Welcome, everyone. My name is Arthur Hsu. I'm a gynecologic oncologist at National Taiwan University Hospital in Taiwan. I'm joined by my fellow junior faculty for the IGCS Early Career Network, having recently completed the International Journal of Gynecological Cancer Editorial Fellowship. And we would like to welcome you to today's Early Career Workshop on Research and Publication. A big thank you for their efforts in putting together today's program. We are thrilled to have a full house today with attendees over from over 70 countries. I want to mention a few housekeeping notes relevant to the Zoom platform for today's workshop. If you would like to see the speaker during their presentation, click on the View button on the top of your screen and select Speaker View. If you'd like to see all the panelists, you can select Gallery View. If you're having any difficulties, please send a message in chat and our technical support will assist. We are pleased to announce you can listen to this workshop in Spanish. In your meeting webinar controls, click Interpretation and then choose the language you'd like to hear. A recording of the workshop will be available for IGCS members to view on the IGCS education portal in a timely manner. We have an incredible lineup of speakers and faculty from around the world who will be sharing their expertise with us today. We have Dr. Robert Coleman, IGCS President from US Oncology Research in the USA. Dr. Rene Pereja from the National Cancer Institute from Bogota, Colombia. Dr. Rhonda Farrell from Prince of Wales Private Hospital, Australia. And Dr. Pedro Ramirez from Indy Anderson Cancer Center in the USA. Dr. Farrell will also be moderating Q&A with our speakers. We encourage you to submit questions via the Q&A feature at the bottom of your screen, and we will do our best to address as many questions as possible. Now we'd like to take a moment for our junior faculty to introduce themselves. Sadie. Hi, I'm Sadie Jones from Cardiff in Wales. Hi, I'm Nadia Nair from New Orleans, Louisiana in the US. Hi, I'm Florencia Noel from Buenos Aires, Argentina. Hi, everyone. I'm Gitu Banduria from Kolkata, India. We have an exciting and educational couple of hours lined up. Hope you enjoy. As a reminder, you may submit questions via the Q&A feature, and we will address as many as possible. Without further ado, let's start with our first speaker, Dr. Rob Coleman, who will be presenting on the topic, Data, Data, Data. Dr. Coleman, please. Data, Data, Data. Dr. Coleman, please. It's good to be here and joining you today. It's always great to see such chipper faces. I'm going to go ahead, and that includes Pedro. Let me go ahead and share my screen here. And we'll get rolling. Okay, hopefully you can see that. I've got a full screen here. So thank you again for inviting me. This is obviously an area I'm very passionate about. It's certainly one that we need to develop a fine skill in, particularly because we're trying to communicate clearly what it is that we're doing from a research standpoint. And we want to make sure that our results are, that they represent the represent the findings of what we're trying to achieve, and that we can transmit them clearly and not ambiguously. That's always a major problem that we suffer. And you'll see in the literature, I'm going to provide several examples of this, but essentially trying to come up with a well-generated hypothesis, the proper tools to assess the hypothesis, and then how you communicate it. This is my disclosures. So I thought I'd do today, as I was trying to get my head around exactly what to talk about in a half an hour, was maybe I thought what I would do is kind of break down clinical investigation in a kind of in its own taxonomy. So how does it break down? Where do you know where you are? What's the difference between a case control study versus a cohort study? How do randomized trials work? How are they constructed, et cetera? And I thought I'd go through some of those designs, talk a little bit about the pros and cons, and then talk a little bit about how statistical testing is done. And then I was going to pepper this throughout the presentation with some real world examples. So on the right hand side is a nice diagram. I've pulled, I've used this for many years. This is actually in a publication from JAMA that was put together by Grimes. And the, I thought it was really well done because it kind of breaks down the kind of the key pieces of the potential study that you may be reading or trying to design and how they fall into these specific boxes. So there's essentially five different or six different types of trials that are listed on here. You have a descriptive study, you have cross-sectional studies, case control studies, cohort studies, and then two forms of control trials, one being randomized, one being non-randomized. And you can see how these things are broken down. So the question is, did you as the investigator assign exposures? If it was yes, then you're in an experimental study and it falls down to whether or not you've done any random allocation. And if it's a randomized trial or if you've assigned exposures and it's done in a randomized fashion, it's the RCT. And those can be obviously phase, it can be a phase one, two, or three type of trial. You have, if you didn't do the allocation, you have a controlled trial because you set up the experiment, but you didn't randomize. That would be a non-randomized control trial. Now, if you didn't do the exposure, and this is where most of our retrospective studies fall, it falls into a group of studies called observational trials. And if you have a comparison group that falls into an analytical study and it talks about, breaks these things down into three different sub-studies based on where the exposure and outcome is allocated. And I'm going to walk through all this with you so you can, so you have a chance to digest it. And if it doesn't, it falls into the descriptive study. So I think as you read and design your own trials, it's really important that you understand these kinds of basic components, because it is not uncommon. It happens in even high impact journals where they'll, the study design will be misclassified and even worse will be misrepresented on the basis of the data. Okay. So let's talk about the descriptive studies first. So there's these descriptive studies basically fall into all kinds of different categories and descriptive components of other studies can also be done. So in other words, a post hoc analysis of a prospective trial is essentially a descriptive analysis. It's essentially trying to understand what was going on in a non necessarily pre-specified or even powered subgroup with the intent of trying to do one thing, generate a new hypothesis. And so if I don't leave you with anything else today, other than my amazing looks, is that you understand that these descriptive studies that are brought as part of either a, that are brought forward either as part of a study, or that's the primary point of the study is that it is generating, not proving, generating a hypothesis. The biggest fallacy we get into is this post hoc ergo propter hoc, meaning after this, because of this, meaning that in a study that you made an observation, the conclusion is that the, that because of that relationship that it caused it. And we see this all the time in retrospective studies and we see it even probably more egregiously in prospective trials. So the point is, is that if you do a study and it's, and you're making an observation that was away from the primary endpoint that was powered, what you are doing is generating a hypothesis. Unfortunately, we make clinical decisions and treatment recommendations based on these hypothesis generating exercises. So please, please, please take it for what it's worth. These types of studies where you're observing data, generate hypothesis to be tested subsequently, making clinical decisions on the basis of that is hazardous. Now they fall into these categories, case reports, case series, cross-sectional studies, surveillance studies, ecological correlations. All these things essentially are, are forms of descriptive studies. Now, why are they so popular? Because they're cheap. You can do them with, there's no ethical issues. And you can generate a lot of very important hypotheses that could be taken either to the lab to be evaluated or to the clinic to be evaluated. That we be cautious of how, how far you make the connection between cause and effect. Now, here's a nice example. Very recent, last year, remdesivir came out in the, in the early days of COVID-19, of the coronavirus pandemic, particularly addressing patients who had developed severe COVID-19 symptomatology. Published New England Journal of Medicine, April 10th, based on 61 patients. Now, one of the things you should note is that there are more than 61 authors. You had 61 patients, 61 authors. So basically everybody here had essentially a patient. No, I'm just kidding. But the point is, is that here is this, is this observational study where they gave this drug, which is an antiviral to try to treat this condition, which is a virus. And so they show that this was effective. Now, now three days later, you see that this came out that said that hopes dashed as coronavirus fails its first trial. So wait a minute, observational, controlled, observational, controlled. Okay. So what they did, and you can see this is what we know about the state. So they, they, they you can see that the there were some, you know, methodological problems in this particular in the pro in the descriptive study that didn't get translated into the prospective study where they actually made the random allocation. Okay. And this is the thing that kills me as such. The study results are inconclusive. It's the pain, right here. We have just now invested a bunch of time and money and patients' lives, and we have an inconclusive study. It's just, it's just a tragedy. Okay. So again, hypothesis generating to be tested forward, but do not make clinical decisions based on the hazard, based on the principle. Okay. If we move down out of the descriptive studies into studies that actually have a comparison group, we can run into these analytical observational studies, and they have three different kinds of outcomes. One is, is based on the relationship between the exposure and the outcome. So what we'll talk about first are the cross-sectional studies. So cross-sectional studies are done to find out what's going on in a population at a specific time. They are generated to develop prevalence. Now, this type of statistic is super important when you're trying to design a prospective study, because you want to know how many patients we have. One of the, and I don't, I didn't put slides in there, but one of the, kind of the unique findings with respect to how well we're doing with ovarian cancer, you know, therapeutics, is to look at the prevalence of ovarian cancer in the United States and monitor that over time. So we all know that ovarian cancer in the United States, at least, is a relatively rare disease. We see about 20,000 new cases out of our, you know, 158 million women population, female population. So it's a very low incident tumor. And we know that the mortality rates are essentially the same and have been for about three decades. They're slightly declining over time for both cohorts, but we've got all these new drugs and we've got all you great surgeons, and we have all this multidisciplinary approach to this disease. So why are we not seeing bigger changes in those two variables? Well, it's because they're not really measuring the benefit of these interventions in a patient's journey. What we find is that when patients live longer than expected, they start to accumulate on the tails of the previous cohort that was supposed to have not made it. And what you see is that if you take a cross-sectional look at ovarian cancer over the last two decades, you see a dramatic increase, even in the last 10 years, about almost 20%. So prevalence is increasing within the United States, which is probably a reflection of many of those things that just mentioned, but they're not showing up in the incidents and mortality statistics. So these types of studies can be very valuable about trying to understand what population we have available to us to actually test in a prospective way. And this is another study that was recently published that was doing a very important trial, trying to understand what the BRCA1-2 prevalence was in the Chinese population. So they wrote this trial published in Gen Oncology a couple of years ago, and you can see they took all these patients that had cancer, all these patients who did not, they had a series of eligibility criteria, and then they tested this cohort of patients at one time. And what they found was that the incidence of BRCA1-2 mutation was very similar to what it is in many of other parts of the world with about a 20 to 25% positive germline mutation rate. Very important because the next study is going to be say, okay, let's test the BRCA population in China. How many patients do we have? Bingo, you've identified it. Here's another analytical study, or excuse me, here's another type of analytical study, the cohort study. And I really like these trials because they actually provide risk assessments. So what this type of trial is, it's forward going, it's going to assess the incidence and the natural history of a disease, and it can assess multiple different outcomes. Now, these types of studies can be useful in rare exposures as opposed to rare outcomes. And we'll get back to that and how we do that. So this particular trial, we'll be looking at the outcomes of people that have exposure. And I'm going to provide you an example here. This is the Million Women Study. Many of you are familiar with this. This is trying to look at the association between hormone replacement therapy and cancer outcome. In this particular example, it's looking at ovarian cancer. And you can see that this particular study is cohort forward going. And so it's looking at patients that chose to use hormone replacement therapy or not. And they were followed in time for the occurrence of ovarian cancer. And you can see that in the patients that were exposed these 474,000 women, 1,142 actually had ovarian cancer. In the patient population that chose not to use hormone replacement therapy, it's 287,000 of those women. The ultimate incident rate of ovarian cancer was 740 patients. And so when you reflect the incidence in the exposed versus the incidence in the unexposed, you get accrued relative risk. And this was basically saying that there's a slight increased risk of ovarian cancer in patients who have hormone exposure. That would be your hypothesis. And you would use that to go forward in making new hypotheses. Going in the reverse direction is what we call a case control trial. And these are defined by outcomes. So once you know what the outcome is, then you go back in time to determine whether or