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A Mayo Clinic podcast for laboratory professionals, physicians, and students, hosted by Justin Kreuter, M.D., assistant professor of laboratory medicine and pathology at Mayo Clinic, featuring educational topics and insightful takeaways to apply in your practice.
(gentle upbeat music)
- This is Lab Medicine Rounds,
a curated podcast,
for physicians, 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.
And today we're rounding
with Dr. Rondell Graham,
a Professor of Laboratory
Medicine and Pathology
and Anatomic Pathologist
here at Mayo Clinic in
Rochester, Minnesota.
We're gonna dive into
Dr. Graham's journey,
joining the staff at the institution
where he did his training.
We're grateful to have
you here, Dr. Graham.
- Thanks so much Justin.
It's really fantastic to be
with you here on the podcast.
- Now we were doing a little
bit of chitty chatting
before we started recording.
There was a line that you delivered
where I was like, hold
on, let's start recording.
(Graham laughing)
- What was that you said?
- So what I shared is that I wish
when I was making my hiring decision
or the decision of where I
was going to stay for a job,
that this podcast was available.
(Justin chuckles)
- All right, so for our
audience to appreciate
the kind of pre-planning
Dr. Graham and I have
for you guys today,
hopefully is something
that a lot of you out there
will find valuable wherever
you are in your journey.
And so maybe let's kick off with,
Dr. Graham, why did you
decide to take a job
at the institution where
you finished training?
- I really think this is
a great question Justin.
And I've heard a lot of
people talk about this
and I've even been involved
in panel discussions
where this has come up
before at national meetings
and it's, should you
stay or should you go,
is really the question.
I ended up staying and I've
loved every minute of it.
I would say certainly collectively
it has been really fantastic for me.
And I would say the drivers of why to stay
will probably vary by person.
But for me, I think Mayo is a
really fantastic institution
with a great culture
and a sense of teamwork,
and I think that's just very
attractive to be a part of.
All of these people kind
of are working together
on this kind of singular goal.
And I think that emphasis on
teamwork is really attractive.
And I would say the other thing
that's really attractive about Mayo Clinic
is the resources provided
by the institution
to help teams accomplish their
kind of specific mission.
So they provide, I think,
fantastic resources
to aid clinical care,
to support educating future generations
and to enable research.
And I've always found
that the institution's
very generous about that
and I found those things
to be really attractive
and I felt like I had a certain momentum
and I felt, well, if I stay
I could just keep it going.
And that was pretty much
the kind of the extent
of my thought process
at the institution level.
We were very comfortable in Rochester,
thought it was a great place to live
and I loved the people
that I trained with.
Great people as
co-residents and co-fellows.
Working on the stuff is a little different
because you're not just
having fun all the time,
but residency of fellowship
felt a lot like that.
- Yeah, yeah, so that was
how you approached it.
Like you highlighted
that each person's gonna have
their own different equation
that they're navigating,
and you have now a lot of experience.
You're now a full professor.
You've kind of really
navigated this journey
I think, very well,
and so a great person for us
to interview for this podcast.
What are your thoughts about,
what are the variables in that equation
that you just wanna kind of
call to mind for our audience?
I know it's not gonna be comprehensive,
but what are some of those variables
you think people should think about
when they're considering the offers
for internal or external,
that should you stay or
should you go conundrum
you mentioned?
- Yeah, I think this is a great question
and I wish I had thought about it
in the way that you phrased it.
I appreciate your generous compliments.
I think about it in kind of three levels
and I'll go in the the order
in which I think about it.
But I think you need to
cover these three domains.
I think the first is
the institution culture.
What's the institution like?
Are people happy there?
Do they tend to have a lot of turnover?
What's the relationship between
people in the institution?
What's that like?
I think that's a key question
to have the answer to.
I think the next comes to
the level of the work unit
that you will be in
and the leadership of that work unit.
I wanna talk about the questions
that need to be answered
and you may not be in a position
to ask these questions literally,
but I think as you make observations,
you wanna find out how your observations
speak to these questions.
So I think it's important to get a sense
of what is the leadership like
and how does the leadership
relate to the people they lead?
Do people feel empowered?
Do they feel encouraged?
Is there a sense of openness?
