Combining research with clinical work
Intercalating at Cambridge
One of the strengths of the veterinary course at Cambridge is that all the students go their separate ways in the third year, in order to study something in more depth. I chose the Part II pathology course because it offered the prospect of a full year of laboratory research, which was something I was keen to experience. I had no idea at the time, but the project I undertook, studying the immunology of diabetes, sparked my interest in autoimmune diseases and in many ways set the direction for my future career.
At clinical school, as well as developing an unfortunate allergy to horses, I realised that I enjoyed the small animal medicine and soft tissue surgery rotations the most, and chose surgery as my elective subject. I also had the opportunity to spend several weeks on a rotating student externship at the Ontario Veterinary College, University of Guelph, which was when I began to understand the different specialities within the profession.
Practice years - a steep learning curve
After graduation, my main aim was to get some clinical experience, so I returned home to Newcastle and worked in a local veterinary hospital for several years, sharing a flat with two friends who had recently qualified as junior doctors. My first year in practice, with a one in four on-call rota, was probably the steepest learning curve I will ever experience. I was fortunate to work in a friendly and progressive practice, alongside supportive and sociable colleagues. Many of the lessons I learned in this environment were not simply clinical or practical, but included managing clients and their expectations, as well as developing confidence in my own decisions. This valuable experience in first-opinion practice still informs my teaching and clinical work today.
Embarking on a PhD
While in practice, I realised that I was enjoying medical cases most, so I undertook the RCVS Certificate in small animal medicine, which focused my work and improved my clinical knowledge. Visiting Edinburgh vet school to see practice with my adviser Jimmy Simpson inspired me to think about returning to veterinary academia. The idea of a PhD had always appealed to me, but it felt like a big step and I wasn't really sure how to go about choosing a project or supervisor. Fortunately, fate intervened, and I saw an advert in Veterinary Record for PhD studentships. In April 2000, I visited the graduate school at the Royal Veterinary College Camden campus for a series of informal interviews with potential supervisors, having mentioned on my application that I was interested in immunology, diabetes and small animal medicine. I suspect that, at this point, my concern about leaving practice must have been fairly apparent, but I was reassured by Colin Howard, the Vice-Principal for Research at the time, that ‘A PhD opens more doors than it closes’, and I have certainly found this to be true.
"Valuable experience in first-opinion practice still informs my teaching and clinical work today"
I was exceptionally lucky that Brian Catchpole, at that time a recently appointed lecturer, was looking for a PhD student to work on canine diabetes. The project he had designed, co-supervised by Mike Herrtage at Cambridge, offered the perfect balance of clinical and laboratory work. I couldn't have asked for a better opportunity or a more enjoyable three years (although living in London on a student stipend proved to be financially challenging, and I was glad to have a regular weekend locum job). Presenting research abstracts at international veterinary conferences, although hugely daunting at first, proved to be an enjoyable and sociable experience.
Medicine residency in Cambridge
It was at this point that I began to wonder whether it would be possible, after my PhD, to be a clinician scientist and spend some time doing research and some time doing veterinary clinical work. I had considered applying for residencies before my PhD and I started to think of this route again. In those days, there were far fewer internships, so becoming a resident after several years in practice without doing an internship was not particularly unusual, and I was very happy to be offered a medicine residency in Cambridge. I still had some work left to do on my thesis when I began my residency, but such was the pace of life that it took me several more months after beginning in Cambridge to submit my thesis. I remember getting the train to London and racing across to the university library with the three blue-bound copies of my thesis required for submission. I reached the desk five minutes before closing time, and I am not quite sure what I was expecting, but it felt like quite an anticlimax being asked to leave my thesis copies unceremoniously on a large table alongside hundreds of other identically bound books.
"It was at this point that I began to wonder whether it would be possible to be a clinician scientist and spend some time doing research and some time doing veterinary clinical work"
My residency, although extremely hard work, was great fun and allowed me to pass the European College of Veterinary Internal Medicine and RCVS Diplomas in small animal medicine exams. I had hoped to be able to continue with my diabetes work during this phase, but in reality it was more challenging than I expected to fit in laboratory work alongside clinical and exam commitments. However, I tried to stay as involved as possible and to publish as much as I could from my thesis, and I stayed on for an extra year after my exams to consolidate my clinical knowledge. During this time, I was again faced with some career decisions. I knew I wanted to continue in diabetes research, but was aware that funding for veterinary research was limited. However, with support, advice and encouragement from several members of senior staff at Cambridge, including Robin Franklin, the Director of Research at that time, I decided to apply for a Wellcome Trust Intermediate Clinical Fellowship to undertake postdoctoral training in diabetes genetics. This application felt like something of a long shot, as the scheme appeared to be directed towards medical registrars rather than vets.
Postdoc in human medical research lab
I was keen to use the four-year fellowship to experience life as a postdoc in a human medical research lab while also maintaining my veterinary skills, and spoke to many potential supervisors. I was delighted when John Todd, Head of the Diabetes and Inflammation Laboratory (DIL) at the Cambridge Institute for Medical Research, agreed to act as the sponsor for my application. To say that I was surprised to be awarded a grant in this Wellcome Trust scheme is an understatement.