not there was an exposure or not. And so what you're trying to identify are what the odds are for developing that cancer relative, the odds of bad exposure relative to the outcome. So the pros of this type of analysis, and these are one of the most common ones in literature, is that they're relatively easy to do. You already know what the punchline is. What you're trying to figure out is how did you get to the punchline? So the problem with this particular type of trial is that while you can clearly identify the affected cases, the real problem is identifying who are appropriate controls against those patients. And you can imagine why there's all kinds of trouble doing this, the major of which is that both the patient who has developed, for instance, cancer remembers all sorts of exposures. The patient who never developed cancer really doesn't attribute any of those prior exposures to the cancer because they don't have anything to reference at point. And so this type of recall bias, et cetera, and habituation bias, they're all listed here on this slide. But I just want you to know that these can be difficult to do. However, they are really valuable. Here's a great example I pulled out from the literature a couple of decades ago. They had an outbreak of gastroenteritis on a cruise ship in the Caribbean. And so they were trying to figure out what was going on. They couldn't figure out where this might have started. So they did a survey of the passengers who became ill. They found 84 patients out of the 900 on board who got ill. Then they looked at what they ate, when they ate it. And they looked at the passengers and the crew. And you can see here on the right-hand side the dates of exposure. And then you can see there's this big spike when patients developed this illness. So they did a nice little case control study. And they looked at various different food items. And they found that the potato salad was a culprit. So if you look at the odds for the patients who had disease, now they looked at their exposure back in time. And they found that the odds were 10 times higher that you would have gotten this disease if you had taken the potato salad. So they said, hmm, that's interesting. So they sampled out what was the issue. And they tested the stool samples from the crew and, of course, the patients. And they found that there were two asymptomatic workers who were rare carriers of the Shigella infection. It was the dishwasher and the kitchen garbage worker. Oh, my goodness. But it was a very clear and nice way to use the data they had at hand to identify a source. And obviously, this led to a benefit for health. OK. So those are the kinds of retrospective studies. So let's talk about the prospective trials. And we've got a lot of these out here. So on this taxonomy, this is the situation that the assignment of the exposures was made by you. This is an experimental study. And it could be done either randomly or not. OK. And as I showed in that last slide, which I jumped out of, here we go, that this is kind of where clinical trials fall. They fall into these phases. They have them listed here from phase 0 to 4. And I have them listed down by some major discriminators. I'm not going to talk much about phase 0s in phase 4. Phase 0 trials are frequently done in healthy volunteers to look at specific biomarker changes in sub-trivial therapeutic doses, usually placebo-based dosing with regard to treatment effect. But they don't always have to be. So we have done phase 0 trials as a way to evaluate a biomarker in a cancer patient population. And this might be looking at specific alterations in chemistry. So there are those types of trials. And then phase 4 trials are usually a FDA requirement for trials of newly approved drugs that came from phase 3 settings. So for instance, pembrolizumab, as you guys know, is approved for MSI-high endometrial cancer. Now, it was approved under an accelerated approval. So it has an ongoing phase 3 trial in a different setting to be the confirmatory trial. If that gets full approval, then they're going to monitor how people use it in patients that wouldn't necessarily fit the criteria for a phase 3 trial. So they look for how it's used in the general population. As you guys know, for the COX-2 inhibitors, this is how they made an association to cardiovascular disease and that particular drug. So these phase 4 trials are a commitment that the industry makes to a new drug approval. OK, so the phase 1 trials, there's lots of these out there. These are usually kind of our first attempt in in to uh evaluate the this the safety of these compounds in humans they have all different kinds of little nuances to them some of these phase one trials are first in human meaning that they are they are uh they have filed the investigator new drug application with the fda and they have um uh committed to do this the fda works with the company to develop an initial dose it's usually done at one one uh between one tenth and one twentieth of what they think is a biological effective dose and that's done on based on the animal models and the observed toxicities this doesn't always apply but this is kind of how it sometimes works and then those go into patients with the rapid dose escalation scheme trying to identify what would be a recommended phase two dose sometimes that's a toxicity barrier sometimes it's a target barrier in other words did we modulate the the expression of a specific protein that would be the biologically effective dose as opposed to the maximum tolerated dose and these types of trials are done in all different kinds of ways this is my least favorite the three plus three design everybody knows how to do a three plus three design but i it to me is a very inefficient way to address what you're trying to find which isn't a recommend dose but the way this is done is you put three patients on you get them through what's called a toxicity window which is usually a month of exposure once the last patient clears that window you look to see if any of those patients had any dose limiting toxicities if there were none it goes up to the next dose level and so on if a dlt is observed you add another if it's one you add another three patients and if another toxicity has occurred then that would be considered this would be the recommended phase two dose and they usually will add three to six patients at the lex dropping back from the this dlt to the previous dose to confirm that this is the recommended phase two dose now on the right hand side i have a kind of an example this was done looking to compare the three plus three design versus some of these newer techniques of doing a bayesian analysis and this particular example with the with the with gem side bean was was trying to look at the dose in a dose escalation fashion and what they found using the three plus three design was that half of the patients on this on this particular example would have would essentially target it would have concluded that 100 was the most was the biologically effective dose however if you look over here there is no effective biological dose on based on the three plus three in in this one scenario so it's you've got you know you have a wide range of outcomes here on the other hand if you use the these basing designs you can see that there's you're much more likely to to arrive at the correct mtd which was 300 in the study based on the toxicity window and so these have have i think i think illustrate you know the benefit of using some of these newer designs we've um there's a number of them out there i'm not going to go through them all but you should just know that when you're running a phase one trial if you're in that field that i i would recommend that you look at some of these other designs uh newer trials finally are starting to adopt these uh because they are much more likely to come up with an effective dose and keep you in this promising zone or even find a place where an interim analysis could lead to approval the phase two as i mentioned are looking for efficacy these are a little bit larger trials they can be randomized these are usually after we find a toxicity signal where we can deliver these drugs safely they go into the clinic there's lots and lots of examples of them this is one that is coming out in print in the next month or no in the next two months in lancet oncology looking at a new uh uh antibody drug conjugate called uh tesotamidotin this is a antibody drug conjugate that targets tissue factor this is our experience in cervix cancer in second line and beyond you can see this is a waterfall plot which is showing the um uh the the magnitude of the responses based on rhesus criteria for this drug and you can see the with the response rate um uh response criteria being around 30 percent that there were a large number of these patients who had developed an objective response uh almost 20 uh 26 percent um which uh is very favorable in this very tough to treat population and we hope this will get regulatory approval that was a single arm here's a randomized trial that was looking at the combination of a PARP inhibitor and an anti-agenesis drug cedarinib and olaparib this was published in lancet oncology um uh and you can see these from these two trials this is actually um niraparib and bev so both these are two trials that are looking at that strategy of PARP and anti-agenesis both of them look very positive in this randomized phase two trial showing a benefit for the combination so remember that i'm going to come back to it in a second now the phase three trial ours are the standard of care um analyses these are ones that are going up against the standard of care uh looking at a new intervention now when counsel a patient who's on this kind of path you want to make sure that they understand that the control arm is the standard of care meaning that if they don't participate that's what they're going to get right it does it's happened to me many many times when i've counseled a patient to a phase three trial where it's randomized they'll say oh can i pick the arm no it's randomized right and why is it randomized because we don't know if we knew that the new arm was better or if we knew the new arm was worse which has happened then we wouldn't use it so the standard of care is the um uh is the control um the null on this and so the hypothesis is is that the new therapy is going to reject that they are the same okay so it's a that would be positive these are big trials they involve a lot of patients and you want to know what the cost is you just add five zeros to these numbers so the usual cost for a regulatory trial is about a hundred thousand dollars per patient so they are very expensive trials which is why there aren't very many of them but they are the best way to eliminate bias they help to um uh to approve or disprove a hypothesis and they provide the highest confidence for treatment and that's how we get new drugs now when we get it right it's really right so here's solo one you guys are very familiar with this trial this is a trial that was done in patients who uh had newly diagnosed with very cancer had responded to their frontline therapy and randomized to standard of care placebo or the new drug allopurib now what was neat about this trial and this is what i think is just another take-home message about this is that this this trial had a biomarker it was a biomarker for efficacy so it was looking at patients who had a germline or somatic mutation in BRCA and they were given a drug that had been proven to be a uh to be more active in patients who had BRCA mutations so this was a integrated an integral biomarker for the trial actually was an eligibility criteria but it was based on the efficacy relationship between a PARP inhibitor and a BRCA mutation so you guys know that the punch line here it was very positive has ratio of 0.3 something we've never seen in in in this space before and of course this led to an FDA approval uh it was in within two months of the first presentation so we have that in our armamentarian now there are cons to these trials sometimes they are limiting limiting to even make the trial go forward and one of those is that they are expensive and take a long time report overall survival as i'll share with you in just a second is very difficult endpoint for ovarian cancer mainly because patients have the expectation of living a long time where many different confounding variables can disrupt the initial event result pfs so um these things and these are various different ways that we've tried to combat that we try to use a blinded blinding stratification variables blinded independent central review looking at the rate of crossover and analyzing crossover um we um try not to to over interpret the subgroups because they're not the primary outcome remember the mantra i mentioned these are hypothesis generating exercises not proof of principle okay and one of the issues we have with phase three trials is that no matter how good the phase twos look they could still be wrong so remember this example i showed you the benefit of plus uh an anti-hypogenesis drug or norepinephrine plus another anti-hypogenesis drug very positive look at those hazard ratios point four two okay and so the thought was they would be positive in a phase three setting well we took that to a phase three setting and look what happened it didn't work it wasn't better than chemo so here we have the winner of that last trial sedentary laparib compared against platinum based chemotherapy in a patient population and you can see this was an all comer patient population but no difference so yes positive no positive so just be careful about that we don't want to um over interpret these results so um just some considerations you know we try to make these um trials as as um available to as many patients that it's appropriate to but we want to make sure that we don't make it too broad that we were able to eval to control our type 2 risk this is uh this is done in our power calculations we obviously have to make a um you know we're trying to find a goldilocks effect here we're right we don't want it too big we don't want it too small we want it just right and we want it to that trade-off between size and cost and we want to make sure that we increase our technical success probability and the way we do that is best is by using predictive biomarkers of which unfortunately there are a few so let me just share one of the this is the one of the um kind of the last two punch lines i want to give you before i leave here and that's the um the issue about um uh ovarian cancer and the difficulty between making it a relationship between pfs and overall survival i think we finally convinced our fda that overall survival is not a relevant endpoint for trials that for for disease conditions that have long post-progression survivorship like ovarian cancer because power reduces exponentially as a function of time so this is in an experiment that looked at a pfs um between six and nine months between the experimental and control