Is there like a fit a
kind of this environment
that's filled with fair
or is there good communication,
I think asking questions about that.
What's the work environment like?
What's the culture like
relative to leadership
and then among peers?
I think a very good
question to ask literally,
is ask people who are in
your similar situation.
So people who have stayed,
what it was like staying
and notice what they mentioned
and what they don't mention as well.
So I think if you ask
people who are staying,
you wanna get a sense that they
felt like they were treated
as an equal pair.
And I think all the things
that correspond to that
I think will be really helpful.
You really wanna sense
that there's kind of mutual
respect in the environment
and a sense that there's
equitable distribution
or allocation of
opportunities and resources.
And so I think you wanna
ask them those questions
and I think that's really
important at that work unit level.
At a personal level you'd wanna say,
when you look out three to
five years in the future,
does the work environment,
based on what you know of the institution,
based on what you have asked
people in that work unit,
does it seem to support the kind of career
that you envision for yourself
three to five years in the future?
And I think that requires
that you know what that looks like.
So I think for me,
I was always interested in, and still am,
in an academic career
at the intersection between
GI and molecular pathology.
I love the opportunity to collaborate
with the bedside physicians
and to bring teams around
complex problems to solve them.
And I think you wanna get a sense
is that kind of career
possible in the organization?
Have people done it before?
How do people respond to ideas like that?
I think those are kind
of some of the things
I would work through,
if I were doing this again.
And I think those are kind
of key questions to answer.
- I love you're throwing out gems
and I think I'll put a pin in that one
where you're talking about,
knowing what kind of a
career that you want to have,
'cause I think that's something
that we can probably revisit
in the future, to dive into,
'cause I feel like that's
a whole conversation
in and of itself.
I wanted to ask you one
follow-up question though, right?
I think you're so insightful,
Of highlighting it's not just
the questions that you ask,
some questions you can't
literally ask, I think you put it,
but also what are you seeing
and is there one or two things
that when you go for your
onsite interview at a place
that you're kind of eyes wide open
and noticing when you're
in that environment,
I imagine for a lot of people
it's kind of very wide eye, all new spaces
and you're just kind of taking a lot in,
but what might somebody focus on?
- This is a great question, Justin.
When going on an interview
or being offered an interview at a place,
I think it's really
important to pay attention
to the trajectory of people.
So separate and apart
from what they're saying,
are people in that
practice being promoted,
if it's an academic practice,
being promoted in academic rank?
And what is the timeline
like for promotion?
Is there a high turnover?
Do a lot of people start there for a year
and then they leave the practice?
Certainly you want want an environment
where people are being promoted,
that's a feature of productivity
and a kind of a constructive environment.
You will be concerned if that timeline
seems unusually long
or different from other places
that you may be looking at.
And of course if there's a lot of turnover
that's usually a sign that
something's not quite right,
at least one thing is not quite right.
I would say pay attention to the people
that you are invited to
meet or set up to meet with.
If you are a, a GI
pathologist, as a for instance,
and you are only gonna meet
with two or three of the GI pathologists,
but they're really six,
I will be curious why
you're meeting with some
and not all of that.
And that, I think a fair question to ask.
So you wanna know who you're meeting.
Are you only meeting people
not in your peer group?
So people who are very
senior, well established
and not people in your peer group
or obviously if you are
the reverse scenario,
you're meeting people
not in your specialty
and no one in your specialty.
Those are things that I think
you would wanna pay attention to
and certainly be curious about
because you really ought
to be meeting the people
you'll be working with.
I think it is important to observe
kinda what are the interpersonal dynamics.
In particular, I would say pay attention
for smiles and laughter.
When people are comfortable together,
have a good relationship,
it's easy to laugh.
But a relationship that is
fraught or really tense,
laughter is very unusual.
So if you see spontaneous laughter,
that's usually a feature
of good relationship
and smiles, even if they're
not highly extroverted people.
You'll see people who enjoy each other
and who have great respect
for each other laugh.
The other thing I'll say to
is that if you see people
speaking positively
of their peers,
so if you were to interview at a place
and they talk a lot about the institution,
I think that's great,
but it's normal and I think healthy
to see people having respect,
appreciation, admiration
for their peers,
regardless of their specialty.
So I think that's something that comes out
in healthy environments.
