What attracted you to academic medicine?
My selection of medicine as a career reflects my strong family tradition of medicine. My underlying interest is in how things work, which I’ve been able to explore in the medical sciences as an undergraduate and in my basic science interests at present. A parallel interest in ‘what happens when things don’t work’ drives the translational and clinical aspects of my current job as an academic hepatologist (liver specialist).
As a medical student, I’d enjoyed my intercalated BSc thoroughly, due in part to having an excellent supervisor. However, I didn’t originally plan a career in academic medicine. I worked as a registrar in gastroenterology/hepatology in the South-West Region and came to the Royal Free Hospital in London to do my MD research, mainly due to a clinical interest in viral hepatitis, and a lack of local research opportunities. I enjoyed the basic science aspect of the work and took a specific interest in immunology, a subject that I’d first encountered on my BSc programme. I was lucky enough to have two excellent supervisors who encouraged me to continue with research. One of these put me in touch with the laboratory at Stanford University, where he had been a post-doctoral fellow. I met with the laboratory head and he offered me a post-doctoral position. I then spent nearly four years in his lab, which was a most stimulating time both academically and socially. In 2001 I returned to the UK with an MRC Clinician Scientist fellowship, received my CCST in gastroenterology in 2003 and now have a Wellcome Trust Senior Clinical fellowship at Southampton University. In addition, I continue to practise as a clinical hepatologist.
Were there any problems in getting going?
Like many individuals I found it hard to get research funding, but I’ve also experienced difficulties with some of the medical institutions that shape a trainee’s career. The greatest problem was the requirement to relinquish my NTN (national training number) to pursue research at Stanford. This decision was made at the discretion of the local clinical training authorities and led to further difficulties on my return to the UK, especially in the interface with the national training authorities. However the deanery to which I returned was extremely helpful and ultimately my clinical career was resuscitated by the NTN(A) scheme. I think that patchy support, potentially at the discretion of an individual with little interest in academic training, may be an issue for other academic trainees. However I feel that currently significant strides are being made to address these issues.
What are the most enjoyable and challenging aspects of your life and work?
I now have an excellent job. I am lucky enough to be able to combine clinical and academic work in what I feel are the right proportions for me; and also to have a very understanding wife, and three wonderful children. I think that for me a stable home life is an intrinsic part of a successful career. I enjoy the wider company that both science and medicine bring at national and international meetings. The biggest challenge for me is being able to switch instantaneously between the various roles that I find myself in, as clinician, scientist, teacher, and amateur politician.
What research are you currently undertaking?
My research is to understand the innate immune response to hepatitis C virus (HCV) infection. HCV is a clinically important viral infection of the liver that can cause cirrhosis and cancer. Most people that are exposed to HCV become chronically infected. I am studying how natural killer cells might be involved in the immune response to HCV at clinical and basic science levels. My work currently has clinical, genetic and functional immunological components.
What role has mentoring played in your career development?
I’ve been fortunate in finding the support and encouragement that mentorship brings at all levels of my career. I think that mentorship is a fluid thing and that as a career develops so the issues that one requires support with change (Figure 1). Rather than having one mentor I have had different mentors at different stages of my career. These relationships have usually ‘dropped into place’, rather than being sought. However I found a mentor through the Academy’s mentorship scheme and this has worked very well for me. I would urge current clinician scientists to make use of the scheme. Overall, while many individuals find one mentor for the majority of their career, the multiple-mentor model is the one that suits me best. I've mapped out how I see the changing relationships for a clinician scientist and the support a mentor can give at different career stages in a diagram which is available in the download panel.
What are the pros and cons of combining academic study with medical practice?
The combination of academic study and medical practice gives a great diversity to the experience of working. It allows interaction with a wide variety of individuals at numerous levels, and permits integration of ideas from one discipline to the other, often augmenting the results. Throughout this I’ve tried to remain focussed as I think that this balance is so finely poised that one must be extremely wary of being ‘spread too thin’.
What would you tell a student about your life as a clinical academic?
Ultimately your career choice should be one that you are happy with and not felt pressured into. Working as a clinical academic has many benefits, but the career choice isn’t for everyone, and not only for the most brilliant. Don’t write off the possibility of a career in medical research too soon, as there several mechanisms for entry. If academic medicine is what you want to do, pursue it tenaciously.
© AMS 2006