arms but it has a ratio that ranges around 0.7 and what they showed was that over time depending on the power that you chose for the trial that that a trial that has a patient population as a 20-month post-progression survivorship has only a 20 percent conserved power to address overall survival and so the way that you combat that is you increase the sample size well look at this if you want to preserve that probability of hitting overall survival with a with a hazard ratio of 0.7 based on pfs you need about 2700 patients if the expectation is that they're going to live 20 months after they progress so this is the this is a big problem and again how we combat that is to is to is to get the regulatory agency to understand it that's number one but two is to choose biomarkers that can increase our hazard ratio so that we have a better shot at it last thing i'm going to say is about statistical significance everybody lives and dies on p less than 0.05 oh my gosh kills me uh if you get something that's p equals p equals 0.052 does that mean it's not significant no it just means what is the conventional risk that you're willing to accept as making a in to make the wrong conclusion here our alpha is set at 0.05 meaning that in 1 in 20 chances we're willing to take that as a chance of being wrong if it's one in if it's one in 19.8 it's still pretty damn close to that number and so there's this great paper in nature i love it it was in 2019 and it says maybe we should retire statistical significance i love this article it's actually more of a commentary but what it brings you down to is to say listen divorce yourself from the 0.05 understand what the magnitude of effect is this is going to be represented by your hazard ratios and the 95 confidence intervals but once you understand what those confidence intervals it gives you better confidence in how you want to claim those outcomes and use that as your guiding principles to develop your research strategy so my take-home message here if you haven't heard me say it many times is that first you ought to know the divots of your research right know where the where the where the difficulties are and try to construct your trial as best as possible to get over those understand how the the clinical trial development follows the science and try to make sure that you you stay as that you have as fidelity to those assumptions analyses that are based on normal normality need to fulfill the assumptions of normality so make sure you check before you do a t-test that it's actually normally distributed there's lots of easy ways to do this they're all available online for free but these types of things are really important so craft your hypothesis make it specific craft your population do the right type of trial and limit your interpretation to what was being analyzed in that taxonomy and i'll close there thank you so much for your attention thanks so much dr colman that was a fantastic talk and i've learned a lot i'm sure everyone else has too now just remind everyone to send their questions through to the q a section of the of the platform um we have some questions for you dr colman if that's okay the the first question is from sarika gupta in india um she's asked hi sarika thanks for your question she's asked for your advice on how to preserve data if you working in a small practice small group practice or a solo practice where you don't have a data manager yeah so it's difficult because somebody has to do it right so um what we typically will do is and there's there's a fair number of these but it's it's helpful to get some some um to get some help from a database builder um there are a fair number of free resources that are available online but what i do um and there's many of people on this call have done you know is to develop a database that um can be um uh with with the elements around what you want to preserve for your study so make it specific develop the database and then ultimately that it's what you need is is is your own um help and this is where medical students are really helpful you can get them um but um uh you know unfortunately you know somebody has to do the data transfer until we get the automated systems for that we're obviously working on that but those type of automated systems that will take direct data from the emr directly into a data field that can be analyzed is uh you know obviously expensive so um what i would say is i would develop i would craft my hypothesis my hypotheses carefully and then try to bridge out your data fields that are consumable uh and build them into a an open resource type of database um program like red cap okay great another question from the audience so when you're combining data sets from multiple sites what's the best way to do this successfully um to to um get ahead get with your group ahead of time so one of the biggest difficulties we have in combining data sets is that people capture data in different ways so um and pedro could could attest to this as well for those trials that we've done so one of the biggest things that you need to start with is a data dictionary so for instance how do you classify hypertension is it arrow up bp is it htn is it um you know 120 or 140 over 90 you know these types of things are really critical so what i tend to do when we when we're going to combine data sets is before the trials start is to try to get a common data dictionary if the trials if you haven't done that and you got to do it later then we try to do is you have to do basically compare documents type of approach where you look at how the data is recaptured in individual fields and start with the highest relevant endpoint topics first like how was how was pfs assessed how was the objective response assessed and then try to make sure that you capture the uh the elements that are common between the two and then the hard work comes when they don't match and then you have basically have essentially a your steering committee your trial steering committee will sit down and go through those data points and figure out how they're going to be mapped but if you can i i promise you you'll save your hours and hours of time get to with your group ahead of time and develop a common data dictionary that will help immensely coming down the road that's great okay with the final question this is a question i'm sure everyone would like to know the answer to it's from fanagani oncologist in china her question is how can we balance between clinical work and scientific research i mean we do not have enough time because we're always busy in dealing with patients in the clinic so what have you found helpful rob yeah well yeah that's it's all yeah it's the it will always be the problem i try to find something that i'm super passionate about and try to carve out a little bit of time uh try to just try to rather than try to you know swallow the entire ocean try to just pick off a specific topic that i'm that are really really passionate about and and and just work in that area it's always good also to find like-minded people um so if you have a couple friends that you want to work with uh even if they're overseas it's always good to just get a small group together uh and start to tackle a specific kind of problem that way you don't have to actually like i said swallow the ocean you don't have to do it all yourself um and you can and you can tackle it together the collaboration will be much more fruitful and you'll gain a lot of new friends well thank you so much rob we've run out of time and i know you have to get onto important other important meeting so um we say goodbye to you thanks a lot okay thanks for having i'll try to jump out okay so um we'll now move on to the next portion of our workshop it's renee pereira from columbia he'll be presenting for um on from abstract to manuscript um again i just remind you to put forward your questions for the q a section and we'll answer that at the end of his talk so dr pereira please begin when you're ready thank you dr for uh at first i'd like to thank igcs and its education department for giving me this opportunity uh also i'd like to thank to the speakers the fellows and of course almost 200 people connected from all over the world i'd like to speak a little about from abstract to manuscript it is always tough to speak after rock but i'll try to to do my best i have no conflict of interest for speaking about this and i would like to start saying that a modern teacher a modern gynecologist oncologist is basically a researcher and research results have to be published because people have to write to know the facts that can change science or that can change practice i'd like to consider what type of career do you want when finishing your training gynecological and academic research including of course research and publishing uh just teaching and it is very common in in latin america the our professors taught us how to see patients to operate but not publishing because unfortunately in in many parts of the world we are not trained for for publish just an attending physician not teaching too much just private practice and if you go to private private practice forget about academics because you will not have enough time for a thing for other thing that that do your job social health care focus doctors going to very um poor places in order to to care those those patient there and basic research any of those is a good choice because there are personal choice is not is not a better doctor a doctor that publish that order that that doesn't publish okay they're just life options and regarding mentorship, we are going to talk about mentorship later, but one question you should make to yourself is which of your teachers do you want to be like? And the answer probably is a good option for a mentorship. And why publish? Why we publish? To improve my writing skills, of course, to upgrade my knowledge, to recognize my research, to assess my work quality, to help the society with my research. Those are reasons for publishing, but there are a few more. To be recognized in Latin America, to be famous, and we can talk later about fame. To serve as an example, ego-related reasons, and this is quite important because I'm looking for personal development, professional development. I like to accept challenges. Early morning, you know, in the United States, there's an economical difference among being an assistant professor, associate professor, and full professor. And those categories depend on the number of publications and mostly the quality of the publications where your work has been published. To motivate other people and to help people, to help students, to help residents, fellows, to help patients. My preferred reason is to convince others that they can do it as well. This is the reason why I publish. The rationale for publishing is to try to impact science and to get some advance on the field. Outstanding science does not equal to definite publications. It depends from many other things. Personal anecdote means nothing. And the results are only believable if published. This is really common in medical meetings when a doctor stands up and says, according to my experience, I would like to remind you the pyramid of the evidence. And the lowest level of evidence is experts' opinion, but experts' opinion written, not spoken. You have to write. The priority in the journals for publication is new and original research. Research, of course, prospective randomized trial, but as Rob said, it's very difficult to run a prospective randomized trial. It's complicated. It's so expensive. Largest retrospective series of a topic of interest. This is opinion for journals. Data that contradicts previously established results. And a good example is lab trials. Reviews of relevant and current topics. Reviews are cited very, very well. So if you can write a very comprehensive review, systematic narrative, et cetera, probably will be accepted in a given journal. And videos or new or novel techniques. They are low priority publications, such as editorial commentaries, case reports, et cetera. Case reports are important from the point of view of training, for training to medical students, training to residents. Case reports should be the first step when you are pursuing a publishing career. How to find an interesting topic? The first thing is to do a literature search to be sure that the issue hasn't been published yet. Review the current literature, discuss with an expert in the field, not a friend, not a peer, just an expert. It's important to be attentive to capture the missing element, the gap in the knowledge that you can provide with your research. It's important to visit abstract and posters in the meetings in order to get the addresses to make contacts with those people in order to establish collaborative project. And additionally, discuss the proposal in group conferences. This has been a kind of introduction. Now I'm going to talk about abstract and manuscript. And what is first, the abstract or the manuscript? Depends. If you have a project and you have already the results and you are planning to present it in a scientific meeting, such as SGO, ESGO, IGCS, you should write first the abstract because it's a requirement. And second, when you revise all the data and information, the abstract and the final abstract can change. Information can change. So for a scientific meeting, you should write first the abstract. Otherwise, you should write first the manuscript and then the abstract. Regarding abstract, the abstract must be appealing to readership. And unfortunately, but this is really true, is the only thing that most people will read about your article. Not the full manuscript, just the abstract. Please be concise in doing the abstract. There are different structures according to the journal. One is a short background, methods, results, and conclusions. Another is just objective methods, results, and conclusions. And you have to say this in just 200 or 300 words. And please avoid discussion elements in abstract because you won't have space for doing anything different than the requirement. Some recommendation is construct the title and abstract from keywords from all sections of the main text. Use important keywords at the beginning of the title. No abbreviation or passive voice. It is important to state the objective and start the results sections with the objective of the research. Give the sample size if you are reporting percentages. And present effect size with confidence intervals and rubsits. An isolated value means nothing. They're useless. Always a P should need an interval. You should consider the four W's. What is known and why is this study needed? What did you do in methods? What did you find in results? And what does it mean in discussion? From my point of view, the most difficult part of writing a manuscript is discussion. Because in discussion, you have to think how to sell your idea or how to offer your proposal. Check the abstract can be read independently from the main text. One more important thing is every time