 Welcome to everyone joining us for the first ECR Wednesday webinar of 2018 hosted by ELIFE, the series that aims to give early career researchers a platform to discuss issues important to you and your research career. My name's Emma, I work for the ELIFE features team and today our speakers will be discussing how they balance their careers as clinicians with scientific research. The webinar will begin with the panelists sharing their stories. Then in the second half of the webinar we'll be putting your questions to them. To ask a question you can type in the question box on the go to webinar functions panel or you can tweet us we are at Eli community using the ECR Wednesday hashtag. Please also join us on Twitter and mainly after the webinar where we'll be continuing the discussion under the ECR Wednesday hashtag. Today's chat will be moderated by Vino from the Eli Early Career Advisory Group. Finally I'd just like to let you know that we are recording the webinar and we'll make it available on YouTube in the near future. Now I'll pass over to Margarita to introduce the panelists. Hello and welcome to our webinar. I just need to mention that Eli, is a non-profit journal and its aim at improving the way science is performed and communicated. It's committed to support early career researchers, me and through different initiatives and I'm a member of this Early Career Advisory Group. I would like to talk in this webinar about how medics can be researchers as well. So we would like to discuss a different career path that exists to allow clinicians to be scientists. So we know that working clinicians who have a career and research are ideally positioned to the medical relevant questions for scientific research but the career path is although it's becoming increasingly popular it can often be long and challenging. So in this webinar we would like to discuss the different training routes that exist around the world to facilitate this career path and how to balance the demands of juggling clinical practice with scientific research. So we have three speakers today. One is Claudia Sommer, who is a professor of neurology and runs a preferred neurology lab. Then we have David Bennett, who is a professor of neurology and neurobiology and a consultant neurologist at Oxford University. And we have Clifford Rosen from sorry, Claudia from Germany. David from the UK and Clifford Rosen who is from the USA who is the director of the Center for Clinical and Translational Research at a main medical center. And our speakers are going to talk a little bit about their experience and how the different career paths exist in the different countries. So first is Claudia going to tell us about her experience. Thank you Margarita for the invitation and for the introduction and I'm very happy to talk about this subject because it's very important to me. I have always wanted to be a medical researcher. In fact I started studying medicine to be a medical researcher. This has always been my motivation. And one thing I wanted to tell you the new generation is that things nowadays are much, much better than they were then because we had 12 hour shifts and no shifts and never a day off. And then to do research was really difficult. So I had to find my own research time, which I found after doing psychiatry residency, which I found in a neuropathology lab with a stipend for two years. And then after doing my neurology residency in an experimental pain laboratory in San Diego in the US. And this is possible. And I came back to my home university, built up my lab. The environment was supportive but not so supportive. So I changed university, went to the next place and here I am still. So this was successful in the end and the lab has grown and has given rise to several young researchers who already have their own labs. Nowadays we have found that it's not possible to do research like this anymore because all the fields, not only neurology, have become a lot more competitive. So we also need better programs to help young doctors to do research. And I just wanted to give you some examples from Germany where I think there are some quite good programs. For example, the medical school in Mannheim has already for several years a program for the medical students where you can rather early choose if you want a more clinical path, a more clinical scientist path or a more health economic path. And in parallel to doing your medical school you can follow master courses in the different subjects. For example, health economics or biomedical engineering if you are engaged in that way. And another example, the medical school in Cologne, they offer a research track that the medical students can enter from the beginning if they know I want to be a clinical scientist, similar in the medical school in Munich. So what did my medical school here in Würzburg do? We, first of all, we established a mentoring program. I think this is very important. There is mentoring by experienced clinical scientists but also by the peers. So those people who are engaged and want to be clinical scientists, they see that they're not alone, that they have peers with the same ambitions and maybe similar problems. Then we established also several courses to become a master of science in parallel with medical school which is ambitious but can be done. And it's now been changed and put into one course which is called translational medicine but within this master course the students can take several branches, for example, a more experimental science oriented or a more epidemiology oriented plan. One particular thing to understand the system in my country is that the MD thesis, the doctoral thesis has always had a great value and it is in our country it has the same value as a PhD thesis. So when you had your MD doctorate you did not have to do a PhD in addition because you already had done several years of research work in parallel to your studies. You were in a team, you learned how to do research, you wrote a thesis so this was great. But given that internationally this is not so well understood and sometimes a PhD and official PhD is needed for a career, this has also changed and first of all we have more structured MD thesis programs which are also more ambitious and we have MD PhD programs where very ambitious students can do both in a certain