Academia in Surgery



Join us at 19:30pm on 21st June for our ‘Academia in Surgery’ webinar with Ms Stephanie Bollard. Sign up via the MedAll link

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Hi, everyone. Welcome to the Northern Ireland Foundation Trainees Surgical Society, sixth webinar in our webinar series. And my name's Callum Walsh. I'm a current F two and this year's teaching lead. Um And we're delighted to have Stephanie Bullard, um, register in plastic surgery and currently undertaking a phd and keen to talk about academia in surgery. Um Well, let Stephanie Bullard and go through her slides and explain um what she's doing. Um And then we'll have a not an option for a question answered at the end. Um If anyone has any questions, feel free to place them in the, in the chat through it and we can either answer the, answer them there and then at the end. Um, so thank you very much Stephanie for offering to speak to hand over to yourself. Um That's great. Thanks so much Kyle. Um It's really nice to get an opportunity to talk to some people who are kind of starting out. Um Kyle asked me to speak to you guys a little bit about um academic surgery and I suppose my own experience in it. So I'm just going to give you a brief of view of kind of how I've gotten to what I'm doing at the moment and the different schemes and things that will be available to you all as you go through your surgical training a little bit about my own research and then a little bit of advice, I suppose, for anyone who's looking at starting some projects or he wants to get involved in any research going for it forward. So surgery kind of covers a few different domains. I suppose we're clinicians. And most importantly, you want to be certain at the end of all of this, that's why you're here and to do that, you need to get through your higher surgical training, usually get a Subspecialty Fellowship and then you go on to get your consultant appointment. But the academic side of surgery or things that are kind of part of our job anyway, but can take up as bigger role or as little as you want. And that's things like being a teacher where you get involved in mentoring or actively teaching your trainees on the ward. Oh, then it's also being a researcher and that comes with doing different investigations trying to figure out better ways that we can prove patient care. It involves getting things like funding to fund your research and setting up collaborations with other disciplines. I suppose academic surgery itself is really a combination of all three of those things I supposed to tell you a little bit. Um, and um I graduated in 2010 from Galway. When I was there, I started doing some recent electives and went on to do my internship in UCD in Dublin where I start doing plastic surgery oncology into my memberships. And there was my basic surgical training that I started doing a master's in surgery. Really began to get a bit more heavy into the research before I started the higher surgical training plastic surgery in 2018. I suppose it's really importantly, along the way, it's a design mentor. So these are, you can see your current Helena Hennagan and Shirley Potter. I need to kind of, we can only see the first slide of your, of your powerpoint. I don't think it's moving on, the slides are moving on. Oh God. Okay. Right. We might, what do you think's best? Do you want? Can you share or I can, I can share the PDF? You just give me two seconds. Do you want to share? So annoying. Sorry guys. I think, I think I have it here, Carl, I'm uploading it now. Go for it. Okay. So what I was saying there was that each kind of stage along the way through my training from Galway to internship two basic surgical training. I was very lucky to have different mentors and I suppose what each one of them kind of said we're things like design your own training scheme, which you consider taking time out to phd, which isn't something that when I started was really open to me, um my higher surgical training and then that led me to where I started in 2020 where I became a full time phd student. Um in the scheme called I Cast, which is available to everybody in the foundation training scheme in northern Ireland and as well, a specialist registrar in plastic surgery um in the Royal College of Surgeons in Ireland. So kind of doing dual academic and clinical surgical training. So the ICAC program is designed to be this um integrated into your clinical training and it's open to basically any specialty. Um so not just surgery, but it's meant to run along in parallel that you start your surgical training and then take three years kind of out of full time where you're somewhat engaged in clinical practice. But your main focus there is that you are a phd student and you go ahead and do full time research where you really get to dedicate your time to it and understand, I suppose what full time research is and what you need to do to integrate that into your career as a consultant. Later, the idea is then once you're done that you come back into your full time surgical or clinical training, you do your fellowships and you get your consultant appointment, but always with a view to kind of have research as an element going forward. And the eye cap program itself is, it's very well structured. It is um an all Ireland program. So all six Irish universities, they view the program as kind of 6 to 7 years long. And in order to be eligible to get on the program, you have to be a higher specialist trainee, your specialist registrar. So on your final training program, but not yet achieved your CCS to your certificate of completion of clinical training. The advantages of it, I suppose it's pretty multidisciplinary. So this is the kind of intake up until 