you check the manuscript or revise the manuscript or revise the data or the results, you should check the abstract. Because as a reviewer, it is very disappointing when you read the abstract and authors are presenting some information and when you read the results sections are completely different. So you should check the abstract every time you revise the manuscript. When writing the manuscript, you have to be concise and go to the point. A lot of words does not equal to a good story. And this is particularly important from Latin American people and Spanish speaking people. Because we use a lot of words, we love words. In English, you have an economy of 30% compared to Spanish. English is too sharp and you have to be very precise and try to use scientific language. For non-native English speakers, it is highly recommended to include one English native speaker in the team because the way to write is completely different. Please try to avoid non-scientific language. We perform this approach in the easiest manner. The blood loss was less than expected. The approach was done as routine. You have to explain. This vague terminology is not appropriate for a manuscript. And also language that can be misinterpreted. The length of stay was very short. What does mean very short? Three hours? Three days? In China, 21 days? Who knows? The rate of sentinel load detection was outstanding. You should avoid adjectives all the time when writing a manuscript. Complication rates were minimal. What does mean minimal? You have to provide data. You have to provide numbers. Never split the tables or figures in the middle of the manuscript. In fact, the managing editor will give back the manuscript to you if you find tables included in the body of the manuscript. There is a right place to put those in the platform. Please use real English-speaking editors. Some examples, hysterectomy, appendicectomy, similar to appendicectomy in Spanish, but it's appendectomy. They are very, very common mistakes in manuscript. Don't use Google Translate. As a reviewer, I can notice this easily. Google Translation looks really, really bad in a manuscript. Please try to find a native English-speaking person revising the manuscript. I think this is fundamental. Some journals offer English edition, but this can be costly, $2,000, $3,000. In the introduction, you have to provide the reader essential information in order to understand why this study is being conducted and informing about the research question. The introduction must allow readers to understand the biological, clinical, or methodological rationale for your study. The most important thing is a good introduction will sell the study to the editors, reviewers, and reviewers are the key element. I'll speak a little later. Readers and sometimes the media. The introduction doesn't have a number of words, but typically should be about 10-15% of the full length of the manuscript. The introduction is the first part of the story that you are trying to tell. Every story has a start, a medium part, and a final part. Introduction is the initial part, the middle part are methods and results, and the final part is the discussion. In introduction, you should not exceed 3-4 paragraphs. In the first paragraph, very brief background information. Second paragraph, why this is important. And third paragraph, what is the gap in the knowledge that you're trying to fill with your manuscript. And additionally, in the final part of the introduction, you should state the aim of your study. Please don't use more than 8 or 10 references. It is really tiring to see an introduction with 30 references. That does not make any sense. If result is the final aspect of the meal, methods are the ingredients and the recipe. Methods are important because they will help readers to understand how the study was conducted. IRB approval always. It is very difficult to publish a paper in a manuscript in a top journal without IRB approval statement, even for retrospective studies. What kind of data was collected? It is common to find this statement. This is a retrospective review of prospectively collected data. That means nothing. Don't say prospectively if not. For same prospective study, you have to provide an IRB statement and a registry, clarifying that it is a prospective study. Who was the study group? From where? When were recruited or included? Provide details for its replication, the methods for statistical analysis, and this can be written with the help of a statistician. The consent process for subject is a prospective study. Give some details on the process of randomization. Don't forget to explain how the sample size was calculated. Include basic information on the design of the study, setting and subject, data collection, data analysis, and ethical approval. Always. Refer to previous publications from the same large research project, such as Study Protocol, for additional information, if applicable, and in supplementary material. Consider providing detailed information on the methods as well as web-only supplementary materials. And the question you have to ask yourself is, would a researcher be able to reproduce the study with the information I provided in this paper? This is quite important in systematic literature reviews. The results should reflect what was collected in the methods. Always begin with the number of patients included. Provide chronological sequence of the data. Make sure that numbers match abstract and table. This is one of the most common mistakes when making reviews of papers. Make sure that all numbers are up. Provide data that will be of interest to the reader and do not interpret the data in any result. Just give the facts. And in discussion, please start with a single statement of your main findings. Do not repeat results. Place in context of previously published literature and be sure to include comparison of major articles. We found this and other authors have found that. Please provide comparisons between the information you have obtained from others. Please include strengths and weaknesses. This is very important and this is a missing element in most papers that we receive for pre-review process. Provide future directions, provide details as to why this is contributing to literature, and please don't make editorial statements. Just a discussion. This is a checklist. There is a very good publication in Journal of Clinical Epidemiology in 2013 where all of those aspects are highlighted and very well explained. References. Please use the format that the journal are recommending to. Double check spelling as a specific for every citation. Keep reference to what is relevant. And important, really important, think about including reference of work, of previous work, from people you are selecting for reviewer. This is just politics, but it's important. In Latin America, there is a very heavy discussion about who should be the author. The authorship can be discussed before starting writing the manuscript, before, not after, before. So, an author, according to the International Committee of Medical Journal Editors, is the person who substantially contributes to the conception and design or acquisition of data, analysis and interpretation. Draft the article or revise it critically for important intellectual content and give their approval of the final full version to be published. All three conditions must be fulfilled to be an author. Sadly, in Latin America, it is not rare to write a manuscript and when you present to the boss, to the chief of department, the chief can ask to, yes, put me first, because you are here because of me. And there are other patients, or the patients of our clinic, so put me first. So, you should discuss this seriously before starting the manuscript and if you want to be the first author, you should state and you will write the whole manuscript by you. Before, regarding selection of the journal, we are trying to submit your work. You should consider basic versus clinical research journal, a general versus specially focused. We have in gynecological oncology, of course, International Journal of Gynecological Cancer, Gynecological Oncology, Journal of Gynecological Oncology, and European Journal of Gynecological Oncology, and other journals on the topic, and the generalists can be the Green Journal, Great Journal, Lancet, etc. Traditional journals versus electronic journals, most of the journals have moved to electronic versions. If there is a subscription journal versus open access, and if it is an open access, you have to be aware that you will have to pay. You have to balance the desire to publish in top quality journals with the need of rapid publication. Consider but not be fooled by impact factors. Impact factors is not the only important thing you should think in the audience you are looking for. Draw up a prioritized list to three to five journals in case your manuscript were rejected from your first choice, then go to second and third. And importantly, be realistic. If you have a retrospective series on vaginal trachelectomy, please don't send it to New England Journal of Medicine. Don't send it to Gynecological Oncology because that's a common issue. So try to find the right journal for the kind of manuscript you have. I like this image because publishing is always a frustrating process, but it can be the opposite. It can be very satisfying, but you will need some requirements. Finally, I would like to share with you some take-home messages from my experience writing manuscripts. The first is, find a mentor, or at least try to be found by one. According to my point of view is more easy for a mentor find the right mentee that the opposite, but the mentor have to be needs some characteristics and we will discuss later on the right mentor and the right mentee. It is better to be realistic than too optimistic and this will avoid some early frustration in your career. If you are a non-native English speaker please include one in your team. This is one of my the most important recommendations today. If you do small steps and you accept progressive challenges you will get sequential achievement. So if you are starting your career in publishing publish case report then small case series then larger then collaborative series and look for journal with modest impact factors because higher the impact factor higher the more difficult the possibility to get accepted for publication. After a submission anything responds other than reject is a success and celebrated because reviewers and editors are giving you the opportunity to improve your manuscript to put in a better shape your manuscript. So be grateful with them they are not trying to dissolve your life they are trying to have a better manuscript in their journal. This is important for Latin American people don't write motivated by fame or looking for immortality you should write for reviewers. When you are preparing a manuscript you always have to think as a reviewer what things would you ask if you were the reviewer of that paper and it's important to use a guideline according to the type of article we are writing. For randomized trial a consort for observational studies retrospective course case control studies stroke systematic review prismas study protocol etc. This is an example of the consort the checklist and when you are writing your report you should check that every aspect is included in in your manuscript. Same for retrospective series case control studies cohort studies this is the the stroke for a country or for a cohort study check every aspect because frequently as reviewer you use these guidelines in order to check that all the elements have been included in the in the manuscript. Probably the most important thing that I will say in my presentation is this become a reviewer if you want to learn how to write papers become a reviewer because as a reviewer you will have a huge exposition on how the authors write the manuscript what styles they have to write what they try to say when when submitting your your your manuscript as a reviewer you can say the opinion of the other reviewers and you will verify how authors respond to the reviewers queries and requests so it's strongly consider become a reviewer because being a reviewer will improve your writing skills heavily. Networking is crucial the if you see the the manuscript it is rare to see a manuscript signed by just one author always this is a team of this is a work of a team not an individual so you have to be you have to find a network of collaborators inside your hospital inside your city into your country on in your continent try to build this this kind of network which is really really important this will allow you to get involved in multi-centric collaborative projects please try not to pay to have your work published in some parts of the of the world particularly again Latin America. One of the requisites to to be graduated as a specialist is to have a manuscript published and many times this is this is paid. Try to get your work published due to its quality not because you have the money to pay for publishing it. The name of this game is resilience. Resilience is the ability to recover from adjust or adjust easily to misfortune or change you will receive rejections you will receive major changes and major changes can be three four ten pages of changes to your manuscript so be patient because every manuscript that you produce will be better than the other and will be better and then at the end when you have published many manuscripts and it will the flow will be natural this will be spontaneous and the quality will improve. As a final remark I would like to say that for me even today seeing one of our manuscripts get accepted and published gives me a unique feeling of happiness it is this this is real it reflects the satisfaction of a duty accomplished a challenge accepted and always I'm always proud and grateful for my work team that ultimately are the responsible that the manuscript can be accepted and published and that's all I like to finish with my editorial team at International Rural and Ecological Cancer all of those people are trying to have better manuscripts trying to improve your work so don't hate them love them as I love them thank you very much. We thank you so much Dr Pereira that was a fantastic talk again some really invaluable information for our audience and we have some really good questions for you if that's okay. The first question is from Sagar Chotsky he's from the US he's a junior attending intending to apply for the fellowship he wants some advice on trying to publish a negative study a negative study that still adds to the literature without significant findings how do you get that published? Such a good question and there is a thing called publication bias on positive results because in science reviewers and editors prefer positive results than negative ones but if the paper is well written and the conclusions are well supported definitely you can publish even negative results. Great another question that comes from