Author: Anisa Jafar / Editor: Charlotte Kennedy / Codes: HAP29 & CC2O / Published: 28/08/2018
My Personal Journey into Disaster Medicine Research
I always think of my academic journey to date as some form of organised serendipity. I did not take the usual medical school path to academia, in so far as having no intercalated degree. Therefore in some ways I discovered the Academic Foundation Programme (AFP) by accident as it was not very well known about to those outside of the academic circle at the time, and I internet searched it mostly out of curiosity.
The Academic Foundation Programme explained
In the United Kingdom (UK) all new medical school graduates undergo two years of training designed to equip them with the generic skills and attitudes required to progress into speciality-based training. This is called the ‘Foundation Programme’ and junior doctors can expect to rotate through a variety of placements including medicine, surgery and community practise. The Academic Foundation Programme allows trainees to use part of this time to gain experience in academic medicine. Different foundation schools offer different programmes but in general there are 3 tracks available: research, medical education or leadership and management. The amount of academic time and how this is allocated vary, with some offering blocks of academic time and some integrated pathways.
My supervisor at the time, Dr Javier Vilar (I was in 4thyear of medical school doing a project option), agreed to be a reference for the AFP application. He was hugely encouraging although very humbly hesitant to be a reference as he said at the time “I’m only an Honorary Lecturer” and was concerned he wouldn’t strengthen my application. From my perspective he was a genuine reference who had worked with me on my most research-oriented piece of work to date, and had supported me in getting my first conference poster presentation. This was a wonderful lesson in taking opportunities even if they seem unlikely to succeed.
The importance of tenacity
I was surprised to be offered an AFP in North East Thames, which I’d mostly been attracted to because of its integrated public health post which seemed to marry with my emerging interest in global health. The research aspect of the job was not something I had many ideas or expectations of. As it happened, my AFP Emergency Medicine post was where I met Professor Tim Harris, who quickly became a mentor and remains a mentor and friend to this day. We developed his research idea around early warning scores in the emergency department (ED). I got my first taste of developing and managing a research study in the ED which was a challenge on many levels, not least that it was my first ever ED job! We produced two papers from the work, however that was where I learned another important lesson: the power of tenacity. These papers took many, many years to publish for lots reasons. Reviewers requested huge revisions time and again and we were sent in circles with statistics and paper structure. However, tenacity (or stubbornness) meant that I and my colleagues saw them through eventually.
Developing a research interest
By this time, my initial plans to do medical training had switched to emergency medicine, however I was unsure whether further research was for me. I’d enjoyed what I’d done but the style of research wasn’t necessarily one I’d want to continue. Since medical school I’d always planned to break my training to complete a Diploma in Tropical Medicine & Hygiene (DTM&H), with a view to spending some time working overseas in a less-resourced setting. Once again I had not really fully considered how the academic training pathway worked. Whilst in this post-AFP year I again had the itch to look at what would be next if I did want to continue any research. I came across the Academic Clinical Fellowship (ACF) programme, which I discovered existed for Emergency Medicine but only in a handful of centres across the UK at that time.
About the Academic Clinical Fellowship programme
Academic Clinical Fellowships (ACFs) were designed to offer protected academic time to doctors in England undergoing speciality training. They exist as part of a wider research career pathway offered by the National Institute for Health Research (NIHR), a diagram of which can be seen below. Successful ACF candidates are allocated 25% research time over 3 years of their training (or 4 years for academic General Practitioners) with a view to developing academic skills and beginning the application for doctoral fellowships.
One of the ACFs was in the North West (where my family are based). I contacted the lead at the time, Professor Fiona Lecky and enquired whether, if an applicant were to be successful, they would be able to choose global health oriented-research. She advised me that this could potentially work, and suggested I contact Professor Tony Redmond at the University of Manchester who would be an ideal supervisor in this case. As it happened, Professor Redmond was giving a DTM&H lecture that very week and so we arranged to meet beforehand. We discussed a few tentative ideas and he agreed in principle he’d supervise me if I was successful so I decided to apply. Fortunately, I was successful and so began my current journey of combining emergency medicine with global health-focussed research. Profs Lecky and Redmond co-supervised my ACF, based at the Humanitarian Response and Conflict Institute (HCRI). I completed my Masters in Public Health at this time and then started to consider “what next?”. The topic area I was building an interest around was documentation in sudden onset disasters and I had multiple ideas as to how I could take this forward into a PhD proposal.
Obtaining funding: try, try, try again
I filled in many funding applications for PhD fellowships, some of which deemed the subject too “medical” for their humanities funding, and others that deemed it too “humanities” for medical funding. I was successful in getting an interview for NIHR PhD funding however did not win it following the interview. I was given some really useful feedback from many of these applications and so I accepted that I would continue to keep my eye out for suitable opportunities but if none arose, I’d return to ED training after my upcoming maternity leave.
Around the time my son arrived, I found out that RCEM were offering matched PhD funding and so with some bleary-eyed form-filling, I applied and my wonderful parents accompanied me to the interview, 3-month old in tow. I was happily granted the part-funding with the condition that I needed to secure the rest. Some months afterward, after much emailing and searching, Prof Redmond got in touch with an opportunity to match the funding which had arisen following some collaborative work with the HCRI funded by the Hong Kong Jockey Club Charities Trust. The PhD I was to undertake would helpfully align timing-wise with the World Health Organisation emergency medical team initiative to standardise medical documentation.
The benefits of research
The past couple of years have afforded me enormous opportunities both professionally and personally. I am hugely fortunate to have a very supportive husband and family which has meant flexible child-care, allowing me to embrace multiple opportunities to learn from and work with international colleagues. The PhD itself combined with clinical work at the very supportive Royal Bolton Hospital, although quite a juggling act in organisation, has allowed me to work flexibly and spend time with my family.
As for the future, I feel very differently about research now than I did following my AFP, mainly because I have found a style and subject of research which combines theory and practice in a way which really suits my way of thinking and working. Similarly, I have dipped in and out of different research techniques to match the questions I’ve needed answers to. If I’d want any take home message from my short journey, it is never to write off research as something you aren’t interested in because it might be because you haven’t yet come across a style, an aspect of research or even a supervisor that suits your way thinking. So keep an open mind and if opportunities arise, take them and see what happens; you might surprise yourself