Podcast – Managing a clinical and researcher career

Voice Over:

Welcome to the dementia researcher podcast, brought to you by dementiaresearcher.nihr.ac.uk a network for early career researchers.

Amy Monaghan:

Hello, my name is Amy Monaghan. And welcome to the first podcast recording for the NIHR dementia research website. Every month we will be inviting a group of researchers and experts to share their thoughts and advice on a wide range of topics, which we hope will be of interest to early career researchers or others thinking about coming to work in dementia research. This week our topic of discussion is managing a clinical and research career. Our first panellist today is Ione Woollacott. Ione, if you’d like to tell us a little bit about yourself and what you’re doing at the moment.

Ione Woollacott:

Hello. Thanks. I’m a medical research council funded clinical research training fellow. I was a neurology registrar until two and a half years ago when I took time out of my training to do a PhD at the UCL Dementia Research Centre. So my research is a basic science project looking at the role of inflammation in a type of dementia called frontotemporal dementia. And my research focuses on markers of inflammation in the spinal fluid and brain tissue, post-mortem brain tissue. So I do a mix of techniques. And trying to find out specifically whether the markers different in different genetic types of frontotemporal dementia. So my research, that’s the kind of basic science side. But my clinical side is that I do medical assessments and lumbar punctures for FTD research trials at UCL, and also see patients in the Cognitive Disorders Clinic at the National Hospital for Neurology and Neurosurgery there.

Amy Monaghan:

Thanks. Okay. Our second guest today is Timothy Rittman, who’s a clinical lecturer at the University of Cambridge. Welcome, Tim. If you’d like to tell us a little bit about your research and what you’re doing at the moment.

Tim Rittman:

Thanks Amy. So I’m in the final stages of my career as a neurology registrar at Addenbrooke’s Hospital in Cambridge. But I also do research as a clinical lecturer at the University of Cambridge, which I just started over the last month or so. So my work looks at cognitive and imaging biomarkers in tau associated dementias, particularly progressive supranuclear palsy and looking at how the underlying pathology and genetics influences what we see in brain imaging and brain networks. So my PhD finished in 2014, so quite a long time ago now, and for the last four years I’ve been carrying on a full time clinical career and carrying the research along alongside that.

Amy Monaghan:

Great. And our third and final guest today is Akin Nihat. If you’d like to introduce yourself, Akin, and tell us a little bit about what you’re doing at the moment.

Akin Nihat:

Hi. Thanks. So I’m an MRC clinical research training fellow at the MRC Prion Unit at UCL, in my first year of my PhD. And I came to be a clinical research fellow at the unit really after my core medical training, where I then worked up a research proposal. I kind of split my time between lab work and clinical work at the moment. The primary project for which I’m funded is a lab based project where I’m trying to develop better cell models of prion disease, which causes a very rapidly progressive dementia. But I also do a fair bit of clinical work on the side, and I’m particularly interested in looking at the longitudinal progression of the conditions and clinical tools to try and predict progression and objectively quantify that.

Amy Monaghan:

Great. So those are our three guests today. I’m Amy Monaghan and I’m a postdoctoral research associate at the Alzheimer’s Research UK Drug Discovery Institute. So not a clinician at all, but I’m just here to help everyone else discuss what we’ve got to discuss today. If you want to join in on Twitter or if you’ve got any suggestions for any future podcasts, you can use the @dem_researcher, or the #ECRdementia. And obviously there’ll also be a forum topic on the website, which is dementiaresearcher.nihr.ac.uk. So the life of a clinical academic is a constant balancing act between the demands of delivering patient care and driving research that’s relevant to that. And although they’re complimentary, there can often be a wide gap between the basic science and the clinical application. So to start off, maybe Tim, you could start us off because you are balancing research and clinician side by side constantly. How do you manage the tension between being a clinician and being go a researcher at the same time?

Tim Rittman:

I think that’s a very difficult balance to get right, to be honest. And I’m not sure I always have. Particularly when you’ve finished the PhD and when you’ve gone back into clinical training full time, I think that’s the most challenging time, well certainly it was for me. Basically research becomes your hobby. So it is what you do outside of work, when you get home, and at weekends. And what becomes very difficult is that when you’re in a research group, you go to the lab meetings, you’re in touch with people from day to day. When you’re back in the clinical world, then you’re very much cut off from that. So I think the most important thing, and it took me a little while to figure this out, was actually to work out how you communicate with the people who are in your lab. Because you won’t bump into them as you would have done in the past.