time with a respective tutorial. Right and just after graduation from medical school there are also several programs that have been started and one is actually called the clinician scientist program and this is a program where the young doctors go into their specialty or the specialty they want to do whether it's pediatrics or orthopedics or whatever but with certain research times so one-year clinical, one-year research and so on until they have fulfilled a certain program and done a certain research and at the same time are licensed for their specialty. So this has recently started and I think it's a very good thing to give the young researchers really protected research time. So this is the biggest of the programs and there are several smaller ones like the first lab rotation program where they get half a year of protected time or the first grant program where they can compete for an eternal grant and have their first own research project. My medical school is just one example and there is this development luckily I think in many medical schools they have seen that there is this need that a clinician scientist cannot do everything by themselves. That we need structures programs and they are there now so I think today is a very good time for anybody to start in these programs. Thank you. Thank you Claudia that was very interesting. I think the next weekend will be day if you can please provide us your experience and what different career paths exist in the UK. Sure well thank you very much for the invitation and I echo Claudia's comments. This is an issue that's dear to my heart so I thought what I would do is I'll speak a little bit about my own experience and again echoing Claudia's comments I think training has changed in the UK quite a lot since my time but then I'll bring you a little bit up to date on the kind of things that are offered in the UK now. So like a lot of things actually my experience was somewhat driven by chance so I did like a number of medical students in the UK I did a one-year BSc what was then St Thomas's Hospital and that BSc was in Neuroscience and the really the issue of chance was that I happened to work in the lab of someone that became a very good friend and mentor and that's Steve McMahon and in fact there was more chance than that because he was meant to be going to do a research project in in San Francisco and his wife became pregnant and he couldn't go and so that summer I went in his place to run this project and had a great time and so I did a kind of two-month research project in the US instead of going on a summer holiday and came back and decided that I really loved research and at the same time as that happened the medical school decided to set up what they termed an MB PhD which in the US would be called an MD PhD and they said to me do you want to do an MD PhD and we'll pay for it and I thought well I've just had a great time in San Francisco this sounds like I'm really enjoying the research so I said yes so this was not something that kind of I'd set out at the beginning of my medical career as what I was going to do is that these chance things had happened and that really set me on my career in the sense that I had a very enjoyable PhD spending some time in the UK and some time in Genitech San Francisco and I got a great training in basic neuroscience and so I did all of that PhD prior to completing my medical degree and certainly one thing that one question I often get from people still now is when should they when's the best time to do a high degree like a PhD and I think there's no easy answer to that I think actually there are pros and cons so one of the disadvantages of doing an MD PhD is you're quite junior in medicine you might not know exactly what specialty you want to do so you know had I done a PhD in neuroscience and then decided actually what I really wanted to be was a cardiologist potentially that could have caused some issues although I would say that there's a lot of generic techniques in science in general and actually having a good scientific training can cross some of these different specialties but some people use that as a reason as preferring to wait to do their PhD until they've at least started their specialist training I think what I would say is if you have a great opportunity to work in a wonderful lab and that lab is very productive and you think you can do great research there then probably is one of the best reasons to do a PhD so one of the disadvantages I had again was not dissimilar to what Claudia was saying was that I then went back into medicine and in fact in my time there was no scheme for combining research and medical training so I went then back into full-time medicine for seven years and I was trying to write papers and exactly as Clara was saying I was my elective was spent doing research at every spare moment was spent in the lab but none of this was actually meant to be spent on research time and then I guess I had another stroke of luck when it got to the point where I could apply for some more research funding I kind of actually wrote a grant with very little provisional data but I had an idea and it was going to be partly working again in the same department as I've done my PhD which is a very supportive department and I got that grant from the Welcome Trust which is a charitable foundation in the UK and that really set me on my course for the future so kind of how things change and you know what improvements have happened in the UK I think one major thing that is a definite improvement is that there are now specific academic training programs for medics that want to combine research and medicine and so even at the level of kind of the most junior medical doctor which would in our in the UK would be a foundation doctor and then really at tiered levels up from that you can apply for special academic training programs where there is some dedicated research time that can be combined with your medical training and that's I think a really excellent advance and the route now that many people take is they will they will if they want to do academic medicine they will enter one of those academic programs they'll use some of that dedicated time to start making links with a lab which obviously there's a there's a commonality between the interests of the lab and the and their