Dust yourself off

The song “Tubthumper,” released in 1997 by the British rock band Chumbawamba, skyrocketed in the music charts to No. 1 in many countries, No. 2 in the UK and No. 6 in the U.S. Ironically, the band members wrote and released this soon-to-be hit single when they “were in a mess; we had become directionless and disparate.”

The message of the song is embodied in the refrain: “I get knocked down, but I get up again. You’re never gonna keep me down.” While the elegance of the language might not rival that found in a Shakespeare sonnet, guitarist Boff Whaley describes the song as a tribute to “the resilience of ordinary people.”

The message of “Tubthumper” was recalled to me upon reading a recent scientific paper published, in all places, in the super-prestigious journal Nature Communications.¹ The authors examined the records of scientists who applied for the standard grant awarded to scientists by the NIH.

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Called an RO1, these grants are very competitive, with five to 10 applications for each grant actually awarded. In their paper, the authors looked to see what happened, over ensuing years, to junior scientists who applied and either just made the cut (and received their funding) or just missed the cut (and faced the decision of whether to apply again or give up). The findings of the paper are instructive.

A substantial percentage of the near-miss applicants gave up, with over 10% never again applying for NIH grants. But amongst those who persisted in the pursuit of NH research grants, over the long term the junior people who had a near miss in their first try proved to outperform those who narrowly won their first grant.

The authors conclude that “early-career setback appears to cause a performance improvement among those who persevere” and believe their findings “are consistent with the concept that ‘what doesn’t kill me makes me stronger,’ which may have broad implications for identifying, training and nurturing junior scientists.”

Thinking back on my own experience, I recall a brilliant colleague who applied for his first NIH grant only to receive an extremely critical review. Angry and disheartened, he vowed never to apply again. And he didn’t. Decades later, I believe he very much regrets that decision. I wonder if this phenomenon applies to clinicians.

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One acquaintance, performing her first cataract extraction as a resident, had the patient experience a choroidal hemorrhage and the eye was blinded. She went on to become a better-than-average surgeon. Does early adversity in the operating room stimulate young surgeons to practice their surgical skills more than their colleagues whose first operations go smoothly?

Closer to home, I remember being a young and inexperienced department chair in California. I made a decision that didn’t produce the results I had hoped. I was disappointed and aware that the members of my department, who were depending on me to make sure things went well, would be disappointed.

I told my dean, who was a very experienced and wise person whom I admired, and waited for him to criticize me. But he didn’t.

“These things happen to all leaders,” he said. “You admit your mistake and take your lumps as people criticize you. Then you get back up, dust yourself off, go back to work, and do your absolute best.”

So the next time things don’t go your way and you find yourself getting a tad discouraged, dear reader, find “Tubthumper” on your phone app or tell Alexa to play it for you when no one else is around. Sing along in a loud voice and awaken within you “the resilience of ordinary people.”

Read more editorials by Dr. McDonnell 

References:

1. Wang Y, Jones BF, Wang D. Early-career setback and future career impact. Nat Commun. 2019 Oct 1;10(1):4331.