I joined the DIL at a very exciting time in diabetes genetics because the first genome-wide association studies in human type 1 diabetes were just being published. This meant that there were several areas of the genome that had newly been associated with disease risk, with many novel genes of unknown function to study. I became part of an enormous research team of geneticists, immunologists, statisticians, bioinformaticians and clinicians, and in doing so I learned a whole new language and experienced research on a scale unlike anything I had come across previously. Although we all had our own individual projects, the DIL works on big data in a big way and it was a tremendously enjoyable and enlightening experience. My project was to study a new region on chromosome 16, and for 4 years I immersed myself in molecular genetics, emerging in the final year having identified a novel candidate gene involved in the risk of autoimmune diseases.
"Time spent in research will open more doors than it closes"
Having painstakingly identified my gene of interest, the question remained of exactly how this new gene affected the risk of type 1 diabetes and other autoimmune diseases. Having published the work from my intermediate clinical fellowship, I returned to the Wellcome Trust for advice and, again with the support of the vet school at Cambridge, I secured a Wellcome Trust Veterinary Postdoctoral Fellowship, to allow my work to continue. It was now time for some functional work on my new candidate gene, which involved another step, even further out of my comfort zone, and a move to the Wellcome Trust Centre for Human Genetics in Oxford. Although this move was partly due to a relocation with my husband's job, we had deliberately considered Oxford because of the number of research opportunities available there.
Professor Todd generously allowed me to take my newly discovered gene to Oxford to work on it there, and again after meeting various potential sponsors, I was fortunate to join the lab of Professor Chris O'Callaghan, where I have now worked for four years. This fellowship was the first time I had worked alongside a clinician scientist; Chris leads an innate immunity lab alongside having a clinical job as a Consultant Physician at the John Radcliffe Hospital. This experience has taught me a lot about the challenges of balancing clinical and laboratory work, but I have also seen that, with careful planning, it is actually possible. Meanwhile, my knowledge of biochemistry, high throughput sequencing technology and in vivo models has expanded exponentially and I have enjoyed working my way towards research independence in such a stimulating environment.
After three years in Oxford, my fellowship funding was drawing to a close, so I again had to consider my options, recognising that I wanted to do some more clinical work but also to carry on with my research. This was the point at which, if I was a medic in the NHS, I would have been able to apply for clinical lectureship funding (as the Wellcome Trust pointed out to me when I returned to them for advice). However, such options are not widely available in veterinary medicine. Having said this, the discussions I had regarding my options at this stage really made me recognise how keen the UK vet schools are to support researchers as they move towards independence. The support of many researchers I spoke to, including Clare Bryant and James Wood in Cambridge, as well as people in several other vet schools, gave me the confidence to stick to my plan of becoming a clinician scientist by trying to secure further fellowship funding and working towards independence.
In October 2014, I was appointed as a fixed-term university Lecturer in Genetics and Small Animal Medicine at Cambridge. This temporary lectureship, alongside an extension to my Wellcome Trust fellowship in Oxford, has allowed me to play a more active role in veterinary clinical work, while also continuing my research and preparing my next round of fellowship applications. This two-year post is proving crucial in allowing me to generate the type of pilot data I need to be competitive for more senior funding.
Getting the best of both worlds
Although combining research in Oxford with clinical work in Cambridge has its logistical challenges, at the moment it mostly gives me the best of both worlds. I get to keep up the momentum of my research, which has built up in Oxford over a number of years, while retaining my clinical skills and enjoying veterinary teaching and collaborations in Cambridge. I have also found that many of the techniques I have learned are useful and applicable in answering veterinary research questions too.
"Although combining research in Oxford with clinical work in Cambridge has its logistical challenges, at the moment it mostly gives me the best of both worlds"
I am grateful that we are able live at the school near Oxford where my husband works and also that my clinical colleagues in Cambridge are so supportive and flexible about the weeks I am able to spend on clinics. Alongside this, I also enjoy attending veterinary conferences, participating in the European College Exam Committee and the Society for Veterinary Endocrinology. I am also able to undertake smaller collaborative projects in canine genetics and diabetes, together with my work on human autoimmunity, all of which mean I still feel genuinely connected to the veterinary profession. As the One Health agenda becomes ever more prominent, funders are increasingly recognising that vets are in an ideal position to play a leading role in improving both animal and human health.
In the longer term, it makes sense to bring my clinical work and research together in one place, and my next challenge is to secure more fellowship funding to work towards this goal. It is true that when you are constantly judged on your publication output and grant income, while technically being without a permanent job, life can feel precarious. However, the excitement of research discovery, the friendships I have made along the way and the huge variety of interesting aspects to my job more than make up for the relative uncertainty. The support, advice and encouragement of a number of mentors has also been hugely important in keeping me on track. I have been made to feel exceptionally welcome in every place I have worked, and I have also found that the vast majority of medics and scientists are fascinated by the diseases that vets diagnose and treat on a regular basis.
To anyone considering alternative ways to use their veterinary training, I would certainly recommend a step out of your comfort zone and into research. I am sure you will find, as I was once advised, that time spent in research will open more doors than it closes.