2019, it's expanded somewhat since you can see down here with plastic and reconstructive surgery. That is just me, just one. And that is still, sadly, the case. Um up until only this year, we've to surgeons and neurosurgeon in a general surgeon starting on the program in 2023. So they're up until then there hasn't actually been any surgical people have managed to um take advantage of this just yet. And this is kind of how it works. So like I said, you started your core skills and your first year in the program, you do 70% clinical and 30% academic in which you're kind of designing a phd project. Um working with different supervisors, seeing what sort of team you want to work within. And then for your next three years, you do 10% of the clinical commitment. So for me, that's kind of just looked like staying on call. So you're maintaining your surgical skills while doing your phd. And then you go back in again later on in your five and six to finish up both your phd and your clinical training. And where I am at the moment is currently in the middle of writing up my phd with the hope of submitting maybe next week and then back to full time work engine. So my research itself is on Melanoma and skin cancer. So that's one of the most common problems with plastic surgeons face, we'll treat about 1/1000 cases um in the Republic of Ireland a year. Um But our lifetime risk is increasing up to one in 60 it's currently the fourth most common malignancy in men and women and increasing. I suppose a lot of that is to do with the fact that we do get quite a high amount of UV exposure. And uh you know, up to date have had very little education on things like some protection factor in sun cream. Um I'm particularly interested in bio markers and new prognostic indicators to try and predict who's going to get melanoma that's likely to spread or progress. I always compared to breast cancer that, you know, you learn about all the different kind of subtypes and hormone receptor positivity, things that make a really big difference to patient with breast cancer. We're really lacking behind with that melanoma and things like the BRAF mutation was only discovered in 2002 and the eat things like N Ross and things like that really only come to the forefront in about 2015 or typing. And while we're beginning to develop targeted therapies, I think that's become very widespread yet. And that's what I'm really interested in. I suppose one of the big advantages getting to step out of full time clinical practices, you get to kind of do something a little bit left of field and if you have the time to work with different disciplines, you might be able to do something that interests you. Um So I'm working on something called Comparative oncology. And what we do with that is that we look at the similarities and differences between veterinary and human medicine. So cancer doesn't just affect us. It's one in something like 3 to 5 dogs will die because of cancer. Um They naturally get it with the same risk factors as us. And the advantage is that it's spontaneously occurring, they live in the same environment, they're really genetically similar and there may be incompetent, I suppose as well. You know, we say that one dog's years, 12 years and up to 13 years in the humans life, they have compressed progression times. So while it might take up to 3 to 5 years for a super aggression and melanoma and a human, you can see that in 12 months in a dog. So if you to research at the beginning where you're looking at spontaneous disease and natural occurrences. So you're not giving any animals any cancer and you start studying both animals and humans at the outset, the likelihood is you're going to develop treatments and markers and biomarkers that benefit both the humans and the animals. And that's what my phd has been in for the last three years. And it's been pretty interesting. Well, I think, anyway, um, so here you can see a human melanoma and then a poor dog has gotten a melanoma on his cheek as well and they're treated much the same with surgery in some amounts of chemotherapy as well. With immunotherapy is beginning to come online for dogs and cats affected with cancer too. So the my environment, as I said has been quite nice and that I've been able to stay working clinically in the matter hospital with a supervisor, Dr Shirley Potter. So she's a consultant plastic surgeon. But I've also been lucky enough to go work in the university in a place called the call my Institute under the supervision of Professor Amanda mccann, but also working with a veterinary supervisor. So, one of my main supervisor advisor, my research is Dr Pamela Kelly and she is a veterinary pathologist in the UCD Veterinary Hospital. And I suppose how does that all look when you're combining it into a week as a clinician academic? I don't know if the slide is going to work, but it means that you get to have the best of kind of both worlds. And you really get to enjoy working in clinical practice operating while also combining with research. So what this basically shows you is what my Monday starts with is lecturing students um mostly on zoom at the start of the pandemic to going into the lab, working with the pets and cells to writing the papers in the evening. So then on the Tuesday going into the hospital doing operations like a free flap being on call, attending MG TS. Uh going back then to the lab again where you're working on scientific experiments and then back into the clinic. And usually what I found throughout my week when I had all of these different things going on was that my research really fed into my clinical practice. So I was recruiting patient's to clinic to my research studies that I'm seeing in the clinic and similar things I was learning