Diaz Saewan Diaz is asked how do you choose or select articles to form part of your discussion is there any criteria can you choose to use any paper once it has a link with your study? Interesting question for me I'll try to include in my discussions first the pyramid of evidence if we have prospective clinical trials necessarily I need to put them in my discussion then systematic reviews on the issue and then papers similar to my paper based on the number of patients included or the journal that the work has been published those are my criteria for choosing the elements of the papers for being included in discussion. Great the third question is a technical question it's related to reviewing papers so if you've written a paper how do you have your co-authors review your manuscripts sequentially or at the same time? I prefer at the same time and it is important it should be one writer not again it is common please you George you write the introduction Anna write the methods you Philip write the results and I will write the discussion this is always noticed by reviewers and by editors the author of the manuscript the writer should be just one and then all the co-authors have to provide their comments but try to not include several hands several brains in the same manuscript because the result will not be good. That's great advice I think this will be the final question and we can go through other questions later on our Q&A. What is the first and most important thing you look at when reviewing a paper the first most important thing? Thanks for nice questions the first thing to me is novelty I as a reviewer I select the title and put it in PubMed and then play with words in order to find similar papers if the paper is not novel there is no a value reason for getting published unless the paper to have a really really new or relevant or contradictory message but the most important thing is the novelty of the of the work. That's great Rene look thank you for your valuable insights today thank you thank you we're going to move on to the next segment of our workshop which is about finding a mentor so I'm going to kick off with an overview on how to find a mentor and important aspects to look at. Okay so thanks for asking me to speak about how to find a mentor I think there's a few important steps to go through first of all but before I do that finding a mentor is really important and many of you probably already have a mentor and been a mentor but the many different reasons for finding and developing an ongoing relationship with a mentor is important you may have already had a relationship with a colleague a family member a sports coach who has been a mentor to you and if you look back and see what you got most the most valuable things you got from that relationship is what you should be looking for with future mentors mentors not only impart their wisdom and advice to help you navigate challenges that lie ahead but they can teach you new knowledge and skills they encourage support and empower you to be the best clinician and best person that you can be in the future mentors can also open up opportunities by introducing you to a wider professional network which might be important for future employment for academic pursuits or other supportive relationships so the first step is to to work out yourself what are you looking for in a mentor are you looking for someone to help you develop your academic and research career are you looking to be a better clinical doctor making clinical decisions and improving your patient care are you looking to be a better surgeon are you looking for overall career someone to help with your overall career decisions and it's really important also to have someone who supports you personally for example if it's a high priority for you to have a family whilst you're training or as a junior consultant you might find a mentor who has managed to balance their family with work successfully a mentor can be local so someone in your local hospital or network for example someone a surgeon who will help you develop your surgical skills it may be someone in your country particularly someone who's a leader in a field that interests you and that you'd like to pursue or internationally for example finding someone from a country that you think you might wish to train in or work in in the future is really important or your faculty in your hospital may already have a relationship with an overseas unit and you need to foster and establish that relationship you may prefer prefer a more senior a senior mentor someone who's experienced and has life experience to help you and you know retired or semi-retired surgeons and doctors have wisdom and often they have more time to impart their knowledge and support to you whereas you know if you're about to sit your exams maybe someone who's just a couple of years ahead and has already sat the exams could be a good mentor for you so first of all find out what you're looking for in a mentor where do you look for a mentor well a professional mentor is most likely found through an existing work network such as your hospital university or a society such as IGCS and we're currently working at IGCS on establishing this network because we realize how invaluable it is to know where to look it can help about what you want to be and where you want to be in the future so say in two five or ten years time and identify someone who is that person already have a look at what they've done to get there and and develop a relationship with them and most importantly do your research ask around ask colleagues that are a few years ahead of you how they found their mentor what processes they went to and what they found helpful step three is how to choose your mentor well it's really important to have someone who's willing ready and available to commit time to be a good mentor you might have someone you really admire and who you think is great but if they're so busy with their own work that they can't commit any time to you they're not going to make a good mentor a good mentor will also be knowledgeable with the necessary skills that you wish to learn they're not necessarily going to be from the same discipline as yourself for example you know if you're wishing to develop surgical skills in gyne oncology you can have a mentor that's a general surgeon a colorectal surgeon a peritonectomy surgeon and they're going to be a great mentor in that area keep an open mind I mean I have a patient who's a mentor I've had the same patient for 10 years who's taught me more about communicating with patients in any course that I've ever done a good mentor should be caring and supportive and a good listener and is quite likely that you're going to need multiple mentors because you're going to have multiple needs as you go through your career and they may change over time and it's also hopeful that one day you'll be a mentor yourself because you've learned all of those important aspects on how to be a mentor the last the last step it's being a mentorship is not a one-way stream to get the best out of a mentor you will require working it's work from you to foster and develop a good mentor mentee relationship be organized and know your short and long-term goals I think the best trainees I've mentored have been organized and they know where they're going and what they want and what their goals are to be a good mentee you need to communicate with your mentor well you need to take the initiative to communicate with them and establish the relationship and be clear in what you want to achieve out of that relationship plan for and commit to regular meetings that fit in with their schedule it's really useful that you to make best use of your shared time with a mentor and to get the most out of those meetings that you send an agenda to the mentor beforehand with the topics that you'd like to be covered before each meeting summarize what you got out of the last meeting and what you discussed and then send them what your aims and goals are of what you'd like to get out of the next meeting and it really helps to establish and foster that ongoing relationship finally you should be open to constructive feedback because that's what mentoring is about is improving you and learning new skills and you need to ask this from your mentor and hopefully they can improve your skills and knowledge over time and as I said hopefully one day you'll lose use those skills to be a good mentor yourself for our other other upcoming juniors okay so that's just a brief overview and we're going to move on to the next segment now which is some question and answers thank you very much Rhonda this was extremely informative and we are going to continue the conversation by asking Rene and Pedro to join us for a discussion on finding a mentor and overcoming challenges as early career professionals again as a quick reminder on for those who are just joining the Q&A feature at the bottom of the screen is available during this segment please feel free to submit any questions and we are and we will keep doing our best to address all of them well let's get started Pedro are you on the first one is for you well I'll go ahead and ask Rene if you don't mind then Rene do you have any tips on how to effectively develop a research network I know you've done something amongst the Latin American countries and what is the role that social media can play in this okay thank you Navya for your question building a network is is not an easy thing from my experience it can be start in medical meetings when you organize a medical meeting you have to find people for giving the lectures and then you can organize a dinner with them in order to know them even better ask about kind of hospitals they work kind of activity really willing to publish really willing to make collaborative projects this is the the first step motivated by yourself then when you go to other places invited as a speaker you can meet with people and try to do the same in other places this is one strategy the other please visit the abstract the the poster session the poster session in the medical meetings because you always will meet interesting people there if someone is showing an abstract in a medical meeting certainly is interested in publication certainly is interested in some kind of networking so share addresses with him or with her and when you start doing this uh at the end in five years eight years you will have a huge network we have a huge network in Latin America recently we published a paper including more than thousand one thousand three hundred patients on radical hysterectomy a retrospective analysis including people from Mexico Argentina Peru Italy Spain and this is possible just because networking you start sharing projects sharing ideas then this network become a network of friendship rather than colleagues they become friends and this is one of my recommendation networking is crucial be open to to share the knowledge to share the things that you fortunately know, give them, give the knowledge because the knowledge has enough honor. The knowledge is for everybody so don't be selfish with the knowledge. That's really amazing. Congratulations on your publication and we know what a great group you have and we've heard from Flora about what a wonderful mentor you are. I think Sadie has the next question. Yeah, hi there. Where's Pedro? Where's my mentor? Can't find Pedro. Is Pedro here for the next question or no? Okay, Rhonda, would you mind if we went with you for this one then? No, that's fine. Great. I think a big question, I think it has come up actually briefly in one of the talks but it's about time management as a clinical academic particularly in the early years and how to say no and when to say no. Yes, yeah I think that's a very important question when to say no. I mean you can only do so much and you don't have to say no forever. If you don't have the time now maybe in a few months or six months time you may have time but you know if time is of the essence for the person that wants to get that study or that project going then you know you use your network, you put them onto somebody who you associate with, who you know has the knowledge and the skills to help that person and connect them with that. That's how we all work, we connect to each other. So that's how I look at it and I have gotten better over time learning to say no when you're having the balanced family work and trying to stay fit. That's very, I always put fitness as last thing but it's really important to spend some time staying fit, doing exercise or it helps you function in every other area so you really have to take some time out for yourself as well. Great, thank you. Did you want to, could you add anything to that Rene at all? It is difficult because your career can, your workload can vary across the time. Six years ago I was performing 40 surgeries in a month so the time for writing has been so constricted. My life has changed, I'm now doing 10 surgeries so the time available for doing all the things different to handle patients have increased and this change has allowed me to review more papers, to mentor more people, to get involved in more research projects, academic projects. It depends on your interests but even if you are a very busy person you have to organize your time, you have to run, to work out, particularly I play billiard. I always find time to play billiard. You try to find time to share with your family. It is not impossible, it's not impossible. You just have to organize your schedule but if you look at the great minds of gynecology, oncology, I'd like to mention Zibula, Nadima Burustum, Cristina Fotopolo, Pedro Ramirez, all of those are really busy people, but they also find time for their families, for living their own life. It's just a thing of sense of balance and when to say no, when do you want, when you want to say no, say no. For me right now it's very difficult to accept reviews. I receive at least two papers for reviews daily so I started to don't accept those reviews unless the reviews came from great journal, green journal, but because a good review is time consuming. For doing a good review you will spend four hours, six hours sometimes, so you can overload for constricted time doing too much, too much reviews. These are my ideas. Pedro, is Pedro here? Oh okay, okay, here I go. Pedro, we were just talking about time management and saying no. Ronda and René have answered it quite extensively already. I don't know if you had any very poignant points you wanted to add or if we should move on to the next question. Yeah, I mean I think it's obviously, it's important. Thank you so much first of all for the invitation and it's really great to participate and congratulations on putting this together. You know, obviously as it pertains to time management I think it's really key and important to, particularly in the setting of having a busy clinical practice and doing research and having obviously also administrative responsibilities, is to make sure that everyone that is interested