Tim Rittman:

So for me, I found things like Slack, particularly useful, which is a sort of online chat type forum website where you can have a team of people that you invite and discuss things with. And that means even if you’re in clinic or your on a ward round, you can still pick up the messages and answer briefly between patients or something like that. So it’s a way of keeping that contact going. But it just does take up a lot of time really. Yeah.

Amy Monaghan:

Worthwhile time.

Tim Rittman:

Yeah. I think so. On balance. Yeah. I think life in general, I’ve got a young family as well as. So trying to fit everything in. You have to be quite strict and plan what you’re going to do and when you’re going to do it. And things like working out… If you’ve got clinic the following day, staying up to 1:00 or 2:00 in the morning to do research is not a great idea. But on other days it might be possible. It’s getting that sort of balance right.

Amy Monaghan:

Yeah. I think work life balance is probably something that all researchers need to learn a little bit more about.

Tim Rittman:

Absolutely.

Amy Monaghan:

Probably a topic for a future podcast maybe. Have either of you got any more ideas around managing your clinical and your research career? Or indeed, keeping them separate, depending.

Akin Nihat:

Yeah. I mean I think… To be honest, I’m at the opposite end of the spectrum to Tim. In terms of where I am in my research, obviously I’m in my first year having not really done any consistent work as a registrar. But in some ways it’s quite refreshing to hear that it’s still a problem that more senior people have to deal with, because it’s something that I’ve struggled quite a lot within the past. And it’s a bit of a cliche, but I think probably the single most useful technique I found is just to be ruthlessly organized as best as you possibly can. I think inevitably, the areas tend to bleed into each other as much as you try and separate them. Particularly if you’re doing a clinical job that requires kind of quite acute commitments. Or for example, part of my clinical role is to assess patients with prion disease and we can’t always predict when we’re going to get referrals in.

Akin Nihat:

So sometimes you simply have to respond to things and you have to put research to one side. So I think in trying to be absolutely as organized as possible at using every free moment to do something productive. As opposed to just kind of in a tacking away at something that’s not really getting you anywhere. I think the other thing that I found really helpful, again kind of picking up on what Tim said, is in some ways try and align some of your research work with some of the work you’re doing clinically. Because if you have kind of a shared space between them, it makes it much more easier to communicate between the two and kind of keep your eye on both.

Ione Woollacott:

I’m just going to comment on the work life balance thing actually, because I think this is a really difficult issue. Particularly when you’re training as a registrar, you’re learning new stuff all the time. I’m at the final year of my PhD, so I’ve only got six months left. And obviously getting tense about writing up and things. And trying to write papers and write chapters and they’re slightly different. And also wants to keep hobbies going just for my own sanity. One thing I’ve tried to do is block time. So which is difficult to do when you’re clinical, but say right plan weekends and say, well Saturday I’m going to have Saturday off but work Sunday. So that at least you’ve got in your mind that discipline of, well I’m not going to think about work for this period of time, but then when I am working I’m just going to think about the work, if I can.

Ione Woollacott:

That’s obviously more difficult if you have children as well to deal with… To look after. But I think that’s worked for me because otherwise you end up bleeding. The work bleeds into all your time and all your thinking. And that can become quite stressful. And obviously as you said about kind of patients and things. Part of my research is collecting spinal fluid from patients and that is a clinical contact. But although that’s time consuming, that’s beneficial. Because I’m actually getting samples for research, so that there are benefits of combining the two together. It’s just finding the balance between that.

Amy Monaghan:

And we can touch on that a little bit, because the next question is to what degree is your research and your clinical work complimentary to each other? So Ione, if you want to talk a little bit more.

Ione Woollacott:

Yeah. Although the project is looking at, or using molecular techniques, so I do ELISAs and immunoassays on CSF. Without patients, I wouldn’t have these samples, so they are very clinically aligned. Similarly, people who’ve kind of kindly donated their brains, after death, to the Queen Square Brain Bank. I’m using their precious tissue to look at Microglia. So I’m always in the back of my mind, got these patients who I’ve met or who I know donated this. And I think that kind of pushes me on when research seems hard. And patients inspired research questions as well. I know this has been a cliché, but actually in clinic you might say, well for example, we’ve realized that quite a few people with certain types of genetic FTD have autoimmune diseases.

Ione Woollacott:

Now, for me that was really interesting. We have a few people in our studies and I started to think about that. And Jon Rohrer, who had the GENFI study that I work on, we’ve put a question now in the medical research questionnaire about what type of autoimmune disease that is just to try and pick out that a bit further. And that’s tied into my project on inflammation. So there is overlap and things that seem interesting as a clinical observation might turn more into actually a mechanism of disease.