about in reading while doing my phd was helping with my treatment of patient's on a day to day basis. So as I said, the guy cap program that's open to you, what it entails is a funded spr salary for four years and phd feel fees that completely entitle you to go and do your phd on your own time. Um It means it buys you out of your clinical commitments and you're not really under that same pressure that you would be to provide the clinical service that you are when you're training, normally you get monthly study days where you meet up with all the different fellows from all around the country. You also get to stay on going with your clinical development. So you stay operating, you don't lose any clinical skills. I don't know if the slides going to work. Um importantly, you get to have structured academic mentorship as well. So the ICHAT scheme is made up with the border directors with professors from each university or pretty prominent finical academics. And when you enter the scheme, you get paired with one of them who not only helps you in developing phd proposals and kind of planning projects, but also helps you kind of decide how you can incorporate your research in your career going forward and how it helps you start thinking about how you can shape that and begin to think about grants and things you can be applying for so that when you do return to full time clinical practice, you're able to continue research at a high level. And that kind of mentorship is very, it's invaluable really um in maintaining an academic surgery career. The I can't program also, should you get involved that later on gives you a lot of opportunities for international cooperation and they also fund you to go abroad to lots of different places. So unfortunately, I got impacted by COVID. So my first two years, I was very much stuck in, not stuck, but I was staying in Dublin, whereas a lot of my colleagues have had the opportunities to go to places like Stanford, the Karolinska Institute, Harvard Peter Mac in Australia. Um And you can imagine that not only is that great for research and a phd in any project you might do this really opens doors for you later clinically as well. If these are the type of places that you're building up relationships with that you can do fellowships later, it also allows you to build up a pure network. So what you can see here is this is us in 2019. So there was only about 20 something of us at that stage. It's much bigger program now with 50 fellows, but you're meeting up with people regularly in different specialties and it means that you're getting involved in other people's projects. So you get lots of publications that you might help out one of your colleagues on a smaller smaller project or something that you know, something about, about your able to contribute. Um And overall the hope of the ICAC program is that we'll have disappear network that's going to help us as a as an island to develop nationwide research projects going forward. And that will be able to kind of do bigger better research that we're trying to do individually currently. So now what I suppose where I'm at now and finish my clinical academic training, my plan will be to go and do myself specialty fellowship, um probably in something like hand or breast surgery and then eventually hopefully get my consultancy where I will be trying to get a research post where you have some of your time brought out to continue research and work. But I suppose what does, how is it relevant to you guys in academic surgery and why I would recommend it to you is we have chemical exposure and as an academic surgeon, you're gonna be treating patients' and you're the only person who's going to really know what problems those patient's are facing. So it's only through seeing them and talking to them, the clinic that you start to get ideas about what you can really do to help them where we need to improve. And then I suppose the next thing to add to that is that as a surgeon, you are also the person who has access to it, specimens and tissue. So a lot of my work has been working on Melanoma, Melanoma samples, some of which that I've exercised from patient's myself. Um and being that interface between kind of for me, the lab and the operating theater has been a really, really big help. And I think one thing that I can really say is that your academic surgical aside, your clinical practice and your research really support each other going forward. The I'm sorry now. So I suppose the impact that you're gonna have, I suppose why would you get involved in it, you get a background and translational research, I suppose we always get told that that's important for learning how to interpret evidence and learning how to know what best to give our patient's. But I suppose helping your career, it's also giving you if you take the time out to do full time digital qualification. And like I said, you get that dedicated academic training and access to collaborative networks. It's also really nice that you get to contribute to the knowledge base of the patient that you're helping and you do get a bit of variety. I suppose something I've only really began to appreciate within the last year, some things have opened up is the travel opportunities. And so far this year, research presentations are taking, may have taken me to Japan the UK and then Texas coming up in October. So there's a lot of different things that you can benefit from it. So the next thing there's one question I can see here is about what are some good ways for medical students to get involved um that can benefit specialty applications in the future. So I suppose this would be one thing I'd say about choosing projects. It's really important that you pick an area that you're