medical specialist training whatever that may be to start generating some data some provisional data and then apply for what in the UK we'd call a training fellowship and that that might be to do a PhD if they haven't yet done a PhD or it might be at a higher level of that what we would call an intermediate fellow where now they're just beginning to start their own independent lab again usually with some kind of a mentor or supervisor but they might be beginning to set up their own research program and so that integration has happened across the UK between working between their national health service and the university sectors and in general I would say it's an excellent thing it's important that people choose the right environment to be in and so they're going to want to think about you know where there is a good track record in the both the clinical specialty and research they're interested in and again we we now have mentoring programs so in my department all the clinical academics have have a mentor in fact what almost virtually whatever level of seniority that they are in it's true that grant writing is still very important because at one stage there's a hurdle and that is to get a grant to undertake a clinical fellowship and again we try and mentor people through that process and I would say kind of once you you've got that grant then there's the challenges of setting up your own independent research program and and I would say that things that can be very helpful is if you're in a in a supportive environment to collaborate to have access to shared equipment is it's also extremely helpful and also the more generic kind of professional training in leadership and management that needs to take place as well so that's really a summary of what's happening in the UK at the moment and obviously I'm happy to take any questions later thank you thank you David it was yeah very interesting as well and I'm glad to see that there are changes in most countries at least yes yeah that's that's quite and please work please can you give us a your free and your yeah great thank you very much thanks for the invitation and thanks for tuning in so I had a very different experience too and I sort of echo Claudia and David so I finished medical school in 1971 I was a biochemistry major and worked in the lab and wanted to do medical research but realized at the time I'm choosing between a PhD and an MD which was a very difficult choice for me my mom pushed me into becoming a doctor so I went to medical school instead but with that deep interest in research and I did some work in a lab my first year but got overwhelmed with medical school and ended up getting interested in clinical medicine and it was an interesting time because there were many many changes but the basic molecular and cellular biology advances really began to occur just after I finished my training and so although I had an interest I was really worried about how I would get back into the process particularly with the very rapid advances that were occurring so I ended up going through medicine I did a residency in the chief presidency and then practiced general medicine for three years out in the rural area of northern Maine and decided very quickly after that that I wanted to do research and I applied and got an endocrine fellowship in endocrinology so I could both practice endocrine and potentially set up a lab and I did that went through my fellowship did my research training came back to Maine to set up a lab and to to practice endocrinology and that's where the dynamic between practicing and doing research becomes very very tenuous and the early years were really pretty much what David said and Claudia to some extent as well is that we were trying to practice clinical medicine at the same time that we're trying to set up a research lab and trying to write grants and trying to publish papers primarily in clinical medicine with the outreach to back going back to basic and it really wasn't until I had a PhD student who who subsequently trained under me who then did a postdoctoral fellowship at the Jackson lab who encouraged me to come back to basic science at the Jackson lab and so my career actually was in reverse instead of starting off doing both basic and clinical I was doing clinical and I had to go back and learn relearn genetics and learn mouse genetics and mouse physiology and then come back to become a director of a basic laboratory my interest is in bone biology and we have a very active bone research laboratories funded by several NIH grants at Maine Medical Center I still do some translational medicine and I am I'm involved in clinical trials and I'm an editor at New England Journal of Medicine so I still have the capacity to do clinical medicine but my primary love is in the lab and our work is focused on the stem cell fate in the bone marrow of skeletal and fat cells the landscape has changed as David and Claudia said and it's changed dramatically and when people ask me about my career path I try to tell them that this is not the path that I would encourage people to take one to relearn molecular and cellular biology and genetics was a huge undertaking for me at the same time I was seeing our patients and nowadays there is a much better option and that is in the US is the MD-PhD program of which there are many now which there were virtually a handful when I started my training and so much so that I wasn't even aware that I could do an MD-PhD let alone know that they would pay for the whole seven years or eight years of doing the MD-PhD now we have a very strong MD-PhD program at most if not all the medical schools the funding is still there to support the individuals it's very competitive but it's a spectacular program so you start with two years of medical school and then you go into a lab and you spend four to five years in a lab to get your PhD and then you come back and finish your MD degree and it's a fantastic setup because it provides you with the tremendous opportunity to see what clinical medicine is to begin with and then go to the lab and then come back and ask the right questions and talk about the things that you now know are as a critical thinker is important and I think for us clinician scientists the concept is that you want you want bidirectionality you want to see patients and obviously