Podcasts

Podcast – Maintaining your clinical identity & skills as an academic

Hosted by Adam Smith

Reading Time: 24 minutes

Adam Smith talks with Dr Aida Gonzalez, Dr Daniel Jimenez both from University College London and Julieta Camino the University of East Anglia. Three panellists who all come from a clinical background and now find themselves working as academics. This week we explore how they maintain their clinical skills and identify, while working in academia.

Academics with a clinical background and Clinical Academics may research similar things, however how they study and work can be very different. For one, being a clinician remain part of their day job, for others the clinical work may be left behind, but still be at the core of their research.

Typically, a Clinical Academic will be part funded to enable them to split their time between their clinical work and research. But what about those who have broken away to study full time, but who need to maintain their clinical skills or even just remain in that space to support the research they’re doing? How do they maintain their skills and identity as clinicians? Particularly if they intend to return to practice.

This weeks panel share their experiences on why clinical work remains important to their research, and how they avoid losing those skills which were learnt from years of training.


Click here to read a full transcript of this podcast

Voice Over: Welcome to the NIHR Dementia Researcher Podcast, brought to you by dementiaresearcher.nihr.ac.uk, in association with Alzheimer’s Research UK and Alzheimer’s Association, supporting early career dementia researchers across the world.

Adam: When I’ve spoken before to clinical academics and academics that come from a clinical background, what’s clear is there isn’t a fixed and clearly defined career path for everybody. Everyone has their own story and was drawn to academia for different reasons but there is a clear difference between people working as clinical academics and academics whose basis of their work lies within healthcare. Typically a clinical academic will be part funded to enable them to split their time between their clinical work and their research but what about those who broken away to study full time? But who need to maintain their clinical skills. How do they maintain their clinical skills? And, and particularly if their clinical skills are necessary to the, to the academic work that they are undertaking, and particularly again, if they intent to return to practice at some point in the future which I think as we move on in the conversation will pick up with Daniel, so please before we get started can I ask you all to introduce yourselves and tell us a little how you came to be where you are now. Come to you first Julieta.

Julieta Camino De La Llosa: Ok, so I am Julieta Camino, I am an occupational therapist by background, I graduated as an OT in Buenos Aires in Argentina where I come from. I worked as a clinician for many years before moving into my academic career now so I work at least for 10 years with people with dementia, with family carers, with people with traumatic brain injury, and when I moved to the UK, I, I started again working as a clinician but I’ve always been interested in the research area so I moved towards a PhD, where I’m working now trying to find out what are the factors that might explain the ability to perform activities in people with dementia so that’s where I’m coming from at the moment.

Adam: Fantastic, Daniel?

Daniel: I’m Daniel Jimenez, I’m from Chile. I was trained as a medical doctor and neurologist in Santiago, Chile. And after being working as a general neurologist for a couple of years I started my clinical academic career in dementia and cognitive neurology, and in 2016 I decided to come to London to join the first version of the Masters in dementia here in UCL, and one good thing of that matter was that they combined of course, lectures and seminars but also some clinical activities like clinical meetings, reunions, rounds, and I had the chance to meet Professor Jason Warren, and finally I managed to stay longer at the dementia research centre at UCL, basically spending most of my time in clinical research and that’s where we are now.

Adam: Fantastic, thank you. And Aida

Aida: I’m Aida Suarez Gonzalez and I’m a clinical neuropsychologist by background and now I’m a senior researcher here at UCL in the dementia research centre, and the first time that I came to Queen’s Square was 8 years ago, I was still a clinician in Seville and I was working in a neurology department in the dementia unit and I decided to come to Queen’s Square for 6 months just to have an international experience and learn about how other people were practising neuropsychology in other places and during the 6 months that I spent here in the neuropsychology department here at the National Hospital I got in touch with Sebastian Crutch from the dementia research centre because we had a lot of common interests, I had a long, a big cohort of people with posterior cortical atrophy and other types of atypical Alzheimer’s Disease and also frontotemporal dementia and he was interested in that line of research, we thought that we could do some collaboration, so I when I went back to Spain we continued our professional relationship and we continued doing things together and a year later, there opened up a position for a post-doc to join, I was very interested in the position and I came here and I stayed.