Tim Rittman:

I think for a lot of clinicians, even if they don’t end up going into research, when they do a PhD or a period of research time, that actually develops their sub specialty as well. So it’s been much easier for me coming now to sought out consultant posts to say, well actually I’ve got all this experience in my time during my PhD doing specialist research clinics or specialist dementia clinics and the general memory clinics. And then it puts you in a very strong position to then say, well this is what I’d like to be on my job plan as a consultant. But I think there are certainly some people who I know who I’ve met and are very good friends who are very much towards the research end. And they sort of take the approach that you want to do as little clinical work as possible and really focus on the research. And you’re almost a doctor who is a sort of token title if you’d like.

Tim Rittman:

My own view I think would be that you need to be a good clinician and a good researcher, which is a challenge because it means you almost doing twice the work. But I really think that there’s benefits of being a good clinician. I think the question originally was about how well the research and clinical things are aligned. And I think when you go back again for a PhD into general training as a registrar, you do lots of different bits. So although my research is in dementia, you do peripheral nerve and headaches and epilepsy. And all of those things develop you as a clinician and I think help you look at things in different ways and help you look at your research in different ways as well. So I think they’re all valuable training to be at the end product I suppose, which is a clinical researcher.

Amy Monaghan:

And Akin, do you have anything to add to that?

Akin Nihat:

I definitely agree with what you’re saying, Tim. I think it’s absolutely crucial. Certainly I’m seeing even at my early stage, to have some kind of clinical contact as well. I think definitely my work is very much a lab project and it’s a project which has some very clear clinical benefits at the end of a long period. But having said that, it’s really important for me to try and maintain the clinical contact. Because to start with, I think through the research training you also want to have some clinical training as well, particularly the type of fellowships that Ione and I have, the purpose is also to get some clinical experience. But also I’ve certainly had a couple of occasions where I’ve been seeing patients and some interesting questions have arisen from just the odd experience or the odd phenomenon that you happen to see. And it’s led to some quite promising work actually.

Amy Monaghan:

So let’s follow that up a little bit and ask where you are drawing your inspiration for your research questions from. Is this coming from predefined projects? Is this coming from patients that you’re seeing day to day in the clinic? Is it coming as Ione touched on before where you were doing a little bit of research and suddenly there’s a really interesting question that pops out of that. Maybe Akin, you can take the lead on this one?

Akin Nihat:

Yeah. The first thing I would say is I don’t have complete control about my research questions at this point. Obviously, I developed a fellowship proposal and I’m aiming to answer certain questions. Having said that, a lot of the clinical work I do comes out of either discussions about interesting patients with colleagues, with peers, with seniors or I think basically looking at the literature and seeing if there are interesting aspects that we can answer with the data that we have. And I think that’s something that I found that’s quite important, particularly in our type of work where you are kind of trying to combine two careers. You want to try and be as efficient as possible.

Akin Nihat:

And some of that is really identifying the kinds of questions that you’re able to answer with the kind of data that you have. For example, a lot of my clinical work is based around a big cohort of patients with prion disease who very kindly donated their time, did assessments for us. And we have a really beautiful data set there that has the potential to answer lots of interesting questions which we’ve identified either through looking at the literature or from just assessing individual patients and saying, is this something that might prove useful to aspects of finding out about the condition.

Amy Monaghan:

Ione.

Ione Woollacott:

Yeah. You ask where we draw inspiration from?

Amy Monaghan:

Yes.

Ione Woollacott:

I have to say that the generosity of the families that take part. I work a lot in inherited forms of FTD, particularly within the Genetic Frontotemporal Dementia Initiative, or GENFI. And we see people, individuals who are in their 20s, 30s, 40s who are at risk of developing inherited dementia. There’ll be a 50/50 risk mostly. These people are well. They’re coming, they’re having lumbar punctures, they’re asking questions, they want awareness, they come to our support groups. And I think when you’re having a bad research day or a bad clinical day, you just think, well, the courage and the generosity of these people are actually pushing you forward. And for them that’s when you want to actually answer the questions. So common question is, when will I develop a disease? There’s a mutation in my family, when will I get this? Well we don’t know that well enough. There therefore needs to be research into that. And that’s what’s happening.