seeing patients and then going to the lab and testing those what you see in the lab sounds great it doesn't happen very often but it's exciting when you see a mutation and you're able to identify you know where the mutation is and what the functional consequences are but that's pretty unusual on the other hand taking your laboratory skills and applying them in clinical medicine is actually very very exciting and I'll give you just one brief example we ran an NIH funded clinical trial of a peptide that was used to treat osteoporotic patients and we published it in the New England Journal 15 years ago and it was very exciting and it gets lots of citations and still and it was a big deal I was still writing my basic lab and doing some other work and it wasn't until about eight or nine years later that I started thinking about that clinical trial that I designed and it was the senior author of and said wait a minute you know there are some unanswered questions at the cellular level about what that what are findings suggested or supported so we went back to basic work in understanding the target cell for the anabolic peptide and the metabolism surrounding it and now we've exposed a whole new area with a lot more funding to look at the metabolism of the bone cell in the bone marrow niche and it directly came from the original clinical observation and trial then back to the basic lab to expose some of the areas that we weren't clear about mechanism and then back to the clinical world we now have a new clinical brand looking at analyzing biopsies from patients to see if the hypothesis testing that we've produced in our mouse lab really holds up in humans so so it's opened up a whole new avenue of research and I think that bi-directionality allows the clinician scientists something that is really unique versus just the phd or versus just an md so we now in the u.s besides having the md phd program we have a lot of NIH funding directed at making that translational capacity more inherent once training is complete so we have what's called the k-23 program funded by all the NIH institutes which allow mid-career clinicians to do more scientific investigations and 75 percent of their salary is committed to going to other labs and learning new new procedures but more importantly understanding some of the basic mechanisms and underlie what they're doing clinically so there is that k-mechanism and and on the other side for the basic scientists of course the translational capacity the ability to take what you see and relate that to clinical medicine now is inherent in anybody who gets funded from NIH there has to be a translational aspect of that and nobody is better at doing that than the individuals that have actually done it in the clinic so I frequently approached and said how can I make my you know spectacular science translatable and it's really the clinicians that can help you do it so so the clinician scientists really have a unique role in in in basic and clinical research so that's my experience and I think the opportunities are much greater now they've expanded dramatically in the United States we already have two questions we can get started so the first one is what will be your advice for those people who are not sure whether or not to pursue a research and medical career maybe we'll start with Dave and then the next couple weeks I think one one I mean certainly in the UK and I'm not quite sure how easy be interested in Clifford's experience in the US but a nice kind of taster of whether you're going to enjoy research it is in the UK was a thing called a an intercalated BSC it's like a one year that you put in the middle of the medical degree so nor the minimum time for medical degree in the UK would be two years of preclinical training which would be your basic kind of anatomy physiology biochemistry and then three years of much more clinically orientated work when you're seeing patients and you're on the wards I have to say there's more integration than there used to be but that that's the shorter duration is five years and then quite a few people in fact everyone in Oxford but probably in London it's less than that's more like 50 60 percent they put in a year in between the first two and the last three years and the idea of that is that's a much more research orientated year so they go into depth in one subject it might be neuroscience it might be cardiovascular medicine it might be cancer and the standard part of that will be that there will obviously be standard lectures but then there will also be some time in a research lab and I think to be honest that kind of thing is extremely helpful because you can get a feel for do I actually like the process of doing science do I like the differences that science offices to medicine I actually think that I love the connectivity between research and medicine but actually they're quite in some ways they're quite different disciplines as to how you spend your day and you know you need to be much more comfortable with constant failure in science generally in medicine there's also someone more senior that pretty much always has the answer in science you'll often go to your supervisor and they kind of shrug your shoulders and say we'll do it another five times and when it starts working we'll talk again so so the process of doing science and medicine are quite difficult and I think it's good just to get a taster for some kind of doing a research project and get a feel do I like the process of doing this and then that's helpful because also it's a one-year commitment before you make what would be a much more major commitment of kind of doing a either a PhD for three years or potentially an MD which in the UK is a research degree to prevent any confusion so so Claudia when she was saying was referring to MD she's talking about the German equivalent of the UK MD which we spend two years doing doing research but generally in the UK people do a PhD if there is the higher degree and that's a three-year project and of course that's much more of a commitment so my answer would be if you want to get a feel as to whether you enjoy it you try and get some experience in a lab and an area that you enjoy it doesn't even it doesn't actually have to be a whole one-year research degree you could many medical schools will have programs and they