interested in. So it doesn't, it's very hard to stay motivated, doing any kind of project or research. If it's something that you don't like yourself, sometimes an opportunity will come up that it's a good project. It's likely to give you good outputs and it might not be your first love, but it might be a really good opportunity to learn. But generally you'll find it easier if you, it's something that you're interested in yourself. But that leads into the fact that you shouldn't take off any projects unless it's something with a good research question. So, unless there's a really well defined research question in which you can say you're going to look at how one thing impacts another or the impact of something on a certain group of patient's or you have a definite kind of study plan. I wouldn't recommend getting involved until you've really iron that stuff out. And it's okay if someone says to you, do you want to do some research that you say okay, let's look at this and do literature reviews and see, is it relevant before you commit to undertaking work? Because what I always say to anyone who asked me about picking projects is there's nothing more dangerous than someone who says, let's look at this and you get a lot of people and a lot of offers to say, let's look back at this retrospective series of all the appendix as we've done in the last year. Unless you go collecting data and looking at charts and records without definite plans and questions, it's a very easy. Well, do you think a lot of time into projects that aren't going to give you definite outputs um and presentations and publications that can benefit your specialty up locations. So I think the one thing I would say is that when you start asking around looking for projects, don't be afraid to say, you know, that you want to ask a bit more questions, do a bit more literally, if you find out a bit more about what it would entail before you embark on it and just get started. The other thing I would say is that, you know, it's important to be the right place, the right time with the right people. And so, for example, in my project, at the moment, I'm working Comparative Oncology and I'm working in the only place that has a medical school and the veterinary school on the same campus um in the Republic of Ireland, there would be no use for me to try and achieve that project if the two schools were on the opposite side of the country and I was never going to be having the same people in one room. And similarly, there's things that your center that you work in might be really, really good at have loads of records and loads of data on. It's very important that you try and position yourself to make the best of the environment that you're in and you use the people and the data and the, I suppose the expertise that you have around you and try not to take on projects this, you're not going to be able to compete or answered relevant research questions if there's other people are doing them on thousands of patient's and you only have 10. So I think that's a very important thing to consider. And when you're starting projects, don't be afraid to iron out those kind of find details, ask questions about. Well, can I expect a publication from this? Where do we think we can publish this if we present this? Am I going to be presenting it or is the senior? Right? She's asked me to get involved, actually going to put their name first on everything. It's very important that you kind of get an idea about what sort of outputs in return that you're going to get on any research before you think a lot of your time? Because what you will find dispose if your foundation years before you know it, you're going to be applying for specialty schemes and you really want to kind of get into things that are going to give you good return on your investment quite quickly so they can help you with those applications. So I suppose the next thing I would say is what to do now. So I normally give this talk to kind of undergraduate students and I say focus on undergraduate studies, but that's exceptionally relevant as well. If you're currently doing things like membership exams, those kind of things, if you're thinking about this for specialty advancement are really important and going to probably be more important than I suppose whether or not you manage to get presentations or papers, go talk to your senior colleagues, talk to people who you like what they're doing, talk to uh consultants, talk to senior registrars. You'll find that most of us have to have, whether or not you're doing full time research have to have things like projects and audits on the go who they'll be more than happy to get people involved in. Um That still comes with the caveat, like I said, of making sure you iron out what your role is, what sort of return you can expect on your investment? Is it a good research question? Is something worth looking into or has this already been really tease out the literature? But you're not going to really get their into those kind of nitty gritty is until you start those conversations and the best way to do that is get involved. And honestly, one of the best places to ask is in theater in between cases. Is there something going on? How can I stay in touch? Is there anything I can help with? I always try to think as well as smaller achievable projects, particularly this stage in your career. You're not going to be able to give the dedicated time to go through 1000 charts without giving up every some of the even like evening, night and weekend that you have. So it's really important to define them. Well, before you start and see, is it achievable within a short, um, a short space? And then I suppose I always advise people to kind of keep, think about the role that