in doing research and participating in investigation that they dedicate some time obviously to that and that is allocated within your weekly schedule as to what you're going to devote to the investigation and research and study designs because otherwise it's really very challenging and also obviously having a commitment and a responsibility to timelines because I think it's also important particularly for mentors to assure that they are able to provide that type of feedback and that type of timely response to the mentees. Okay Arthur, should we move on to your question? Yeah, Pedro, could I ask this question and so for like a young investigator like me, sometimes we submit an article and it gets rejected and what if we get multiple rejections and do we stop at any time? Do you have any suggestion on this? Yeah, so I'll jump in obviously and I'd love to hear what Rene has to say as well. You know, I think that one has to understand and realize what is the reason why a manuscript is being rejected and I think that that goes back to the importance of having a good plan and discussion prior to initiation of a study as it pertains to how to design the study, why did you want to perform this study, and what Rene was mentioning before the issue of the novelty, why is this study new and if you don't have those then that may be the reason for the multiple rejections and then also, I mean, we have to realize that at some point then you have to just say, well, personally, obviously, one of the things that, I should step back, one of the things that you have to realize that you can publish ultimately somewhere, somewhere you're going to be able to publish it, but I think personally it's if you have multiple rejections then you have to understand and say, you know, this isn't good, this isn't adding anything and we should just put it away and then start with something else. So I think it's obviously, it's a bit of realization as to why is it that you're getting the multiple rejections and learning from that actually to learn from the points of the reviewers and looking at those comments and just realizing that next time to target those flaws. Okay, I suggest just pass the page because you will not publish all your manuscript and you will not conclude or finish all your projects. You have projects that for many reasons cannot be concluded, the samples were lost, the data didn't come, etc. Just learn from that and move on, move forward because you have many other responsibilities, certainly you will have many other ideas, so try to forgive yourself for this and move on. Thank you, Rene, and now we're going to take some of the questions coming in from the audience. Natalia from Barcelona asks, and maybe I'll pose this to you, Rene, how do you manage the problems with the order of the authors when someone from your unit, specifically your boss or senior mentor, tries to be the first author on a paper that I assume you've done the majority of work for? That's a great question and a very difficult topic to address. It depends because in my current place when I work, if I have a very good idea, I say, hey guys, I have this idea, this is the issue, we are going to address this and the author will be me because it's my idea and I will write the manuscript and you will be the second, you will be the third, and our senior author will be, but this is me in my position. If I am a junior faculty in the first year in the meeting, I can say, hey, I would be the first author, your senior or your boss would say, yes, you think? Why? Because you need to build a career, you cannot expect that if you are in your first, second or third year of your career, you shouldn't expect to be first authors because you need to learn, you need to go step by step and your moment will come, but don't be worried about that. Being first author is important, but just in a moment of your life, if you check the literature and you check for the name Pedro Ramirez, you will find more than 200 papers and this guy is not author of 10% of them because it depends on the moment of your career and your promotion, you need to be first, second, but when you have constructed your academic career, you always will be moved to senior or in another place if it is a big international collaborative project. The place doesn't matter, the important is the learning process, what are you learning in every project that you participate, how this knowledge that you are acquiring will help you from the other projects, that's the message, the authorship is relatively important, but it should be negotiated always before starting the project. That's really great advice, thank you Rene, I think Sadie has the next question. I just actually, I also wanted to add Navia, if I can, to what Rene was saying is that, you know, Natalia, it goes back to some of the points that were raised earlier about the importance of having that discussion at the beginning of the project, at the beginning of the project to make sure that there is a discussion and this should be a fair discussion because, you know, I think that if you have come up with the idea, you have conducted the data analysis, the data acquisition, the data research, you should be the first author in that manuscript, that makes absolute sense, so you should have that discussion even at a point when you're a junior faculty to highlight to the senior faculty that this is your place in that manuscript and, you know, and granted, I mean, I think that, you know, as Rene was saying, for example, you might look up a manuscript for me personally where I'm somewhere in the middle, but that may be because I put most patients on that clinical trial in my group or, you know, I accrued the overwhelming majority of the patients to a new drug therapy, so yeah, I may be the second or third author, but if you are the person that designed that study, that worked on that study and wrote that study, you should be the first author, there should be no question about that and then usually a senior author is a person who mentored you, who perhaps is, you know, certainly the most responsible for the manuscript and the analysis besides the first author, and that should be very clear to anyone regardless of where they are in their academic career. Thank you, Pedro. Okay, so we've got another question that's come in from the attendees, perhaps to Rhonda, if that's okay. Diazi Sehwan has asked, during training in a resource-limited setting where mentors are limited, what is your thought on a mentor being assigned to a mentee instead of a mentee choosing his or her mentor? Yeah, well, I suppose there has to be some process of having, linking the two together and probably the best way to do that is through a society or some sort of group. As I said before, IGCS is looking into that. I think they surveyed the members five years ago, Michael Quinn told me, and about 50% of all members were keen to be mentors, so that's quite a large group. So, I think the best way to do that, and certainly there are advantages for a mentor than being assigned a mentee. So, it's just the process of how that happens, and certainly juniors can instigate that, they can associate with their society, they can ask them to help organise it through their local networks or through a national network. So, that would be very valuable. But it is a two-way stream, I mean, the mentee is still going to have to, obviously, once they're assigned work, develop that relationship, make sure they have regular meetings. It's not all about the mentor sort of working, they're very busy people too. So, but maybe through a society would be the best way to do that. I don't know if the others have input. Okay, thank you very much. That was really helpful. Arthur, would you like to ask the next one? Rene, can I ask a further question to you? And this is from the attendee, and it's from Gemma from the UK. And he or she says, if a mentor-mentee relationship is no longer working, I mean, if the mentor has retired, do you try to acknowledge the issues and formulate a plan to move forward or end the mentoring relationship? Rene? For me? Yes. Okay, okay, okay, sorry. This is a negotiation between both. Probably find another interested people in keeping with the way of the relationship. So, I don't know, I don't know if it's between both. Probably find another interested people in keeping with the mentorship. Particularly, I feel that the relationship mentor-mentee is kind of natural. It's not a formal contract. It's not a junior fellow talking to me, hey, I want to be your mentee. Hey, wait, wait. The mentee has any specific features that can be accomplished, and the mentor is aware which of the junior fellows can be the right mentee. I personally think that the mentee is found by the mentor rather than the opposite, because the mentor is perceiving who is the guy doing the best reviews, presenting the best lectures, always aware of new releases in the literature. When you ask a junior fellow, please, can you do this review for me? And in 24 hours, you have the most complete review that you have ever seen. Probably this is a good candidate for being a mentee, because building a relationship based on mentees' expectations can be difficult. There are many candidates to be mentees, trust me, but for being a real mentee and correspond with the expectation of the mentor is really difficult. I don't know what Pedro thinks about this. I think that it's important for the mentee to look at the prospective mentor and determine or have a very frank conversation with that person regarding the potential possibility of time availability, because that's really very, very important. Certainly, you may admire somebody, you may have certainly a great deal of respect for a particular individual in your department or in your institution or in your field, and you may ask them, I want to be mentored, I want you to be my mentor, and that person's schedule may not have the availability. It's important to have that type of discussion, because ultimately, many of these individuals will say, yeah, sure, no problem, I'll be your mentor, but then you need that consistency in terms of time availability, and that's really important to have a sense of whether those individuals will be able to do that. I think it's also the responsibility of the mentor to say, I have so many things right now that I cannot do it, and don't take that as something that is a rejection or a matter of certainly disrespect. It's just that person's being honest and respect that, because you prefer that somebody tell you that, then they say, sure, I'll be your mentee, and you're trying to follow up on meetings or trying to get to a teleconference, and they're never there, the emails are not answered, so then you obviously are not. That scenario is a disservice to everybody, so I think it's important to have that discussion up front. Thank you so much, Pedro, and welcome back, Dr. Coleman. We were just talking about good mentor-mentee relationships, and we had a few questions from the audience, and as we kind of delve into that, a question for many of us in our early career looking for mentors, reverse question is, what makes a good mentee? What should you be doing to be a good mentee? Do you have any tips on that? This is for me? Yes. Okay, yeah, I was going to say, don't pick Pedro. Oh, I'm sorry. So I think all of us as mentors love passion, so when you come to us as a, you know, requesting to be a mentee, requesting us to be a mentor for you, if you come with passion and some clarity about what you're interested in doing, it's infectious, and I think that most of us, you know, it's a relationship, right? So it's not just I give you an assignment, you come back and tell me what's going on. It's a relationship about building and understanding all of the steps along the way, so when you come in and you're psyched up about a project, you've researched it, it's obviously, you know, you have a genuine interest in it, we will, you know, we will bend over backwards at every step of the way to make sure that you have a clear path. So I think finding somebody that you have, can develop a good relationship with, coming to the table with a defined project that you're very passionate about and, you know, and, you know, again, you want, it's that nice, you don't want to be too much engaged with the mentor so that they're not actually able to see your progress, but engaged enough so that there are building blocks along the way that a mentor can provide for you will really, I think, enrich both people's experience. And I think all of my, you know, most successful mentees that I've had have been, have been like that. It's just, they come just so excited to want to, to want to do, to work with you. If I can add to that, I think Rob put it really well and, you know, one other word that I would describe in addition to passion is commitment because it's a bi-directional commitment and it's incredibly discouraging for someone who is a mentor who has already an incredibly full agenda to see that there is not that commitment from the mentee. And then also, obviously, that, that drives too often to a very uncomfortable discussion where the mentor will say, you know, I have a thousand things to do. I don't see this same type of commitment from you. And, and that, you know, often is reflected in timelines. We need to get this project done by this time. If that's not there, that's also obviously discouraging in the, in the discussion. So I have reviewed your manuscript. These are the comments that I've made for you to change. And then the revision has exactly the same issues as well. So these are all elements that reflect a poor commitment from the mentee. And that often, again, may lead to a termination of that relationship very, very quickly. So I think that that's incredibly, incredibly important. So I really would encourage the mentees to assure that when they're signing up for this, that there is a bi-directional commitment, not just, well, if I just work with Rob Coleman, I'm going to be guaranteed a manuscript in the New England Journal of Medicine. That's typically not the case. Okay, that's really great. Thank you. I think we've got time for one more question, which will go straight to you, Pedro, if that's okay. It's a combination of one we already had with Hadi from Houston. And it's about networking with other institutions when you're at a junior stage of your career and potentially seeking mentorship in other institutions where perhaps your research interest is not so active where you are. Yeah, no, I think that's a great question. And I think that that shows excellent initiative, because a lot of times when we have discussions with young faculty, one of the things that often comes up is the issue of, well, I haven't been really active in research, publications, investigations, because my institution is not a fertile ground for this type of work. So therefore, I just don't do it. And I think that certainly it is to be commended for individuals from those institutions to say, well, where