exist here where in in kind of in the first two years you get quite long summer holidays and you can come and work in a lab for a month or two months and I get people writing to me saying uh David I just want to get experience what it's like in a lab and we pretty much always have one or two medical students that will come to us for four to six weeks and just get a feel for did I did it they like the process of research and that's what I would recommend I don't know what Clifford feels I'll be interested to hear what happens in the in the USA yeah so uh I think it reflects the same thing David actually so we uh we get summer students we have summer uh intern program and a full year intern program where people in undergraduate programs can come and spend a couple hours a day three or four days a week getting a taste of what it's like to be in an active research lab and then we have a very competitive summer program where they spend four months during the summer primarily medical students but also some undergraduates and they they spend they take a tour of our institute they select the lab and then they're and then they're chosen based on their academic record and their interest so one of the uh confounders that we find is that there's a level of anxiety among the physician students or uh undergraduates in terms of getting in the lab and and so the early experience of letting them just get a feel for what it's like and the fact that it's not such a foreign environment there's collegiality people help out we ask good questions nobody's intimidated you start with a very small project that might be just reading slides for example from a biopsy or doing something else that really doesn't require some of the skill sets that we use among our senior people and that helps people get a feel for it and also understand that the black box when you're in clinical medicine you say gee research it's so hard there's so many techniques it's so difficult that gets broken down and we try very hard to do that to allow people some comfort level so that they have a feeling for this one great thing about being a physician is there's tremendous opportunities to do many different things you can do almost anything you can teach you can be an administrator you can be a researcher and um and each of them require skill sets even be an administrator you really need to have a specific skill set although sometimes people don't think that uh to be a researcher you clearly have to have a skill set not just in the lab but the other thing we found is being able to write is extremely important in fact I just tell all my postdocs and grad students if you can't write and if you try this probably isn't where you want to be because writing is essential for not just for funding but for organizing your ideas and getting everything together and so what we teach in in our lab among the young people is can you write if you can't we can help you uh and learning how to write becomes a huge step in the whole process so so I think it's uh I think what David said it is it a year six months three months exposure is really critical one interesting facet in the states is it's very competitive to get into medical school so we get a lot of people who don't get into medical school the first attempt and then they come and they want to do a year in the lab and it's really interesting to see their growth and development because they now are one more mature two they've developed some critical thinking skills that they might not have developed in undergraduate and three they're much more likely to get into medical school after one or two years in a laboratory and that and to me the critical thinking in a laboratory is what makes for a better clinician so in some ways it probably should be mandated that everybody spends a year in the lab before they go to medical school yes yeah thank you very much for those answers I think we have two more questions so let's continue so one is can doing both medical practice and research be detrimental for your career would you like to sorry doing medical practice and research at the same time can that be detrimental for your career can it be bad because you get you don't get on the top of it too career I'll start and let David think about it first for a minute okay because I think it's actually a very insightful question I think you know in my experience as I was growing my lab and shrinking my clinical responsibilities there was some concern I had that I was losing my enthusiasm for clinic and gaining it for the lab and I think you have to appreciate that your experiences with patients require your full undivided attention and you really have to be able to be able to balance that with the lab you cannot and this happened to me and I began to realize that I had to confine my clinical practice to what I could do not what I think I could do and and that meant that I had a limit the patient exposure a bit while my lab was expanding and and I think it's really important to understand what your capabilities are because if you're seeing patients and you're and you're trying to build your lab or you've got a busy competitive lab you don't want to be in a situation where you're thinking when you're seeing patients that I should be in the lab or I should be doing this or I should be doing that I shouldn't be seeing patients and and so I think it's not detrimental and a lot of people do it and one of the things we just got this big 20 million dollar clinical grant to build infrastructure in northern New England and one of the emphasis was how to get more people engaged in research clinicians and so what we found is clinicians who have been in practice really want to see if they can do research but they don't have the tools they don't have the infrastructure they don't have the equipment necessary and our grant is actually designed to try to help them see if they can transition at least part-time or just you know as part of their practice into addressing clinical research questions and so I think those kind of opportunities exist and I think you can do it but it requires a fine balance and I can tell you I think it takes time to develop that balance but I'm interested to hear what David has to say yeah I think it's a really good question and I mean I've kind of discussed this quite a lot with people