you want to have at the end. Um Keep that in mind for you and research isn't for everybody. Um Research might just be for you. What you need to get onto your higher, special to like higher specialty scheme, it might be what you need to get a consultant appointment later on. That's fine. And in that case, you're going to probably be focusing on those kind of smaller projects that give you easy deliverables because we all need to somewhat engage with the practice. But if you're somebody who wants to be doing kind of research for 50% in your job, be leading research groups, maybe be a prof of some description. There are the kind of things in which you do need to be considering. Should you be taking full time out for research? How can you be getting money to fund the sort of research you want to do? Who's going to pay you to do that research if you're not operating and all that kind of stuff, and it's worth kind of figuring that out as in what you want it to be. Is it something that you just want to be kind of comfortable interpreting evidence, reading papers and qualified enough to get jobs or is it, something that you want to take on as a, more of a full on career in academic surgery because there's a wide range of things open to. And then I don't say, kind of keep eyes open for future opportunities. I've obviously done quite a good bit of speaking about ichat and how great opportunity I feel that is, but it's not the only program that's there if you want to have a look at it. Um There's Icat program dot org, but even, I don't know if many of you're on Twitter and things like that, you'll often see opportunities come up for funding and projects and things like that, that you can get involved in. And what I often say is that there's not, there's always another way to do it. So if you set your heart on doing one particular scheme or one particular, you know, research program, there's lots of other ways means and ways of getting around that. Um And you'll find lots of other opportunities will come up in the way along the way as you're progressing, no matter which way things work out for you. So I know that's kind of a whistle stuff on a lot of stuff. Um I can see some of the questions that you're asking here. I think Michael, I hope I've answered your question about good ways for medical students to get involved. Um The most important thing I would say is talk to people but I guess when, as I said, at the stage that you're at, it's really important number one to focus on things like your, your undergraduate studies, make sure you do as well as you can there. That kind of holds a very big part in your specialty applications. But also it's important to not be too worried to really iron are details of projects and don't ask ideas, look around for questions and projects that you can get involved in, but don't commit to something unless you're certain that you can get something worth your while out of it. Um But yeah, around theater, I think talk to people don't be scared to email people. Um Usually it's particularly actually coming up to the summer, there's lots of people have projects on the go and in fact, we do a couple of distant projects out of the matter hospital in Dublin, which I'm very happy to chat to you guys about if any of you want to get in touch. Um We're doing research in a specialty different from the one you have eventually want to do leisure have an impact during train section process. No, it doesn't really. I think it's really if you choose to do research at all, one of the most important things that you can do is show that you can take your project from start to completion. So it's really important when you do have if you take something on and if you want to talk about it in interviews and, and kind of your research stuff. It's really important to say how you close that off. Now. Obviously, the ideal way of closing that off is a paper. Um But if you don't get a paper, it's important to say, well, look, I presented this work in this place and that's demonstrating the ability to finish off a project and bring things completion. So doing research in any specialty shows that you have that ability from a kind of training selection process point of view. What does help you though is if there's a specialty that, you know, you like and that you're interested in having done research in that from a very early stage, more helps you and then it shows that you have a lot of interest. Um And if you're showing interest from a really early stage, it's going to kind of help you from a training selection process later on that, you know, this is what you've always wanted and this is what you've really put your mind to from day one. So regardless what specialty you're in completing projects will always help your CV and help you during the training selection process. But if there is something that you have in mind, it's good to try and do it. And like I said, email, people call, call, find reg is that, you know, you like, if there's somebody like in theater most the time people are happy to help and if they don't have something, even themselves, they might be able to tell you who does and send you in the right direction. And I don't know if like the start of my side, you might have seen that well, but like to kind of get through a lot of surgical training, mentorship really helps. Um So generally having seniors who are willing to help you out well, does go a long way and they're usually happy to help us. Most of us have had people who helped us to cool. Um I just had one other like personal experience and with Michael, um it can be tricky for medical students to get involved in researching. Obviously, it can be a bit of luck along the way that you sort of meet the right person at the right