do I go to reach out for these types of collaborations? And I think that now, particularly with the frame of networks that we have in terms of the interaction with teleconferences, social media, all of these engagements, I think that it offers a great opportunity for us to be aware as to what's happening in other institutions. And I think it's also often very encouraging to hear someone say, I saw your protocol, or I'm interested in getting engaged in this study, or I have an idea about formulating this study. Love to be engaged and love to work with you on this. And I think that for the most part, very good mentors will be embracing of that type of relationship. And I think that you will often find yourself surprised as to how receptive many of these very talented and recognized leaders in the field will be to your desire for engagement in collaborations. That's great. Thank you. Did anybody else want to add anything? Okay. Arthur, I think, oh, I think actually we need to move to Gitu now for a quick sum up that's flown by with all of the great questions from the attendees. So Gitu, would you like to summarize? Yeah. Thank you, everyone. Extremely interactive session. Difficult to summarize everything, but I'll try. So I think one of the important points that was brought on was that be a good mentee to find a good mentor. So to me, who would be a good mentee is a hardworking guy, sincere, dedicated and committed. And yes, then you have to find a receptive mentor and then this relationship builds on. Then next would be networking. Since most of us early career researchers struggle networking. So I guess to start with find like-minded people who are equally interested on your areas of interest and then gradually build up a team and then maybe move on to expand it in your country, outside your country, go on and make an international collaboration. So it takes a while, but networking there is. Then there was some discussion about time management. Time management, as far as the research is concerned. So I think most of the senior faculty agreed that we need to find something that we are passionate about. Rob mentioned that rather than running after many things, pick a few areas of interest and then keep working on that. And probably since that would be a passion, you will find the time for yourself. And for that work. And lastly, moving on, Rene highlighted that very well. So moving on on a rejected paper, moving on unfinished projects and maybe moving on from not being the first author. So I think that sums it up. We will now move on to our final segment of the workshop. And it's my pleasure to welcome Pedro and Florencia to discuss what it means to be an IGDC editorial fellow. Pedro and Flor, the floor is yours. Well, before Florencia starts, I wanted to say that, you know, certainly the International Gynecological Cancer, for us in the journal, this has been a fantastic addition to the journal to have all of the fellows that have been joining us as part of our team. And I'm really extremely proud and happy to work with all of you. And I think, again, you know, today exemplifies the great work that you do, the great initiative that you have. And again, we look forward to many continued successes with our fellows in the International Journal of Gynecological Cancer. So I'll let Flor present on the topic and happy to answer any questions after. Okay, thank you very much, Pedro, for your comments. First of all, in the name of all your fellows and mentees, I would like to thank you for your hard work, for your friendly availability and your support and trust. For us, it was an amazing experience. So now we are going to try to summarize what it means to be an IGDC editorial fellow. Well, it has to do with opportunities for young trainees and for faculties to gain experience in peer reviewing, also to get involved in scientific communication and to participate in editorial teamwork. I must say this is a unique, to summarize, it's a unique learning experience for us. And what are the objectives of this project? Well, first, I think is to encourage trainees and fellows' involvement in the editorial field, to increase interest in the editorial field and in the research field also, to learn how to analyze and to understand a paper and to review the paper, and also to create and tighten the relationship between the new generation of gynecological oncologists and the more experienced generations. And finally, is also to increase the visibility of the IGDC among younger gynecological oncologists to make IGDC accessible for the younger trainees. And what are the goals of being a fellow? Well, the core of all this, I think it's to have your word in the manuscript decisions, to participate in manuscript decisions, to get your tools for creating strategies for the journal, also to join editorial team conference call and to join, obviously, and participate in the journal's annual meeting. And last but not least, I think, of course, one of the main objectives and goals is to improve the quality of medical research internationally. Well, about the fellowship activities, I think we have three main activities. One is reviewing, the other is posting and promoting the journal through social media platforms, and the last one is to create our own podcast. About reviewing, I think this is our favorite task. We have weekly sessions with our fellow mates and with the editor-in-chief of the IGDC, Dr. Pedro Ramirez, who kindly and patiently shares his knowledge with us and help us to develop our own skills for reviewing. You know that it's a huge responsibility for us to be part of the decisions in the manuscript, so thank you for your trust, Dr. Ramirez. Then, about social media, I think this is our favorite tool. Posting from the fellow's account, it's a daily task, but it's not just promoting the journal, it's also learning how to handle the most important communication tool today, so that's a great job too. As you probably know, we have the monthly journal Twitter club where we share questions and we access to the authors of the lead articles of each month, so that's a great activity too. Hi, Flor, I'm sorry to interrupt. Are you sharing your screen? Because I don't think we can see your slides. Yes. No, yes, I shared my screen. I can stop sharing. You're seeing just the title. Okay, okay. Now you can see it. Okay, so well, I can start again if you want, but what about the goals? Thank you. That's okay. Well, let's start from here, reviewing, posting through social media, and creating the podcast too. About reviewing, as I said, we have weekly sessions with Dr. Ramirez and we discuss and we develop our own strategies to review a manuscript and skills to review a manuscript, and we finally get involved in the decisions of those manuscripts, so that's what I was saying. Thanks for your trust. In social media, well, as I already said, we post daily through our journal account, the fellows account, but not only for promoting the journal, but also to learn how to handle this communication tool that nowadays is one of the most important tools in medical communication, and also we have our monthly Twitter journal club where we share with the authors of the lead articles questions and thoughts regarding the manuscript and the different articles of that month. Well, then this is our, my favorite, I have to say it's my favorite, the fellows choice podcast. We get the 10 highlighted articles of each month and we create and record our fellows choice podcast. We do it in English, of course, and also in Spanish and in Chinese, and I must say that we count on the best DJ of the world for the final touch, so thank you, Guitu, for your help. This is really teamwork for us. Then we have the pleasure and the honor to participate, to join the editorial teamwork calls. We, monthly, we participate in the associate editor calls and this is the moment for us to learn how to develop network skills, so this is also a great part of the fellowship. And what happens after the fellowship, when the fellow, well, once the fellowship ends, we can progress to becoming members of the IJCC junior editorial board. Also, we are able to develop greater gender and cultural diversity in gynecological oncology in our field, and it's a great possibility for us to learn how to expand horizons and to reach different corners of the world, so to summarize, it's like the best moment for teamwork. And, well, to sum up, I would like to highlight some tips and tricks for prospective fellows. I think it's really important to, as you already said during this workshop, it's really important to count on the local support of your team, your department, and your colleagues. Also, to familiars, to be in touch or to know how to handle social media because nowadays is one of the most important and powerful communication tools, so this is a must. And to enjoy every part of the medical, of the scientific activities, from medical writing to publishing, mentoring, peer reviewing, everything, to get involved in the medical activities, in all scientific activities. And finally, well, to offer novel and innovative ideas regarding strategies on how to improve the quality of the journal. So thank you, thank you Dr. Ramirez for becoming our mentor during this trip, and I think we should move on to the next part of this session, the interviews. Well, great, thank you very much, Flora. I think, you know, once again, I'd like to reiterate that it has been a really great experience for us in the journal to have such enthusiastic, motivated, and really an amazing team of fellows who devote so much time, effort, to improve the quality of the journal, and you have done all incredibly well. I have been very, very impressed by that. So I think that there were a set of prepared questions that we had for the fellows, and I think we'll start with Arthur. And Arthur, one of the first questions that was submitted was, what is the impact of publishing on your academic career? In other words, how do you see publishing in scientific journals of benefit to specifically your academic career? Well, I think publishing is everything in my career, and well, basically we get promoted by publication, and from deep inside, I want to help my patients in Taiwan and in Asia, and during the preparation of publication, it helps us see our own data, and when we look back into that, we try to improve our condition. So what I want is to translate these conditions to publications in order to help our patients well. And I also remember that during the fellowship, when we were having these interview calls, and Pedro, you always ask us, does this publication change our practice? And this always makes me think about, well, what manuscripts, what publications I want to prepare, and how are we going to do it? And this fellowship also helps a lot with my networking, which also would definitely help my preparation for further publications in my career. Yeah, thank you, Arthur. And I think that those are really very important points, and I think you and I have had discussions about that, that it's really very important to know that the value of a publication should not be just to get your name in a journal, or tell your friends that you published, or to say, well, you know, in my department, I have the most publications, but really, ultimately, is to impact patient and patient care. And one of the things that I've always discussed with you, all of the fellows as well, is that when you are reading a manuscript, or you are about to start writing a manuscript, is at the end of reading this manuscript, how should I change my practice on Monday when I see my patient in clinic? How should I counsel my patient differently based on what you're demonstrating? Because if at the end of that question, you say, I don't really have anything new to offer, then you're not really contributing. And then, you know, you're just adding to the many, many papers that are published in the literature that are really not making any impact at all. So I think it's very important to always have that as your primary question. And I think that if that primary question is answered, then I think you have a good paper. If you, ultimately, when you say, well, I'm thinking of doing this, and this would change how I talk to patients, or how I counsel patients, or how I manage patients, you got a good paper. If at the end of that question, you say, this really wouldn't change anything, forget it. Don't even start writing the in that manuscript. So thank you for that. And I think probably we'll take questions or comments from the from the attendees at the end of each of the questions. Flora, is that okay? All right. Yes, perfect. You can do it at the end. All right. So the next question is for Gitu, who is our fellow from India. And Gitu, I wanted to just get your perspective and hear your your thoughts on the question, does your institution provide any incentive for academic growth in the form of protected time for research? And I think this is an important question, because for a lot of people, they say, well, you know, I want to contribute to science. I want to contribute to patient care. I want to write. But basically, my institution says, if you want to do this, do it on Saturday night or on Sunday morning at your own time, not during the Monday to Friday work hours. So I just wanted to know, what's the situation in your institution and how do you manage that? Well, frankly, no, I do not have any protective time as such for research. So it's actually my own time since I am passionate about certain topics, certain subjects. So basically I'm finding time on my own. And I think I can speak for most of the institutes in this side of the world that we do not really have a dedicated research time or a research day as such. We are all bogged down by the huge workload, the clinical workload that we have. We are a hugely populous country and most of our tertiary care centers are also sort of overloaded. So everybody manages, you're right, Saturday evening or they use their Sundays or holidays or whatever off time that they can manage. So maybe except dedicated PhD programs, which we don't have as many, not at least in the clinical practice, like it's there in your side of the world. So PhD is not generally done by clinicians. So, but then just like the mentee mentor session, you find such like-minded, passionate people who like to work on these, you find your common areas of interest and then you network and then you pull in the data and that's when you kind of come up with whatever studies or papers. So it's a struggle doing research, frankly, this part of the world, but we are trying a bit. So let me ask you just a follow-up question to that, because I know that maybe many who are attending may feel this way. They say, well, when your boss or your colleagues say, we're not really interested in you publishing anything. We just want you to see more patients. Where do you find the motivation? Maybe whatever kick that one gets when your paper finally gets published in the