Ione Woollacott:

And I think that the patients themselves can generate things. But also, as you said, looking at questions that other groups are answering. And you think, well, with this amazing data set, what can we actually do with that? What’s meaningful and what’s not going to be wasteful of data? And I think there’s a lot to be said for having… So for example, I talk about why we use lumbar punctures for research. Because lots of people don’t like having lumbar punctures, unsurprisingly. And actually the questions patients ask, or their families asked at the support groups really informed how we need to explain that better to people. And in fact inform people about what spinal fluid does, et cetera. So I think there’s a two way process and I think that’s really important.

Tim Rittman:

Yeah. Definitely. I’d agree. And I think going and meeting people with the disease that you’re studying, I think is really important. Even if you’re not a clinician. All of these diseases have support groups. I’ve done a lot of work with the PSP association and with Alzheimer’s Research UK. And it’s really valuable actually to see what people’s lives are like, to talk to them. And I think firstly that gives you the inspiration to think, well, these are terrible diseases which need addressing and need an answer. And I suppose that’s where my ultimate motivation comes from. And then yeah, there are sort of aspects of disease which you look at and think, why are the eye of movements funny in PSP? What’s that telling us about the disease? What’s that telling us about where this starts and how it progresses and things like that? So I think it does start with seeing just how bad the human cost of dementia and seeing that for yourself and what that is. Yeah.

Amy Monaghan:

Yeah. And I think I would emphasize to people, myself, that it is really good to go and do these outreach events that are possible, even if you’re not a clinician. I’ve been into care homes and things, and just talking very basically about the research that you’re doing, to people either living with dementia or their carers or their families. And sometimes it’s just the fact that you’re doing something is all that they need to know. So that’s really good. So our last question, actually, it’s flown by, our first podcast. What advice would you have for someone working in clinical practice who wants to take up research? So Tim, I’ll come to you first. Full circle.

Tim Rittman:

That’s a difficult question. I think firstly, you’ve got to really want to do it. And if you’re not interested in a career in research, that’s fine. Don’t do it. If you’re thinking about it and you’re not sure, try and get some experience. And try and choose your research group carefully. I think that can be quite tricky when you’re sort of looking from the outside in. But try and talk to a few different people who are doing things that you’re interested in and don’t take the first offer that comes along. And talk to, not only the bosses… I think people tend to go and talk to the PIs who will give you this amazing picture of how wonderful their research group is, which may be true, but go and talk to the people who are actually doing the research as well. And try and find out what the lab group is like.

Tim Rittman:

What other advice would I give? Well, certainly think about the time commitment. Because you’re essentially doing two careers. Think about some of the financial implications as well. Because when you start to do a PhD, your wage does drop a bit. And think about where your support and advice is going to come from. There are some departments which are very well set up. I’m incredibly lucky in Cambridge that people are very encouraging of people doing support. But try and find people who are on your side who will help mentor you through the process.

Amy Monaghan:

I think some of the advice you’ve given there is not just for clinical researchers, it’s for all researchers can take some of that on board.

Tim Rittman:

Absolutely.

Amy Monaghan:

Akin, what about you?

Akin Nihat:

Yeah. I think probably someone at my stage, I went into this process having come out of core medical training. So I had a strong idea that I wanted to do research. And I had a particular set of skills that I really wanted to acquire. I dabbled with it a little bit in an integrated BSE, as a lot of medical students for example, will do. And it was really a matter of saying, well, I’m really, really keen on it and I don’t think I’m going to be able to get that level experience if I leave it later. So I would certainly reiterate what Tim said about essentially having a really clear idea of why you want to do it. And trying to gain as much experience as you can early. That’s not to say if you don’t get early experience, it’s not an option, but it’s always going to stand you in better stead.

Akin Nihat:

The other thing that I really want to pick up on is the benefit of a really strong mentor. And I think that’s ideally someone who doesn’t necessarily have a particular stake in what happens to you, but is potentially someone who is in a similar kind of area or someone who’s in a position you would quite like to emulate and can give you objective advice, both on choosing a research group for example, or on these difficult decisions that you have to make along the way that’s not always very clear which option you should take.

Amy Monaghan:

I think a mentor can be very good as well at sometimes telling you what not to do. So you don’t have to do 100% of things all of the time, actually that one can wait. Especially in your case where you’re trying to balance two careers at the same time. Ione?