time who maybe start the project. Um I'm not sure what stage you're at, you're at yourself, but I depleted and I know it's been a bit more controversial now that they removing um additional qualifications from some of the application process is, but I think it's much more important than that because when I interrelated, there was an opportunity to do a project or a dissertation. And from that, then you can, I, I did a literature review and then you can present that or early or as opposed to presentation um at different conferences um across the UK. And that sort of, is that the first step I supposed to try and get involved in some research. So certainly if you, if you haven't got to that stage that you can choose to interpret, um, I think it's definitely worthwhile even if the doesn't counterpoints. Unfortunately, the application, to be honest, I would agree like I did, that wasn't an option when I was coming through again. I would kind of heart that back to what, how you envisage it kind of working out for you. So integrating is great, like you said, for getting involved in getting publications and things like that. But I suppose number one, I guess if you haven't really had an experience yet to see if you like research, it's hard to know how much you want to be involved. But if it is something that you're really focused on kind of specialty applications, some of the stuff you said kind of like doing literature reviews and systematic reviews, a lot of consultants have ideas for things like that. Um And even if they don't have a project ongoing, they can give you an idea about something that, you know, would be a nice literature review that you could go and do. And that's not something you need necessary to be on site for looking at charts force, it can be really useful. But yeah, I would um all I can say is just keep asking people and you will find someone. Can I just ask another question generally? And how does your work life balance compared to other colleagues who are, especially programs? Is it better, is it worse or is it much the same, uh, currently terrible? But, uh, it's actually not too bad. I think like the academic stuff gives you a lot of flexibility, um, particularly when you're doing full time research. I mean, at the moment now I'm working late into the evenings and over weekends but there was also days where, you know, if you want to, you know, if I needed to start later at something on, I was able to do that because you have, when you're doing things like dedicated research and a phd, your time is very much your own. Um, and no one's really watching you to see what you're doing. Um, because they, you know, it's your project. So at stages in the phd in on full time research, you do have a bit more flexibility, um, in matching it with clinical practice, it is hard. I mean, when you're doing your full time, you know, you're doing an alcohol commitment, you know, you might be up all night operating, then you're trying to do research the next day. You do have to do quite a lot of open communication with your colleagues about where your commitments are. So, you know, sometimes in the lab, you might have people who think, well, gosh, she's off in the hospital the whole time and then in the hospital, you, people being like, oh, sure she's just off in the lab the whole time and I suppose being kind of split between both places does make that a little bit harder. Um And you do have to work a little bit harder in both places to kind of make up for that, to be honest. Um But overall, it does give you a nice kind of flexibility um that you're able to kind of work things around a little bit more and be more flexible with your time to facilitate that and to facilitate things like social life as well. So I don't know if that answers is I would recommend it like the full time. I would the advice I give to anyone who's considering full time research is that you need to make sure your motivations are doing for doing it are right that, you know, you don't need a phd to be a consultant, you don't need a phd to get on your specialty training, like things obviously qualifications help, but you don't need them. And if you're going to put yourself through that sort of stuff, you need to think. Okay, why? And is it that you want to be working for, in my case, working with the lab group going forward that I'm the clinician advising research externally, which is what I hope to do is it that you want to actually be mainly research focused and your clinical practice just gonna props that up. Um If that's the kind of way you want to live and work, then it's great. But if you don't want to, if that's not really something you want. And as a surgeon, if all you want to do is you want to do, you know, your, to operating less the week, your clinic maybe do private work on the side. And research isn't something you really want to be doing once you're done, uh, the full time research probably isn't the the best use of your time and it would be hard. It's harder if you don't like it and if you don't see it kind of being in your future. That's brilliant. Thank you so much. Um If anyone has any other questions um to pop them into the group chat, um I will send a feedback form now, I am I would appreciate if, if you would fill it out the feedback form and it does help us for future future and webinars. Um So I sent that into the group chat and noise. Um Please do fill it out and it really does help us. Um Stephanie, thank you so much for, for speaking. That was really interesting talk. Uh No worries at all. And like I said, if I can be of any help to anyone, um you can follow me on Twitter or send me an email. I'm more than happy to advise and help who I can. Thank you so much. No worries. Thanks. Bye.