international journal, like when mine got, so that was like a big blockbuster for me. Frankly, that's given me the maximum boost that I can get it published. So probably others also can, and I hope it serves as an inspiration for others who are hearing me from my country and from other countries. My country and countries like mine or setups like mine, that it may take a while, but maybe we can draw inspiration from each other. Great. Well, thank you, Gitu. And I'll go on to now, Navya. Navya is starting her academic career, young, motivated, energized. So Navya, at this point, you finish your training, you're starting to see patients, you're ready to conquer the world. What is in your mind frame, your decision-making between, I go fully private practice, I'm not interested in going to research, I don't have the time, I don't have the support, I don't have the dedication, or I wanna go into academic medicine and drive the field forward and contribute to gynecologic oncology in a way that would ultimately change practice? Thank you, Pedro. And I don't know about how young, but thank you for saying that. I mean, I have obviously made my decision because I work at an academic institution where we have medical students, residents, trainees. And despite, I work in Louisiana where we actually have quite a scarcity of GYN oncologists. So a big focus of my job is actually clinical work. But in order to kind of make the big picture difference, besides on a day-to-day basis, I think the teaching is really fulfilling. And part of my motivation to do this fellowship was to be a better mentor to my students and residents and help them get started on their academic career and learn how to publish and learn how to ask the right hypotheses and do the right research projects. So for me, going into academic medicine, while it does have its own challenges and pitfalls, is more overall fulfilling. And that's not to say that you don't get the same thing in private practice. And many times, you know, there's lots of hybrid practices where you may be technically in a private practice, but you have students and you are mentored and you have a trial open. So, you know, giving back to the community and moving the world of GYN oncology forward is something really important. Great. Thank you, Navia. Next question is for Flora. Flora is in Argentina. And I'm sure in a similar scenario to many who are in our audience. Flora, what barriers, what obstacles have you encountered pertaining to research and publication? Have you encountered any barriers at all? Yes. Well, thank you, Pedro. I think that's a really interesting question, mostly in my setting. I think, well, we all know that research is one of the most important issues, but also in my setting, I think it's one of the most overlooked in some way. So there are a lot of barriers around it. First, I think, as you already said, and you mentioned several times, the lack of protected time during our practice is one of the most important barriers. In fact, there is no formal training in editorial work and editorial development throughout the whole career in general, and mostly in my setting in Argentina. We don't have a specific training in editorial work. So that's another barrier for me. I think that also, as we don't have enough training, we have the obstacle, another kind of obstacle is the poor handling of the data. Also for us, that's difficult too. So if you can't handle the data properly, then it's difficult to start researching or to create your own projects. And also, as this workshop was designing too, I think that one of the other problem is to find a mentor. It's, you must find a mentor. And I think that mentors don't grow in trees. So you have to find one and it's a hard task. But once you get your mentor, your mentor gets to you, as Rene said, it's like a gift. And I think that's the opportunity to develop our academic skills. So to sum up your question, I think that more or less is about the poor handling of the data, the weaknesses in our training, in editorial training, and also sometimes in some settings, the lack of networking too, if I have to summarize it. Yeah, so definitely. I mean, a lot of strategies that we need to work on as mentors and as institutions as well. And then Sadie, Sadie is from Wales. And Sadie at some point decided, well, I'm going to apply to the Fellowship of International Gynecologic, the Journal of International Gynecological Cancer. So how do you envision getting involved with the International Journal of Gynecological Cancer really advancing your career goals? Yeah, thank you. Well, I'm just about to start actually a clinical academic consultant post in Wales, the UK now. But when I started the fellowship office, I was still at the end of my training. And I think I envisioned the fellowship helping me. In the UK, and I think it's probably the same in many countries, you have hubs where, the powerhouses where all the research is happening. And they're great if you end up in one of those because chance, you live there, whatever it may be. But most of the hospitals are not in that position providing the training and the care more broadly speaking. So, and being somebody who desperately wanted to have a clinical academic career from a very early stage, I saw this as an opportunity to do lots of things because I think being involved in a journal from a clinical perspective, it keeps your finger on the pulse. And so, you're there for up to date, generally speaking with everything that's coming out, which benefits your patients, it benefits your department, it benefits your colleagues because you will be nudging them along. And of course your trainees. So clinically, certainly it benefits the department and your own personal development. But obviously academically, I think as Floor has already mentioned, I think that as any clinician in training, you are trained to be a clinical doctor. There is very, very little training in research, in manuscript writing, in data management, in any of these things, unless you do a higher degree, which not everybody can access. But everybody, as Renee Pereira said, everybody as a clinician should be a researcher to some degree as a clinician. So the fellowship offers that absolute rehearsal of reviewing papers and editing papers, which makes that that practice and practice of looking at all manner of papers inevitably makes you a better writer. So I think it's a training exercise, but of course also a networking exercise. Ultimately, you understand where the literature is in your area, what questions need to be asked still, who's working in that area, therefore who you could potentially collaborate with and helps you develop your network. So, really in every respect, I envisioned working with the journal, developing me as a clinical academic going forwards. And it certainly has done. Yeah. Well, thank you. Thank you very much. And I have to say that every time I meet with the fellows and we discuss manuscripts, we talk about certainly their input. I am always so, so impressed by your capacity and your ability to obviously dedicate time and interpret these manuscripts. And I always learn tremendously from all of you. And I think that the audience could also see the great caliber of the fellows that we have in the journal. And I'm really excited and looking forward to working with the next group as well and continuing to work with all of you. So thank you so much. I don't know if there are any questions from the audience. I think that there were some questions that were set up. And Flora, I don't know if you want to drive the set of questions that have been set up on the platform. Yes, there are some questions. I don't know, first, here. Well, Nicolo Visari is the next fellow. He's asking something. He's asking how important it is to know statistics for gynecologists, oncologists who want to design studies as well as write, understand manuscripts. Are statistics scores mandatory? Many thanks, Nicolo. Hi, Nicolo, and thank you so much for that question. And again, thank you for applying to the fellowship. And we're really looking forward to working with you. I think that's a fantastic question. And I think that one of the things that we realize is that there's such a lack of understanding of statistics or interpretation of statistics. Within our field and outside of our field, because there are often, there is no formal training in statistics. And certainly the tools that are used for statistical programs are often available to everyone. And everyone certainly is free to use those tools. And often those tools are misused, which leads to misinterpretation of the data. So I think that first, I don't think it's absolutely, you know, something that it is mandatory that everybody take a statistical course, but definitely it's encouraged. But if not doing that, one thing that is critically important is to sit with your statistician and talk about how to design a study, even if it's a retrospective study, because you need to have adequate understanding of some of the basics of statistics before embarking on writing a paper. And I say this all the time, when we talk about papers that compare two groups that find no difference in those two groups. And certainly the number of patients that are in those two groups is so small that no matter what you're looking at, you're never gonna find a difference because you don't have enough patients. And it's something as simple as that type of a principle often is not understood by many people. So I think that it's really very critical to sit with your statistician and to sit down and say, well, how do I design this study? Because the statisticians will ask very simple questions that will provide a value to the ultimate completed manuscript that will also be something that as the reviewers evaluate, they will see the validity of that manuscript. So to answer your question, I think, yeah, it's very important at least to meet with the statistician, to have discussions with a statistician. And then of course, obviously, if you have the luxury of taking a statistical analysis course, that would be great. Okay, thank you, Pedro, for your comments. I don't know if Rene have some comments regarding this question. You have to have basic information on a statistic, what is a logistic regression, what is the difference on the type of variables, the type of analysis you can use. But in a general way, you don't have to be a specialist in a statistic because it's really hard to understand and it could be very complicated. So it's really important, the interaction, as Pedro said, with the statistician. You just have to understand the analysis you have to conduct and ask the statistician, what is the easiest way to conduct it? That's it. Okay, thank you so much. I think we don't have more attendees questions. I think one of the other questions that I saw was how to become a fellow for the journal. And we have announcements every year for anyone who is interested in becoming a fellow with us in the journal. And certainly the qualifications are somebody who is completing their training in gynecologic oncology or having just recently completed their training and they're starting their academic career in gynecologic oncology. And then ideally, obviously somebody who has time to dedicate to the fellowship because there is quite a significant amount of interaction with us in the journal. So we certainly encourage all of you who are interested to do so and apply. And certainly we'd love to work with you with many of you as well. So thank you so much. Thank you, Pedro. And thank you, my dear colleagues. And it was really a very insightful workshop. And I'd like to sum up what we've just talked about in the past few minutes. And so for the fellows, for everyone, what is the impact of publishing in our career? I think everyone would say that, well, it might be helping our career. Essentially, we want to help our patients, right? And does doing academic, does our institution give us a protective time? Well, it really depends on what institution you're working in. But if you really want to have some publication or have a production in your academic growth, then maybe we, just as Pedro has said, we have to have a block of time that is protected that we want to be committed in to prepare what we want to work on. And if there were any barriers encountered pertaining to research and publications, well, I think we all have gone through a lot of barriers. So like some of us, like Dr. Farrow, it's three o'clock for her right now in the midnight. And a lot of us have these time zone differences. But I think as long as we have the passion for our patients, for the research, this doesn't stop us, right? And so, well, I have to say that for myself, this really has joining this fellowship, joining the Early Career Network has really helped me, helped me a lot. And a few notes that I would like to say before we close the meeting. Well, today's session was recorded and the IGCS members will have access to the recording via the education portal early next week. And the education portal really has a lot more, some videos of the past IGCS meetings. And if you join the IGCS, there is the Early Career Network that you should definitely check. And if you're thinking of applying to be a IGGC fellow, then that's something that you could also do. And do also check the weekly podcast by Dr. Pedro Ramirez. And it's really insightful and that you catch up with what is really going on every day in Guyanak. And our next workshop will be held in spring and details will be emailed and shared on the IGCS website. And for those that have registered their WhatsApp account, this will be followed in the further emails. And another valuable resource we want to quickly highlight is the Ask a Pathologist available to IGCS members. Oncologists rely on the guidance of pathologists to effectively manage patients. There is a critical shortage of pathologists in many parts of the world. So if you're an IGCS member and have a pathology related question, you can email pathology at igcs.org. Answers to questions are provided by members of the IGCS pathology work group and represent their opinion based on the current and usual practices in the field. So visit the education portal for more details. And in fact, I just submitted my question to the portal and I'm looking forward for the answer. So really, I just want to thank all of our speakers and faculty for their time. And I would like to thank all of you for attending today and wishing you all continued health and safety. And we are signing off. And if anyone else wants to add something. Thank you, Arthur. Okay, then signing off. Goodbye. Thank you very much.

negative study publication

study framing

research question rationale

transparent methods

literature review

study contribution to knowledge

results implications

study limitations

alternative outlets for publishing

negative results contribution

academic career development

publishing importance

time management

mentorship

networking