For example, we appreciate
what you do here, Justin,
with this podcast, educating people
and there are many other things
that we could appreciate
about the Mayo Clinic practice.
And so that's something
that you ought to be
hearing about colleagues
and I think that speaks to
a healthy work environment.
And why I think those
things are so crucial
is there's so many intelligent
people in healthcare
and in pathology right now at
various levels of training.
It's really encouraging to see that.
And what I think probably
holds people back
or will be limitations or barriers
that people will recognize
is usually an environment
where they don't feel quite supported
or they don't have access
to the resources they need.
So where I'm going with this
is that the gap or the
barrier for most people
is not one of intelligence
or certainly not one of intellect.
It's usually the other thing,
so it is important to pay
attention to those other things.
- So on that mark, I
wanna kind of pivot us,
and I don't wanna belittle,
I think there's so many gems
you just laid out for our listeners,
whatever stage they are
as far as what are some interesting things
to pay attention to.
You mentioned a lot of
things like laughter,
I hadn't really reflected
and thought about,
but I wanted to kind of
pivot to this last point
you were making
about what are the barriers
for our successes in our careers.
And I want to kind of take us forward
and let's just kind of
run the hypothetical
of okay, we have now
accepted the job at the place
where we did training, right?
And kind of those first
couple of years in practice
establishing your career,
what's important to be really
kind of hypervigilant about?
- Wow, super great question.
I would say at the beginning,
one of the things that is
perhaps the most important
is time management.
So time management I think is top of mind
is a key thing early.
I learned a lot about this
from one of my mentors,
Dr. Laura Lamb,
she's at the University of Michigan
and I've had other mentors,
including John Goble at
the Cleveland Clinic,
and other mentors here
like Dr. Amina Jatoi.
super fantastic in many ways,
but each of them would emphasize
and Laura's particularly expert at this,
the importance of knowing
where your time is going,
not where you intend it to go
but where it's actually going.
And so one of the things
that we did as a level set
was we started looking
first at my calendar,
where was I going?
Did I need to be there?
How did those things
fit in the priorities?
And then adjusting accordingly.
I found that that was
usually helpful for me
because what I realized was
my energy was going in places
that I didn't intend,
and certain places that it didn't need to.
That helped me to recover a lot of time.
I'm talking about of the order
of a quarter to a third of my time,
I was able to redirect into academics.
So time management and energy
management, super crucial.
I think one of the common
things is going to meetings
where you are needed,
where you are engaged.
I think understanding where you work best,
when you work best.
So for me, I work best in the mornings.
So arriving early with a clear list
of the most important things first
and working through that
list, very important.
So it is the total amount of time,
but also knowing when you work best,
so that will be my top of mind thing.
- Wow, and just to
highlight for everybody,
I deal with a lot of
change management things.
A lot of pathologists, physicians,
laboratory professionals
will talk about just the
time, "I don't have the time,"
and to hear you say
being thoughtful about
your time management.
And I love the fact
that you're highlighting not
where you intended it to go.
'cause at the start of the day,
we maybe intended to knock out a lot,
but just at the end of the day, right,
where did it actually go?
And that you are saying
that you took steps
and you recovered a quarter
to one third of your time
that you were able to redirect
into your academic practice, right?
Which has allowed you
to rise to the ranks,
in really an expeditious way.
- This is really helpful.
I think you, you've captured it.
I think that was a big game changer for me
and I think there's a real
opportunity there for all of us.
The ability to manage that time
and part of the time
management includes delegation,
I wanna mention this
because a lot of learners
are developing skills to do,
which is fantastic.
And once you finish your training,
one of these skills that you need to use,
which you probably don't emphasize,
is to delegate and not to do.
And so learning how to
work with my assistant
and to delegate tasks
related to the calendar management,
related to meetings
and for us in anatomic pathology,
related to materials and planning,
this would be pathology
materials, specimens,
paperwork, et cetera,
was a game changer
because it gave me flexibility to do more
working in partnership with her.
So yeah, total game changer,
time management, really important.
And I would say one last thing about it.
I would say all of the
highly effective people
that I've met at Mayo
Clinic and there are many
and at academic medical
centers across the country
and even in other fields,
they manage their time really well.
- If I could just draw it,
let me paraphrase something,
you could tell me if this is hitting it
or if I'm off the mark.