Adam: Can I come back to you first then, so can you tell us about the research you’re doing now, is there a clinical element to that?

Aida: Yes, there is. I’m focussed at the moment on conducting research in strategies that maybe helpful to support people to live better with the symptoms of dementia in the DRC we’re highly specialised in atypical forms of dementia and atypical Alzheimer’s Disease and Frontotemporal dementia, low prevalence dementias, so this is my research and it sits in the interface between research and clinical practice so it is very translational research that I’m conducting so my clinical skills I think that are very valuable to me for me to have an overview and a vision of how the things that the experiments and things that we develop in the labs can be translated into real clinical practice.

Adam: So, that’s very interesting, so you’re kind of clinical work moves on slightly in so much as you’re not just, you’re not just doing the usual clinical practice that you might see up and down the country provided by your peers in district general hospitals elsewhere or, you’re doing slightly different work here which is embedding research as part of your job to test out different ways to provide that provision of care?

Aida: Erm, yes, but it is, it is still 100% research so I don’t take it to clinic directly, I’m not running a clinic but because it is so close to delivering care actually what we’re doing is, at the very moment I’m working in this work stream 5 of the rare dementia support impact that you’ve featured…

Adam: Yeah, a podcast a few weeks ago

Aida: So, my job is developing an online intervention to support people recently diagnosed with posterior cortical atrophy, primary progressive aphasia or FTD, so post-diagnostic package but it’s evidence-based of course so you need to bring all the evidence around it, strategies and the interventions that have proved useful in this population but they are bridging the gap between evidence-based experimental things to clinical practice that is where I work, but I don’t really deliver care.

Adam: Obviously its important then that you’re maintaining your awareness of what is going on elsewhere and how translatable what you’re doing is to normal practice, with you know, non-academic clinicians elsewhere in the country. Thank you Aida. Julieta, can I come back to you, so, so do you still do, is there a clinical element to your research, what’s your research focussed on?

Julieta: Well, there’s a big clinical element to my research I am focussing on the people with dementia and their performance of tasks so I am running experimental study very practical things, testing people on how well they are doing some activities, and what are the external factors that might be affecting their performance so I’m looking at their environment, the carer management style and if I think in my clinical practice and I used to be an OT and I practiced until very much a couple of years ago, the environment was one of the first things I was looking at as an OT when I visited people with dementia, the carer support as well so I think what I’m doing at the moment it really needs me to be aware of what’s going there, what are the OTs doing in the dementia field in this country and internationally, so I, I really need to be very much involved in what’s going out there so I think at the end of journey of my PhD, I really hope to change parameters within the environmental approach and within the carers approach when they help people with dementia so I really hope to be changing clinical practice in future so…

Adam: Yeah, and that, we don’t, obviously it’s not the focus of today’s topic but I think we’ve definitely talked before about the, how you might translate the outcomes of your PhD into real practice you know that kind of real life’s in the impact and implementing those benefits and I think in the practical work you’re both doing in that clinical setting now there’s, there’s a good basis for the need, it’s not just you’re, you’re work shouldn’t just result in a paper that gets published in a journal and gets forgotten otherwise that would be a complete waste wouldn’t it, you need to then create those tools and translate that into practice that the lives of people actually better, which I think is often not necessarily realised, particularly as you would like, I know Alzheimer’s Society and things like that are very keen, funders as well like ARUK, are keen on seeing that translate through. So I suppose in that basis, having your foundation in that clinical setting is really essential to your jobs otherwise you don’t know how realistic what you’re research could be delivered. Daniel could I come to you for the same question really, if you could tell us about your research and what, how there is a clinical element to that.

Daniel: Yes, well I’m a clinical neurologist so my main interest is clinical research rather than pure neuroscience – and how we transfer this knowledge to clinical practice, following the, as Aida said, this gap between clinicians and neuroscientists and I’ve had the chance to join different research projects here at the dementia research centre looking at atypical forms of Alzheimer’s Disease or familial forms of Alzheimer’s Disease and I’m able to assess patients with different clinical presentations and that’s my main interest, how these different presentations beyond memory difficulties correlate with some functional or structural brain markers, that’s my main interest.

