Author: Rick Body / Editor: Charlotte Kennedy, Govind Oliver / Codes: CC20, CC24, HAP29 Published: 06/12/2018
I’m Rick Body – a dad, a husband, a terrible and ageing Sunday league footballer, an even worse church organist, a doctor, an emergency physician, and – although I still don’t quite believe how – a Professor of Emergency Medicine (EM) with a tenured chair at the University of Manchester. This is the story of my personal journey in clinical academia. I hope that you might find it useful, that it might encourage you in your own personal journey, and (who knows) that it might even play a small part in inspiring someone out there to follow in my footsteps and join me in this brilliant career.
The early years: me as a medical student and houseman
As a medical student I loved my 12-week research placement, creating a genetic mutation and splicing it into bacterial DNA in the hope that one day it might become a gene therapy for multi-drug resistant tumour cells. I got quite far creating E. coliwith mutant DNA. Unfortunately however, I never did manage to cure cancer. I was quite happy returning to work after summer to focus solely on clinical medicine as I started my elective in the Bahamas. Ah, the days.
You see, much as I’d loved my research experience, for me medicine was about the patients. I didn’t want to spend my days in some stuffy lab handling pipettes all day long. I could appreciate the importance of research, but I wanted to be applying it in practice. I had no intention of going back to the lab. The fast pace, unpredictability and fulfilment of working in the Emergency Department (ED) were what it was all about for me. In fact, I wanted to work for a helicopter emergency medical service.
During my senior house officer years, however, I kept having questions. I couldn’t answer them by looking at textbooks or asking experts. In fact, it turned out that my first consultant supervisor in EM and the consultant cardiologist that I later worked for totally disagreed about where we should measure ST elevation on an ECG when diagnosing ST-elevation myocardial infarction. Who was right? Nobody knew. I searched the literature and it turns out there was no consensus at all. So I designed a clinical study to find out. I used my own time, I had no real academic supervision, and I simply did it because I wanted to know the answer to my question.
The surprise PhD: taking opportunities
I’d got as far as getting ethical approval and starting to set up when I met Professor Kevin Mackway-Jones for the first time. I’d applied for a locum appointment for training (LAT) post – a fixed term registrar job accredited for training, which would really be my ticket to being a consultant within 4 years. I was the only applicant. Kevin looked at my CV. He saw that I’d written several Best BETs and he saw my clinical study, which was in set-up. He told me that I should really do a PhD. I laughed.
A PhD was the last thing on my mind when I had my ticket to consultancy almost on a plate. I said no thanks, and I left. But on the long drive to Lancaster (where the new job would be) I thought about his words. I thought about the questions I had, and how fulfilling it would be to be able to answer them – not just for me but for everyone, for years to come. And I decided to pull out from my interview.
A few months later, Kevin advertised an opportunity to work as a Clinical Research Fellow and complete a PhD in Manchester. I applied and got the post. For my PhD I derived a clinical decision rule for acute coronary syndrome, which was the start of T-MACS. I immersed myself in the research so much that stopping my research was never in question. I totally loved it, and I still do.
Postdoctoral life: the impact of my PhD
There aren’t many jobs where what you think up has the potential to change the healthcare that we provide to millions of people and to affect their lives in so many great ways. After my PhD I continued to analyse stored blood samples for new biomarkers, including the first “high sensitivity troponin” assays as soon as they became available. That research went on to change practice. The ‘limit of detection strategy’, which we first wrote about in 2011, is advocated for use by the National Institute for Health and Care Excellence (NICE) and the European Society of Cardiology, as is the 1-hour rule out strategy. T-MACS is used across Greater Manchester.
I then had a choice about whether to get to a consultant job quickly, or whether to do an NIHR clinical lectureship. After more careful thought, I chose the latter – and again, it turns out that I got that decision totally right. The clinical lectureships are terrific. They really help you to develop into an independent researcher. I ran a clinical study at a district general hospital, prospectively recruiting 477 patients in 4 months (with written consent, full clinical details, blood samples and 30-day follow up). Just like my PhD had been, it was a labour of love. When you want something enough, you’ll put the effort in – and I really wanted my research to make a difference.