As I'm reflecting, you're
talking about delegation.
I think that a lot of times I think
when I finished my training
and got into practice,
I thought of myself,
like you were point
out, we wanna be equals.
I thought of myself
as a fully trained board
certified pathologist.
But to your point exactly,
like this was the first time
I had an administrative
assistant to work with.
There are a lot of new things
and I probably failed to appreciate
that was a skill that I had not practiced,
that I had not honed.
And so I think one of the
ways to paraphrase this,
is just that we can fully train through,
but there are additional
skills that we might want
to kind of be front of
mind and to be aware of.
I have not had administrative
assistant before,
how can I best use this person?
Or maybe we find ourselves
several years into practicing,
I don't know, maybe for listeners
to sit back and think,
are you using your
administrative assistants,
people that you can delegate
to the maximum benefit?
Does that kind of capture you think?
- Yeah, you nailed it, nailed it.
- All right, let me
close with one question
that Rondell, I'm really
curious for your answer.
So as listeners may know,
I recently finished teaching a course
for first year medical students
and as we're always knowing medicine
is constantly evolving, right?
And I had a first year medical student
who was wonderful in the
course asked me in class,
who teaches me the updates in medicine?
- That's an awesome question.
- Rondelle, I'm curious how
would you answer that question?
Who teaches you the updates in medicine?
- This is a great question
and I would say for me
it's informal and formal.
I would say in terms
of the formal of this,
this will be participation in CME meetings
and activities organized
by subspecialty societies
of which I'm a part.
So that's a big part of my
kind of formal education
and staying up to date in medicine.
I will say, I think the
meetings are super fantastic,
not quite enough
because that's why I do
subscribe to a number of journals
and I'm sure many of us do
and I will kind of stay
in tune with those.
Because I have kind of like a cadence
by which they come to me in email
and I will kind of like always
read the table of contents
and based on the table of contents
pick up which abstracts
and based on the abstracts,
which full papers to read.
I think many of those journals though
and resources that I
have found to be helpful
will have sometimes updates.
There'll be an article or
a title or review updates
and those are usually something
that I'll pay a lot of attention to.
So those are kind of the two formal things
that immediately jump out to me
along with the institutional
cadence of grand rounds,
and updates, emerging technologies,
these kinds of things.
In terms of the informal,
I would say informally,
a lot of this comes to people
who are considered to be thought
leaders in various areas.
Asking them what's going on,
how things are going,
what are the new things.
I found that to be really valuable.
I will say my approach in general
is actually to ask people
not in my specialty.
So in particular, I will ask people
who are looking at it from
a different perspective
or working in a slightly different area
because I find that to be
really academically engaging
and stimulating,
to kind of see what's
going on in the world
from their vantage point.
And then one that might surprise you,
I surprise some of the listeners.
I look at what I consider to
be some really trusted curators
of what's going on in the world.
So there's some thought leaders like that
and I will check out
kind of what they think
are important perspectives
and sometimes it's really helpful.
One of them is there's a group,
there's a company called
Wellington Investment Management.
And the reason I became aware of them
is because they put out an article
talking about change in healthcare
and I noticed they have researchers
doing research in healthcare.
They don't have a lot of
direct medical expertise,
but they are like, "What
are the key themes?"
And I've found that to be really helpful
in having a, I would say a macro view,
of what is moving the
contours in medicine.
So it's not CME, but it gives me a sense,
or at least their view of
what's going on in healthcare
that's a top priority.
And to their credit, what they mentioned,
dementia, obesity and
is related consequences,
and precision medicine
related to cancer therapy.
So it just gives you a sense,
okay, these are some topics
I need to keep my eye on.
So I hope that's a helpful
answer for that student.
- That is a phenomenal answer.
We've been rounding with the
amazing Dr. Rondell Graham.
Thanks for being here with us today.
- Thanks so much. I've really enjoyed it.
- And to all of our listeners,
thank you for joining us today.
We invite you to share your thoughts
and suggestions by email
to mcleducation@mayo.edu.
If you've enjoyed this
podcast, please subscribe
and until our next rounds together,
we encourage you to continue to connect
to lab medicine and the clinical practice
through educational conversations.
(gentle upbeat music)