Ione Woollacott:

I would definitely agree, obviously with both you, but Tim’s point in particular about speaking to people who either currently working or have worked in a department at junior level. So when I did my academic clinical fellowship… Or actually when I was applying for them, I didn’t know where I wanted to study. It was a point of when I was applying for core medical training after my F2 or F1 year. And I actually looked up on the website and contacted via email and then actually asked if I could speak by phone, which I think is quite helpful to people who’d worked at different centres. And that was really helpful just to get an idea of what kind of lab it was, what they enjoyed, what was difficult, what their supervisor really was like. So that was really incredibly useful.

Ione Woollacott:

The other two things I’d say is, one is that everything takes longer than you think to set up. And I was applying for my clinical fellowship while I was doing my first registrar post. It was very stressful. It was a lot of late nights. And I think you’ve got to give yourself rest occasionally. You’ve got to plan ahead. And then the second thing is don’t be afraid to contact people who you think are quite senior and you think won’t respond to you. Because what’s the worst that can happen if you email someone? They’ll just ignore you or say no. I might try twice. I think probably after twice I’ll leave it.

Ione Woollacott:

But a lot of people don’t even make that step because they’re worried they’ll get rejected. But actually if you’re keen, if you want… I did some summer projects when I was at medical school. If you want to give up your holiday, you want to get off a weekend. If you really want to do it, people are always looking for keen people to do it. And if you don’t email them, you can ever even start. So I would say don’t be worried about that. Just go for it and make a cogent case for why they should take you on. But go for it.

Tim Rittman:

I think that’s particularly true in medicine, because we have a very hierarchical structure. And the consultant or the professor can seem a long way away. So I would certainly echo that.

Ione Woollacott:

But they were us once, I’d like to think. Hopefully.

Akin Nihat:

Definitely. I think I’ve never had a bad experience from contacting someone in that kind of context. And you know, it also kind of leads into having to develop a little bit of resilience, which is something that we all have to do. Because you get to a point, particularly in the medical system, where as you say, you have a hierarchical system, you have a set of jobs, you do them, you do them successfully, you’re happy with that. But having to break out of that and kind of be a bit more creative means you’re more likely to fail and get rejection and you have to develop a bit of resilience about that as well.

Ione Woollacott:

I was going to make a final point about resilience. I actually found the research style of life surprisingly much harder than medicine. Medicine is very stressful. It’s long hours and you have very difficult cases. But actually it’s much more consistently stressful than research. Where it’s emotional highs, but also emotional lows, the peaks and the troughs. I was lucky to learn this quite early on because I did an academic foundation post. So that for months, it was only four months, I thought I’m going to cure and motor neuron disease and I thought I’m just never going to get anywhere, in the same day or week. And I think that’s something that people need to know who want to go into research that there are incredible rewards from doing it. But it can be very hard, long hours. Experiments can take weeks and keep failing. But that resilience to keep going and just remember you to have that.

Akin Nihat:

One of the things actually, along those lines that gave me a little bit of inspiration was, I don’t know if you’ve heard of it, was the publication of CVs of failures. So I can’t remember who initially started this idea, but I think is absolutely brilliant. Because it was a series of quite prominent people, professors or kind of adjunct professors and so on, who essentially published CVs in which they only listed things that they didn’t successfully obtain. So grants, for example, rejected papers. And it’s so easy to get a picture of people slightly ahead of you and think, God, they so successful. Everything they do is just absolutely perfect. And when you see how many rejections these people have had in the past, it just shows you that there is light at the end of the tunnel. Because I completely agree with you, Ione, that I found it much more personally-

Ione Woollacott:

Demoralising.

Akin Nihat:

Exactly. Demoralising. In academia than I ever did on the wards, where I felt in some ways I was… Although I was on my own a fair bit, I was still part of a kind of wider system.

Ione Woollacott:

Yeah.

Amy Monaghan:

Yeah. I think that’s definitely a topic for a future podcast, resilience in research. And not being so… It’s hard, especially when you’re researching something like dementia, not to become emotionally immersed in your research. And when your research is going well, you feel great. And when research isn’t going so well, you feel awful. And getting out of that kind of as you say, cycle of peaks and troughs. On the CV of failures, if you go onto Twitter you can still go on the #CVoffailures and they are on there. And there are some astonishingly long lists. But you only need to be successful once. I think that’s what you need to take away from that.

Ione Woollacott:

Yeah.

Amy Monaghan:

So thank you all for coming in and thank you for listening. Again, if you want to get in contact, you can join the discussion on the #ECRdementia or use @dem_researcher. If you want to suggest any ideas for future podcasts or just get in touch with us, use the website, dementiaresearcher.nihr.ac.uk.

Voice Over:

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