During that lectureship, I also had the chance to complete the NIHR leadership programme. Honestly, that was pivotal in my development as a person. I started to grow from a simple, nave, idealistic researcher to a strategic thinker who could appreciate the importance of not just pursuing my dreams, but of bringing others along with me, while also guiding them as they follow their own dreams. I’d really recommend leadership training like that to everyone considering a career in clinical academia.
Research as a Consultant: building a research team
From there, I had an opportunity to take a consultant job at Manchester Royal Infirmary – a university teaching hospital and to lead the research team. It was almost full-time clinical (I negotiated two research PAs from the Local Clinical Research Network (LCRN) after an immense effort) and my main task after starting was to build a research team. I co-founded the Emergency Medicine and Intensive Care Research Group at the hospital, and we grew the team from nothing to four research nurses and a trial co-ordinator. The team recruited to the National Institute for Health Research (NIHR) portfolio studies brilliantly. We quickly gained a reputation that won regional and national awards. That work was really important for me – in order to succeed long term, I knew that I couldn’t continue running research that was dependent on me recruiting patients at 2am then returning at 9am to recruit more. We needed to build research capacity and a means of recruiting that didn’t depend on me – and we managed it, thanks to the NIHR Clinical Research Network.
In my first year as a consultant, I also applied for an NIHR Postdoctoral Research Fellowship (now called an NIHR Advanced Fellowship since the fellowships scheme was simplified). After a huge amount of work, seeking advice from the world and its dog (including some really key people like Steve Goodacre), and after more than 6 months of preparation, I was successful. That funded 60% of my time to do research for 5 years, as well as funding my first project. Again, this was crucial. Having the time to do research is so important. I couldn’t have achieved a fraction of what I have without it.
Over those years I started to attract grants – from industry, from the Royal College of Emergency Medicine (RCEM) and from the European Union Horizon 2020 scheme. I worked on my ability to effectively disseminate research, harnessing the power of social media. I co-founded the St Emlyn’s blog and podcast with Simon Carley (a constant source of inspiration to me) and we quickly managed to reach large audiences with our outputs. This helped me to build a reputation as a researcher and as someone who can disseminate research in an appealing way.
The hard work pays off (but doesn’t stop): life as a clinical academic
I started to get invitations to speak at conferences, and year on year the number of invitations has increased ever since. I worked really hard on finding new and better ways to communicate research findings effectively, trying to appeal to general emergency physicians as well as those interested in research. I think the hard work paid off. As well as providing free educational material for others, I did seem to build my reputation, and that has definitely helped me as an individual.
The other thing I began to develop was my interest in research leadership. I became the local specialty group lead for the LCRN, I took on responsibility for regional academic teaching with the registrars, I joined the European Society for Emergency Medicine (EuSEM) Research Committee, the RCEM Research & Publications Committee and started reviewing for around 25 journals.
If you do a good job with one thing, you tend to get invited to do more. I was invited to become an Associate Editor of the Emergency Medicine Journal (EMJ) – probably on the back of my reviews – and I was later promoted to Deputy Editor. I was selected to become Scientific Chair for EUSEM, which has been an honour and a privilege since 2014, and I was appointed as a Professor of the RCEM in 2015. More recently, I was offered the tenured Chair in Emergency Medicine at the University of Manchester and was appointed as Director of the Diagnostics and Technology Accelerator (DiTA) in Manchester, which will work with industry to generate evidence for new diagnostic tests and medical devices. I also recently won a successful bid for the NIHR Incubator in Emergency Care which is a great opportunity to improve the research capacity in our specialty.
Lessons learnt: what are the secrets to progressing in clinical academia?
As with everything, I think it’s all about your attitude, your principles and your work ethic. Of course to get on you need to start with some academic ability. But that’s only a small ingredient in the recipe for success. The rest is about your approach. Your willingness to work, to make sacrifices (although not for the most essential things – you should always make time for friends, family and hobbies), your persistence in turning up day after day – even when things aren’t going well for you, your ability to turn negatives into positives, your ability to shake off the failures, the setbacks, the downright embarrassments, and to get back on your feet and carry on until the next success comes your way.
Perhaps most importantly, it’s about having a vision of what you’re genuinely trying to achieve. If you’re trying to improve emergency care for millions of patients, to create opportunities for others to do the same and to build the community of people who are working towards that goal, what more motivation do you actually need? Nothing can beat a career in clinical academia. You can make of it anything you like.