Adam: That’s fascinating, thank you. Aida coming back to you again, how, so talking about the work you’re doing now which obviously has a foundation in your clinical background but isn’t clinical in itself, how have you, how have worked to maintain your clinical skills and is, and is this something that self-driven or, or does your institution, because there’s a professional registration for your field, how, how do you need to maintain that, how is that supported?

Aida: Yes, that’s right, I, I do need maintain my clinical skills if I want to continue being registered and meeting their standards. And this is a challenge, and I think it is a challenge for many clinicians conducting research or mainly research, so I’m not aware of a formal scheme within the institution to support neuropsychologists to keep their clinical skills up to date, I did receive support from my line manager in the past so for instance something that I did a few years ago was I, I had honorary contract with the neuropsychology department and I had this arrangement and I would pop in a few days a month and I will see patients there. Now that I’m not doing that anymore, what I’m doing now is trying embed a bit of private practice of course outside working hours so this is something that you need to plan because you need to add more hours of work to your week.

Adam: I mean you don’t do that for free right, that’s not voluntary work but you do get paid for it, you’re having to do that on your own time

Aida: Yeah, exactly

Adam: And by doing that you could potentially return to practice.

Aida: Yes but this is a way of doing it and it is good enough and I think it is something I would advise to other people to do.

Adam: I mean if you were an employee in a company, you have an appraisal every year and you go through that part of the appraisal form that says oh what training do you need, what things do you need, and you’d be listing out there things like oh I’d like to go on that course and I need that one, this would be good to enable to me to continue to do my job as well as I can – do you, I mean obviously you’ve both finished your PhDs, but do you have the same conversations with your supervisor?

Julieta: Yes, sorry I still haven’t finished my PhD…

Adam: No, no you’ve not finished yours yet

Julieta: Yeah, I’m in my third year now, but I think it will be very much the case of my next job to check whether I will need to have that put on my appraisal to see whether I would need more support for my clinical skills so yeah. I think it’s, you can fulfil a career which is combined with clinical elements and research as well. But I think it’s something at the moment very personal, I have to say.

Adam: Yeah, true. As I was saying the clinical academic role is fairly well-defined and the NIHR is great at supporting that, the organisations are where they give you time off to study but I think, you know, it’s harder when you leave that full time healthcare setting to study academia to maintain that clinical skill, so how, how do you, how do you approach that Daniel? I mean, is this something, because you’re a neurologist, you came to the UK to study remained as a clinical academic, do you intend to return to practice in Chile?

Daniel: Yes, as I was explaining I got my qualification in Chile and I joined the University of Chile before coming here so I have basically that’s my main employer and when I came here I got a scholarship from the Chilean government to do my Masters and then to stay here for a while getting more clinical research experience and this is a kind of deal with my Chilean employers because they can fund me for staying here for longer but then I have to go back and return in some way to…

Adam: There is an expectation you will return and fulfil your commitments to the country

Daniel: Yes, so this year I’m going back to Chile and set up a cognitive disorders clinic to see these patients with atypical forms of dementia and hopefully start collaborating with the research project with UCL and other centres.

Adam: So when you return to Chile to work as a neurologist, having had obviously you’re still in that environment working with neurologists but not practising yourself, will you have to do some extra training when you return or, or, or will the work here you’ve done be sufficient to allow you to just return straight back to the kind of jobbing frontline clinical work you’d be doing in Chile?

Daniel: Yes well here I can be autonomous, I can be an independent neurologist, but I’ve been working the research conduct with patients and alongside consultants and I’ve kept a kind of clinical work during these years and when I go back to Chile I’ll be spending most of my time in cognitive neurology and dementia, and trying to set out the centre to do clinical research in this field, so probably with this experience, I could start to go back a clinical research work in Chile.

