Clinical Academic role

A personal story

Pathway

MB BS/BCh

MD/DM PhD

Intercalated MSC

MD/DM PhD

It depends…..

MDs/DMs• Historically regarded as

highest degree • More clinically/translationally

based• More autonomous/Less

supervised• Completion in approx 2 years

(often part time within training slot) Quality over quantity, possible to do without going OOP

PhD• Most modern universities

promote PhDs as best academic career pathway More /basic science/analtytical/lab based

• Rigid PG monitoring• Standardized minimum 3 year

period (requires OOP funding eg WCAT scheme)– Only 6-12 months research can

be counted towards CCT

It depends…

• Where you are – Cardiff definitely a PhD place

• Instituted PG monitoring and minimum 2y FT period for MD

• People around you – A lot of snobbery. Depends on what you

supervisor has got

Academic pathway combines• Clinical work• Research • Teaching

– Curriculum development– Formative and summative assessment– Undergraduate – Postgraduate

• PhD, MPhil, MD etc

– Administrative roles– Student support/experience

• Innovation and Engagement – Professional roles– 3rd mission activities

Two routes

• Teaching and scholarship • Teaching and research

My route• Natural Sciences/Medicine, Cambridge 1975-78 BA,MA• Westminster Medical school 1978-81 MBBS• House jobs London /West country 1981-82• SHO in Medicine in Cornwall 1982-83 MRCP• SHO in Pathology Westminster 1983-84 MSc

(immunology)

• Register in Microbiology 1984-87 MD• Lecturer in Microbiology Cardiff 1988-91 MRCPath• Senior Lecturer/Honorary Consultant 1991• Reader- Professor

• Initially 5/11 university; 6/11 NHS• New NHS Contract• 4 academic sessions; 6 NHS sessions (1 additional session)

8

• 8 month old boy with Wolmans disease (lysosomal storage disease)

• MUD transplant • Did well until sudden

cardiorespiratory arrest

• 30 year old female AML • 21 days post SCT complained on

nasal congestion and pain sinus pain• Necrotic lesion on face

– Asp flavus grown from tissue

• Extension of eroded down tthrough palate and back into brain

• Died with widespread disseminated disease

The plan

Grow Aspergillus in peptone broth for 6 days in constant

aeration

Harvest mycelial mat

Disrupt mat

Afinity chromatogaraohy (Con A) to separtate into water soluble / unbound/

bound fractions

Develop inhibition ELISA

• commerical assay (gactomannan EIA)– Monoclonal antibody– galactofuran side-chains

2000’s

• Establish PCR as a diagnostic tool – Evaluate clinical utility

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All Publications

Real-time PCR

Conventional

Review-type Articles

Real-time

To define a standard for PCR for Aspergillus to define disease and improve diagnosis

Provide optimal methodology for inclusion in a multi-centre clinical trail to evaluate the performance and impact of PCR diagnosis

Evaluate commercial assays and platforms for diagnosis

Antifungal expenditure

Cardiff patients• Dectin -1 Y238X:• 181 patients

– 84 patients with IFD– 97 patients with no evidence of IFD

• Overall incidence of SNP: 20.4% (94.6% Heterozygous and 5.4% homozygous)

• 50% incidence in patients with proven IA• 4 patients switch post HSCT:

– 3 homozygous wild type to heterozygous mutation– 1 heterozygous mutation to homozygous wild type

Innate Immune response to fungi

6, 67-78 2008

Ongoing studies

• Immunotherapy of ID• Looking at other SNPs in Dectin 1 gene• Participating in Individual risk stratification for aspergillosis:

AspIRS Study Septomics Research Centre (at the University of Jena, Germany)

• Screening ICU patients for genetic risk factors for Candida infection

• Development of management algorithm for fungal infection

Teaching and training side

• In addition to a personal undergraduate teaching load a clinical academic will be expected to take leadership roles and contribute to – Curriculum development, assessment, standard

setting, blended learning, Personal professional development, quality standards, fitness to practice

– Postgraduate training and mentoring– Educational supervision of specialty trainees – External examiner roles (other universities, Royal

Colleges )

Third mission

• Professional roles– Royal Colleges– Professional Organizations– Guideline development– Editorial Boards– Major Grant reviews– Select Committees

• Innovation and engagement– Public information campaigns/lectures

Restrictions

• Need to fit in with Universities/Schools research priorities to stay on T&R pathway– Expectation to bring in minimum of 3 times salary

in grant income• Only counts if you are PI

• Need to be REF returnable– Maintain outputs in high impact journals (>7)

• Not pro rata

Teaching and Scholarship

• Pedagogy• Expected to undertake a higher degree in

Medical Education• Expected to undertake direct teaching

activities 40% of time• Can undertake educational research,

pedagogical evaluation and scholarly activity• Cannot be a PI

Lessons learnt

• Cannot do 3 fulltime jobs– No pro-rata element (REF, CPD, etc)– Employers will use 100% unless there is

physical/temporal separation – Make Job plan clear

• 2 employers means that you get fobbed off re infrastructure support (secretarial, IT payment of expenses etc)

• More freedom for meetings conferences etc– “an absence of professors”

Combination

• Clinical work• Research • Teaching

• Innovation and Engagement – Professional roles– 3rd mission activities