in the past and I'm kind of someone put it quite nicely to me which is that what you should see yourself as a clinical academic is an expert in combining clinical work and science and you maybe shouldn't set the expectation that you're going to be as good a clinician that's doing clinician clinical work 100% at the time and you're not going to be as good at basic science as someone that's doing basic science 100% at the time but where your kind of added value is is that you're actually bringing those two things together and that's a specialty in something to be applauded in its own right and I think you need to kind of set your expectations at that level I think also again going back to Clifford's point about expectations is I think there are ways you can manage this that are helpful and I think undoubtedly one thing that I've tried to do and I think is useful is to make sure that your your clinical work and your research are aligned because if they're aligned then actually the two do feed off each other you see the benefits of that your patients see the benefits of that your research benefits from that everything is in a kind of positive relationship so kind of my interest is is neurology and peripheral neuropathy and most of my clinical work is now focused on peripheral neuropathy and pain which is highly aligned with my research work I don't think I just know that although I'm a safe at general neurology I am not as good at general neurology as my colleagues that spend 100% of their time seeing patients and doing general neurology that I can't set myself that expectation so and you know surgeons have this is particularly true I think is a challenge for some surgical trainees in particular is is the kind of hand-eye coordination the skills that you need in surgery is getting enough time during doing surgery at the same time as doing the science and again I think it's about expectations and probably working in areas where the two are aligned and not trying to do everything I don't think we can do everything and I don't think it necessarily needs to be detrimental to our career in any ways and as I said I think you can say is we're offering one very specific thing which is combining these two things that that's my view on the issue yeah yeah you know I think David's right Marguerite I just want to add I think we have a tendency as physicians to think we can do everything and I think that really is something that you have to grow and mature and realize that it's not possible and I agree I think being both the great basic scientist and a basic great clinician very very very difficult and not part of our it should not be part of our expectations but then in the research career at least we have to be the best to get the grants so I mean yeah be one of the best I mean our added value is that we can we will see opportunities coming from clinical work and translation that other people don't see I mean I purposefully I'm I you know the areas that I work on are areas that I can see the connection with clinical very clearly and and that's my that's my added value really it is that I I'm not going to go into a research area where I know there's a huge number of people that are purely doing pre-clinical science and try and take them on at their own game I mean I don't mean to set this up as a competition but I mean that I think what I try and research on is where I feel I have an advantage in that it's kind of pre-clinical but it's definitely got a clinical translational element and I can see opportunities and for instance I'm getting insight from human genetics and I'm getting those results before many other people and then I can start making the knockout mouse but mouse or the knocking mouse before anyone else so so you know I I'm working trying to work on that area and I think you can do excellent I don't think the quality of my work suffers but I'm quite careful about what I work on that it's it's areas where I'm going to really have that advantage because it's highly translational. We have a couple more questions so we better keep on answering so the next one is have you work on translational research projects if so what's the mixed background of any help I think we have talked about that already but maybe Claudia would like to say something if she's back. Yes great question and I heard David already giving a very good answer to this and I can only agree the patients have led me to questions so if you see a patient with a rare disease which is within your area of research and you just want to find out how this disease works what's the mechanism behind it and that also makes you so motivated to go into detail and maybe set up a lab model and so on and this is translational and I think we are optimally suited for this well yes sometimes we need help um as the other said there may be some techniques that a few basic scientists is better but we can do collaborations we can go into good collaborations with them because they need our clinical questions so I think we're very well set up to do this translation in research. Thank you. We move to the next one. The point that's come up is collaboration is fantastically helpful I mean if you're in an environment where both on a clinical level but also on preclinical science and you have excellent colleagues which you can have a fantastic symbiotic relationship between you that's beneficial to everyone and not necessarily try you know we don't need to try and do everything in-house if you have good collaborations you're so much more than if you're just trying to do everything yourself so I completely agree collaboration is super helpful. Yeah I would like to add that collaborations are really essential and I should mention that translational science or translational medicine is in the eye of the beholder and they can range from virtually anything to everything and we're just doing this new concept of reverse translation where the group at Dartmouth has come up with regional utilization of drugs or looking at different treatment efficiencies and in my case it's osteoporosis but they came up with these drug combinations that increase their risk of fracture that's about the highest level of translation it's right at the level of the economy of what we're spending our money on but then they're asking us to go back and test in the mouse