Adam: Fantastic. So, I mean we’ve talked this podcast was supposed to be talking about both your clinical skills which we’ve talked about and I’m gonna try and recap here just for the, for my own understanding, so Aida you kind of maintain clinical stuff, so you are working, you’re clinical skills are useful to the role you’re fulfilling although you’re not working clinically but you’re having to work outside of your practice, you have a, outside of your day job to do that and you have professional registration to maintain but the institution doesn’t have a formal mechanism by, to support to maintain that, that registration. A wonder, maybe that’s a discussion topic for our, for our listeners to, to message us if they find that that’s different where they work if you drop us a message on twitter we’re @Dem_Researcher and we use the #ECRDementia, I’d be interested to know from everybody else if that’s the same, and also as well whether there’s any difference for doctors, I’m quite interested to see if there is any bias towards kind of maintaining doctor registrations particularly when they have GMC for example, over other professions like nursing or occupational therapy or psychology. The other thing that we talked about obviously for your self Julieta, you’re, I mean, you’re obviously a full time academic, you’re doing your research right now so you kind of have stepped away pretty much from your clinical practice.

Julieta: Yes, but I also worked for a couple of hours for a research study in the University where I’m doing my PhD in East Anglia, and we do have, it, I think it’s, this is really depends on where you are, where is your setting, and how much you are willing to, to do, I, I do need to with my colleagues to discuss our participants clinically, and even though I don’t, I’m not doing a clinical job there I’m not intervening in my participants I do tend to, you know, recap and think what we are doing, what these people are, what is the clinical presentation, what is the diagnostics type and I’m also participating in an OT meeting that is led by the Norwich, Norfolk and Suffolk NHS Trust so I think it’s also a self-driven situation where you want to keep your skills by meeting other people and knowing what’s going on and offering your knowledge from your research point of view and trying to change the practice in a way, you know, in some small way so I think it’s a, it’s a very self-driven situation outside I also worked as an OT for a neuro rehab hospital on Saturdays doing shifts so I tried to keep, you know, that clinical element up to date because you know it is really essential fro you thinking when you do your PhD as well so I think it’s a self-driven situation.

Aida: Can I make a point here: It’s about the consultations, being part of clinical meetings I think it is another tool to keep your clinical skills up to date in periods where I have been unable to see any patients, I haven’t been able to practice at all, I’ve really used this resource so I made sure I was popping in clinical meetings even if I had to skype into the meetings and you know, at least observe the discussion between my colleagues and other colleagues who are actually practising because it is a way of being present and not disengage completely of what is going on in the real clinical world so this is another good thing.

Adam: So you all left, I mean fundamentally you all left full time clinical positions to be full time academics, I mean that academia has benefitted from your clinical background but you all left because of course there is that other way of working which is you split your time, do any of you regret fully leaving clinical to work academia? I mean, obviously personally you may have had challenges along the way which have caused you to question things but I mean, would you recommend that approach as opposed to taking longer to do your PhD but, but doing clinical practice at the same time?

Julieta: I think from point of view, if you are interested in research, I would try, I would leave, I am very happy with the decision that I made about leaving my clinical position for a couple of years to try research and see whether I like it or not and I am not missing my clinical time I have to say but I think it is a combination at some point I will have to make a combination because you know I do like seeing people and working with them and changing their life and supporting them but I think I would advise people to take this path in order to have more options and also to learn different things that can be then taken back into clinical practice.

Adam: And then it can be quite stressful to try and split your time in that way, I mean whether this is been the right decision for you?

Daniel: I think it also depends on the area of your interest – I left my full time clinical position in Chile and came here for a more clinical research role but I think that the research is a very good, an important input for clinicians, especially dementia for example, if you want to see a good number of patients with posterior cortical atrophy or atypical forms of Alzheimer’s Disease probably you won’t get that in your clinical centre you have to go to a centre where research is important part of the work, because that’s where you can see, you know, a sufficient number of patients with those kind of pathologies and you can get a clinical flavour of what they, how they present so I think research is a very powerful experience for clinicians.

Adam: And so given, I think you’ve all suggested that you intend to return to full time clinical practice?

Aida: That’s not my intention at the moment, what I would like to do in the future is to combine my research career and my clinical career so I really love being a clinician, my identity is pretty much important on me being a clinician so when I think about myself I think about a clinician who does research.

