have plans. And there are independent development plans. Individual development plans, I think they're called. So you can, I don't know if you're, probably you're already doing that with Jeff and that. I don't know, but you can, there are, you know, where you just write down what your plan, what you wanna be able to do in various aspects of your life. And it might be your personal and your social and your research and your academic and your clinical and goals that you wanna be able to accomplish. And think of it in short-term goals and long-term goals. And the reason this is so valuable is because after you look at it a year later, you're gonna realize you did a lot more than you thought you did. How many times, so I have to do it for NIH for my grants. I have to write my aims and I have to say what we did each year. And I'm thinking, we didn't do anything on this grant when I'm getting ready to write it up. But then I look back at what the last plan was and I think, oh my gosh, we have, we've got three papers out. Oh, we found this. Oh, and we're moving in this direction. So it's very helpful to do that. So I encourage you, whatever you wanna call it, people used to tell me that it was just a five-year plan for you to do that. And I can give you examples if you don't have it. So that's really all I have. And does anyone have any questions or anything else you wanna talk about? Thank you for your attention. I think it's like eight o'clock, so you're on time. Thank you.