what those combinations do to the mouse so that we can get some basic mechanistic answers to why a combination of let's say opioids and proton pump inhibitors have such a profound effect so so translation is really everything that you're doing and bringing it back back to the patient ultimately so. We have another question and this is for Claudia Sommer so Professor Sommer do you think it is it is justified that that doctor met is seen as an equivalent to a phc I know some people do several years of research for their doctor met but as far as I know most medical students are graduates do much less two months for a year. Very good question and I don't think it is justified for every German doctor met from the past because there were some really easy way of getting it like looking at the last 100 appendectomies in your hospital and listing up the complications and doing some statistics and this was the thesis things like that I'm not saying this is not useful to anybody I'm not saying this should not be done but maybe it's a smaller research project and not a doctoral thesis okay but as in the whole field there has been a lot of development and the rules are becoming stricter which is good the ambitions are becoming higher and we are in the process of moving to the structured doctoral programs also for the German MD which means not only one supervisor one student and they do something in the cabinet but a thesis committee a structured plan structured teaching and I think that in the next years more of these thesis will be a PhD equivalent that there are now there are already some quite a lot who are now I mean somebody who works for three years in a lab like in ours but also in many others and then has two or three publications as an MD why is this not a PhD equivalent but I agree not everybody is like this at the moment they are reaching for it they're aiming for it yeah thank you Claudia and there's another question this is to Professor Bennett do you think that someone who graduated at medical school did f1 and then went for an msc php six year in total will be looked upon favor favorably when it comes to specialty training post or would you at the time out of clinical practice will be seen as a disadvantage yeah I mean that's an interesting question I certainly think so there is some advantage in it depends where you want to get to in life I guess so there is some advantage in having done research when it comes to appointments of training numbers into specialty training I certainly wouldn't think that that is the reason to do a PhD and actually if you were to look at the point scoring system the kind of the extra points you get for doing a PhD they're not much more than having done a kind of a local audit so it's not going to massively increase your chances if you were to apply for kind of clearly the reason to do it is if you want to go on an academic track and ultimately combine clinical work with research that that would be kind of what I think would be a good reason to do that combined msc and phd I'm a bit confused because did it say I mean normally a combined msc phd scheme would be a four-year program not six I'm a bit confused does it say six margarita it says six it says f1 and then msc and phd six years in total oh yeah okay so that's taking into the basic clinical training as well so it's not going to do you any harm in terms of when it comes to appointments especially training it will be of some benefit I don't think it's the level of benefit that it's the reason to do it I don't think it's going to count against you certainly having done that and I think people are not going to say oh this person's done a phd and and therefore they they you know they haven't had enough patient contact in the in the last few years personally probably I would say on balance I would probably do the I think there's a slight balance in terms of getting into the special training and then taking time out to do research because you have a training number and then you can find kind of good research left within your training region I think there are some advantages there but I think if you had for instance a great chance to do a really good phd before then I think you could do that without any problem and you could still get good training after that time so I guess I've kind of fudged my answer there partly because I think it really depends or there is no right or wrong answer to that I think it really depends on personal circumstances and if you're unsure I'd suggest that you kind of speak to people in your training programs locally because they might give you a bit more helpful advice on that thank you very um there's another question that says uh it's general so I mean it's a bit can we do an intercalated bsc at the end of the medical school instead of doing it in the middle of the medical school I don't know if the question is that might be to me that all depends on your medical school so I think you there is no there is no kind of UK wide policy on that most medical schools their chance of an intercalated bsc is between that first two and the last three years but I know there are other medical schools that have made exceptions to that so the answer to that is you really need to check with your local medical school what their their policy is some of them will have some flexibility on that others are less flexible in the US they're very less flexible I mean it's a pretty structured system and the reason is is because they invest very heavily they're all funded by NIH money and their structure is such that they don't they will not allow you to to do any flexibility I think you have answer is there any other question in the audience or between the speakers because you have time for a last question I think maybe I have a it's not a question but um I think one problem that you have when you are doing your medical training and then you go into your specialty training and if you take time off to do research all the other way around if you are doing research and you go back into your specialty training then you'll have at least three or four years of specialty training where you're not going to be able to be doing much research and then there's a problem because then when you went to apply for new grants um you won't have you won't get into the grants because you won't have much