Adam: Oh, so you’ve got an interesting one because there’s not a lot of precedence right? Somebody who tries to find the balance between the two? You know, maintaining that long-term research career whilst also doing clinical work in your particularly in your field? So you’ll be the first

Aida: Yes, so yes so I’ll have to be very creative [laughing].

Adam: And Julieta?

Julieta: Well, I, I don’t close any door to be honest, I decided that I love my clinical experience and my work and I love my patients, the carers and all that comes with this field, but I also love doing research so I kind of see myself trying to be creative and combine, have a like combination of things to make me feel motivated and to try to find really solutions by doing research so I think trying to mix of them in future, I don’t know how but I am open to that.

Adam: And Daniel, you’ve already said, I mean, you’re going to go back and set up your own research institute right?

Daniel: I’d be combining definitely, I mean, that’s a big part of what I wanted to do here so have this experience in clinical centres where research is a very important part of the, the job and for next year, of course, I’ll be resuming my clinical work in Chile, but I’m also applying for funds for research centre just for to start with.

Adam: So at the start we introduced this as saying it was about clinical skills but also about identity, you’ve been out of clinical full time clinical practice for quite a while now, would you, I’m not even going to ask you a question about whether you’ll still identify as clinicians because you’re all just going to say yeah right?

Aida/Julieta/Daniel: Yeah

Adam: But, how long before that kind of starts to fade away, how long before you’re away from the frontline of properly practising that you know, that kind of stressed environment that we know healthcare is like right now before you stop really feeling like clinician and you start to feel like an academic that’s dabbling in clinical work? I’m going to be unkind but I’m going to, I’m being deliberately provocative in that question, what do you think?

Aida: For me, this has been my worst nightmare, because I’ve lived in this crisis, you know trying to balance the both worlds and I always fear that I would lose my clinical skills and then what would become of me [laughing] because it’s so deeply rooted in my identity that I’m a clinician but I think that it is, you have to make peace with the situation and to focus on the positives because you are, you have a double qualification and that’s awesome and I think that it is worth making the effort trying to balance both and also adjusting expectations so you don’t need to become the most famous researcher ever in order to be able to be a good quality researcher and continue conducting research and when it comes to your clinical practice it’s the same, you need to adjust what you are able to, maybe you are not to develop the complexity of a clinic or a service that you would always dream but you can still see patients, you can still see the, become the best person of yourself so there are ways around it but you need to make peace with the situation and also appreciate that it’s a huge privilege being both a clinical and a researcher and not being focussed on the conflict as I’ve done a lot in the past [laughing]

Adam: Yes, forging a bit of a new identity isn’t it, that, that, that in between role. So, obviously some of our listeners will be full time clinicians right now who are just starting either trying to balance their time in academic studies alongside their clinical work or you know, thinking about leaving full time, what advice would you give to anybody in terms of how they maintain their clinical identity and skills in leaving for full time academia, what advice, what kind of mind set, what things should they think about in advance? I’m going to come to Julieta first, I see you’re staring off, you’re thinking about the answer

Julieta: I was really thinking about it because I very much think this is a personal thing about defining yourself as a clinician so I don’t have a particular advice to give people, I think it’s more about what you are looking for by doing research, what is your motivation that will, maybe define what you need to do in order to continue being a clinician as well, so my motivation for doing research is to try to find new things to change people’s lives so in that, in that way I am trying to maybe create things for other occupational therapists who can take my work into the clinical practice so I can see that as a way of you know, contributing and continuing with my clinical experience and contributions so I, I don’t have like a specific advice in this matter.

Adam: And I suppose that way you’re day-to-day research activity keeps you in that environment?

Julieta: That’s right

Adam: I think environment is a key thing here, if you are still working with the same kinds of people, you’re still in touch with the same patients that can help you kind of keep in that space because it is important to keep in touch, otherwise you don’t want to do, to go off into academic studies thinking you know how things work and then coming back five years and we know healthcare changes so rapidly but you come back five years and find everything’s changed.