publications in the last three years so there's always that difficulty between trying to balance the two of them and being able to publish so you're you can get the grants and you can get your career ongoing but also trying to do your specialty training at the same time and trying to get time to do it because it takes time to learn and to practice and to get all the experience so I don't know In the UK that's improved because now there there are a kind of special posts which are designed to coordinate both training in clinical and training in research and and you you have to apply for those posts and so for instance in this department we have a number of what's called lectureship posts and that enables exactly that that you will get certain blocks usually three month blocks of research within the year and then the rest of your time will be spent doing clinical training you have to accept the fact that overall the training is going to be extended a bit I think that's just an excellent idea to keep the kind of research live it gives you enough time to kind of write up some writes on those grants to write up some of those papers so I think that those are the best kind of talks to apply for if you want to combine the two because it makes it much easier sorry Clifford I interrupted you over to you yeah so in the US generally the fellowships are designed so that the first two years of the fellowship are clinically oriented and then the last several years are research based and often what you'll have is a fellow who it gets into the lab and enjoys it and writes a training grant or or at least gets put on a training grant and he's or she is allowed to stay on for multiple time periods as the funding permits so that that research builds up in the publications build up and then they're able to submit independent in grants and that's the last question so I think it's time to wrap up and well first of all thank you everyone for being here and for the conversation I think it was very interesting and I think just a few things that are important and have been improved in the last years is that in many countries there are now programs that allowed clinical training at the same time as a research or scientific training so I think that's that's very useful also I think it's important what you say about setting up collaboration so we cannot do everything so we cannot be the best in the lab the best in the in the clinic so it's good to have people that can help us in the lab or can help us in the clinic so have a good color colorations and I think the other thing is that there's no answer to when is the right time to do a PhD or when is the right time to your specialty training it depends on what things have and the options that are available available at that time anything else you'd like to add or Margarita if we can jump in that we have a few more questions that have just come in so if I can just read them out and maybe help out so we had a question about doing a path of a residency followed by three years at NIH and then starting it up is that path we're gone somebody's asked so I I think you can do a fellowship at NIH and then that is a very common path towards independent investigation residency programs at NIH I'm not as familiar with but certainly the fellowship programs are a great way to launch into a research career and they too are designed to do some clinical but basically to be in the lab and to to extend your time for your projects right um I'm not remodeling that if you can see the questions now um the other ones but um okay so sorry I read the next question then I don't think we have time to answer all of them because they just come up all together uh but there's a question um asking what are the challenges and benefits to doing basic science research while also specializing in a procedural uh heavy fields like gastroenterology or uh of aesthetics and gynecology urology etc who would like to answer that question I think partly there might be some basic science issues that are going to facilitate those it may still be procedure based but actually for instance there's some very important engineering that goes into that so so I mean I think it goes back to what we were saying earlier trying to get a congruence between the research you're doing and and the clinical field I think the training can be a bit more challenging because of this time if it's important that you get enough surgical time uh but certainly um in my department I'm collaborating with surgeons at the moment um in fact some of those surgeons are doing very interesting genome-wide studies on populations of 500 000 and getting some very interesting outcomes that have translational potential so you can absolutely do it and there are examples of that um and you know again they're asking interesting questions that are inspired by their work with with patients so I definitely see there are advantages I don't know if Claudia or Clifford have something to add to that no not really the same answer just pick your research carefully so that it fits what you're doing clinically and I I would agree but I think that it does offer an advantage on the in the long run if you're doing some research at the same time you're practicing clinical medicine the enjoyment factor goes way way up I think we've seen too many docs who only do practice who get bored or tedious or if this becomes more job-like rather than the enjoyment of helping patients and also addressing an answer and critical questions so so I think you have a leg up on some people if you're able to be able to both do some research and also practice clinical medicine actually I would like to echo that I really love my job I love combining yeah we talked about some of the things today but you know I would like to say I think it's I am never bored I do not ever have a book in there so I can recommend it as a as a career I tremendously enjoyed it yeah I think that's a closing remark isn't it yeah I think we don't have enough time for the last question but we can answer it by Twitter or one of those online things so just wanted to say thank you so to all the speakers thank you to Eli for allowing us to have this webinar and thank you for the audience for being listening to us and making all these interesting questions thank you thank you my great thank you by the way