Julieta: Yes, and also can I say some things about trying to disseminate your results within your field because we work as very much dementia researchers but if we go to our, for example in my case occupational therapist congresses or conferences then I can you know, promote what I’m doing in my own area of expertise rather than only dementia focussed you know conferences.

Adam: So conferences are good as well particularly if you don’t focus just on the research conferences, you’re still going to the national conferences for Occupational Therapists

Julieta: The clinical ones, yes, so that’s a way of trying to keep your clinical approach

Aida: And I suppose you’ve got an extra challenge here Daniel, because you’re not even in the same country so you’re trying to keep in touch not just with your, your profession but also trying to keep in touch with the, with the country that’s, that’s developing and moving on constantly as well, does that present a whole different challenge?

Daniel: Yes, it’s, it’s an extra challenge because you know in Chile my country, we’re just starting with the dementia care and research so it’s an extra challenge because I have to persuade people and the healthcare system to recognise how important research is for clinicians and for the clinical practice and as Julieta said, it depends on your motivation, I think, I feel myself as a clinician because the patient and the person is in the centre of my job so my main interest is how all research effects people’s lives and I think that’s a key part of  feeling yourself as a clinician but of course it’s an extra challenge to combine this and that’ why we have this big gap between the clinical world and research that’s still the reality in many places.

Adam: Aida, did you have anything finally to add to that? Or any final points you’d like to make?

Aida: Yes, I would like to, to send this message for people who maybe in the same situation or considering a clinician’s career in research, focus on the positives because it is an amazing thing to be a clinician in also researcher and there are far more positive things than negatives so sometimes you will just need to be more creative or flexible or, you will have to work on making peace with conflicts but it’s, it’s totally worth it.

Adam: Fantastic, so, I mean for me there are a few things to take away from this. Nobody should be afraid to leave full time clinical practice to start academic work, whether that’s a full time PhD for three years or longer. If you try to split your time between clinical work an studies, but you definitely shouldn’t be afraid there are ways that you can maintain your clinical identity and keep your practice up to date. However, don’t rely upon your organisation supporting you to go on courses and maintain your registration it might be that it has to be self-driven.

There are many ways to maintain your skills; through attending conferences, and staying in that environment.You can bury your head in a library for five years, but don’t. You can also continue to work, in your own time, as time allows. Trying to do some shifts in your old profession is one way of doing that as well, keeping in touch with colleagues. Through this you will start to develop a new identity, that is grounding in clinical work, but becoming a better version of yourself, with your clinical background and academic skills.

What I’ve taken away, is all three of you are really keen that, the lessons you have learned and the research you’ve done over the last few years should be given back to the community, to help the clinicians that are still there working. Also try to find a mechanism for feeding back and disseminating and implementing the research you are doing. Thank you ever so much, it’s been fascinating and I hope it does inspire people.

All three of our panellists today are all on Twitter, so please look them up. If you have any questions please post in the comments part of our website or tweet us @Dem_Researcher.

If any of our listeners have anything to add to this topic please do, use the hashtag #ECRDementia, profiles on all our panellists are on our website, as well as a and a transcript of this podcast.

Finally, please remember to subscribe, review and leave messages for us on our podcast, you can find it on iTunes, Spotify, Podbean, Soundcloud. I think you can even ask your smart speaker to play the dementia researcher podcast. And do visit our website which is packed full of all kinds of research, advertisements, funding opportunities and blogs as well and posts talking about how people are balancing their time between academia and clinical work.

Thank you very much to all of our panellists – Julieta, Daniel, Aida, thank you very much for joining us again.

Voice Over: Brought to you by dementiaresearcher.nihr.ac.uk, in association with Alzheimer’s Research UK and Alzheimer’s Association, supporting early career dementia researchers across the world.

END


Like what you hear? Please review, like, and share our podcast – and don’t forget to subscribe to ensure you never miss an episode.

If you would like to share your own experiences or discuss your research in a blog or on a podcast, drop us a line to adam.smith@nihr.ac.uk or find us on twitter @dem_researcher

You can find our podcast on iTunes, SoundCloud and Spotify (and most podcast apps).

Leave a comment

Your email address will not be published. Required fields are marked *

Translate »