Computer generated transcript

Warning!
The following transcript was generated automatically from the content and has not been checked or corrected manually.

And then some people who are ahead. Uh, so I'm going to try and never speak to, uh, an age range of a few years. It's quite a big gap in a few years, but obviously some people are doing a levels and some are actually not too far, big doctors. Um, and the topic I've been asked to speak about is, um, I suppose to, to look at academic, uh, medicine and academic medical career and, and I'm going to base around what I've done, try and broaden that out of it. A lot of what I'm going to talk about has a lot of detail of opinion about Amonte people to really focus on the detail. Just want to get a general flavor of some, the point that I'm trying to make. So some of the slides do have quite information on them, but the idea is to try and understand on each slide, a point that I'm trying to make. So, and I'm also not gonna talk for an hour. I have to talk about half an hour of the time. It's gonna be time for questions afterwards. Um, so, uh, what is going on? So that Okay. Um, so I'm going to briefly just talk about my career so far. We've talked a little bit about specialty training, not very much, a little bit of about academic training. And, uh, and then I'm going to talk about some, the science I've done in the context of those three, uh, initial topics. Um, so looking at how the work I've done fits into my, my career and how I had to look at the way both the clinical training and the academic training has to accommodate that. And then I'm just gonna make a few including remarks. Um So, so it's a bit, so it's a bit of a bit. That's right. So, yeah, so I went to a university of 92. Uh So I'm uh 50 next year so that time flies somewhat. Uh So it was interesting, we just had assassin on the session that Tasha did about applying to uh university is very different then. So when I applied, we did have UCAS, we didn't have personal state. I think I don't, maybe we did. I, I don't recall. Right on. I went on a school trip in the summer I met my one interviewer. Uh and, and we got to know each other a little bit, went back to the interview around Christmas and interview was simply, how is the family? Fine. How was Italy for the fine? How's the, are going there every see you next year? Uh That was the extent of it. So I think things have changed a little bit. Um, since then, but anyway, it worked for me. I haven't done. So I went to more than in Cambridge and I did my undergraduate degree there and did Razaleigh. Well, that most of us who went to Cambridge left halfway through after three years, I went to London or some to Oxford. Although some did stay on, which is in a strange historical work of Cambridge and the medical school there, they have more in the grants than they have clinical places or we're used to. And so I don't think the second half my degree in London raw free, uh got my, uh able to be there and then I did about six years or so of medical jobs. So really caught my house officer and senior house officer, uh which were the first years of our training and then being a clinical fellow. And in those days, the medical structure voters was, was a lot less, it starts to become a bit more standardized, regulated, uh, certainly owned in the house this year. And then you tend to at least two years of senior house officer, but it was in a bit vague as to what happened to get to the specialist level and they were starting to regulate that because some people were spending list about a decade in the sort of jobs floating around and they started to bring a notion of jobs being recognized for training or not. But this was all happening around there. So it was quite a vague to the fluid time. A lot of people went to Australia for a year and things like that as well. So it was, it was all practice of fluid. And so I spent maybe a little bit longer, uh, then some people, um, in getting to, uh, specialist level, uh, I did uh, surgery for a few years. So I got by mrcs, I didn't ever want to be a surgeon, but you sort of had to have a medicine or surgery in those days before he did uh other specialty. So I did some of that. Uh and then I joined the Manchester Radiology Training Scheme. Um and that was in 2004. Um And that's when I then had a bit of a different career plan for those people. So just to give a bit when I don't want to see a matter that I started like this for a normal person in September oh four. And then I only did a year of uh what we call SBR says for ST uh nowadays. Um And then during that time, I then arranged for me from countries such UK and I started a phd after a year. So I had to pull out a program experience and we had three years, uh went through, retired my phd and um then I went back into training, but I went to was a year three. So I never did a second. Uh But during my phd, having all my professional exams which showed you don't really need to actually do medicine to actually pass all these actually time to basically study. Uh So I then went back in and did my climate to trade type. Uh and on that last year and a half. So I had an electoral post holding 50 50 do more research again, post phd and still finishing. So I finished in 2000 and um 12 in January. So I was um nearly 38 when I finished. So it's a long time of trades. It was 20 years from going to university to finishing. But I had to the phd and I did all that training and I said the phase uh which is that point. Yeah. So it's a bit, this phase here is now a lot shorter for a lot of people. So a lot of people now when they qualifies, consultants are more like that, there's more of 32. Uh unless of course, you've done research, ripping up time out saying potentially or other factors. Uh So, um you know, you are potentially quite often sometimes when you get to the uh stage, of course, you know, it's topical in the news about Junior Doctson, junior doctor strikes uh moment and you're, you're still a junior doctor up to that point there. So until the data from consultant, you're a junior doctor. Um so, uh I had quite a long a train but did a lot of research during that, that time. And then from 2012 to 2 now still. And I went up from see Elektra, read a festive that actually everything. Um I do a day a week and the Christie. So up until three years ago I was doing, I was going to say five days for research, one day for clinicals of like 12 session, six day contract. And um that was my job and I had a research group in the university here and I was doing basically five hours of NHS work a week plus somewhat called ST A time, which is I'm supporting professional activity time. So that was my type of job. Three years ago, I was basically uh recruited by the I C are in London, which is a big cancer research institute. And so I took a job there, but I retained my Manchester job. So I still have, I still have my Christian. I have one day you, there's like, I'm a work from home. So I have a reason for even Manchester and other research people longer as well. Uh Let's work to visitors, which is a bit of old arrangements which I'm not sure I'd recommend actually, but it sort of works just about. So I do quite all right. Yes. Uh this, so this side in the wrong place. I put, let me put that in late. So I'll go outside there. So, uh I've got a very odd medical career because I do academia. I do very ready for clinical work and I work in London and Manchester. So I've got one horse career. I found this yesterday, my primary, this actually can read. So, so bear in mind that about half the people who qualify and practice in the UK, doctors are GPS and about half are specialists, right? So I would say that one of the key things when you're thinking of careers. So this is more person to keep the uh medical school at the moment, I think for yourselves uh school college, it's still rather than is, do you want to be a generalist or a specialist? So that's why uh to me that's probably the first question if you're trying to work out what sort of career you want. Um So a generalist, we're generally talking about general practice and especially when generally talking about hospital is probably not quite as hard fast as that. But I use someone who's, for example, a certificate sample of the G P A family doctor. You don't know what's coming in next. You could get for the charge, you could get an explosion, be mental health and you can get someone who's into the leg, you know, etcetera, etcetera. Just don't know what's going to happen. In reality, you tend to get a lot of people with mental health problems a lot safety, Children, air rates, etcetera, people who need asking reviews, etcetera. So you don't tend to get many aneurysms are about to burst, but you need to also spot that. So, but that's quite a generalized general John results of uh skills uh necessary for that. We don't have to have massive in depth knowledge on many things, but you need to know how to appropriately handle things like being short of breath, headaches, etcetera, and all the common conditions that you're going to see as a GP. And you, we need to know how to refer the block. So that's, that's one type of job and tends to be done in the community and practices. Obviously, there's lots of key elements that important for that such as can you manage a business, etcetera. Now that's, that's, that's critical thing. A GP enough of the medicine. Um And um again, actually, I think maybe for the people who are coming up for interviews, um very few people actually tend to mention it. And yes, of course, Manchester, I think more than half the people who finish become GPS. So I think, you know, if you, for example, done economics as a level, that's actually probably quite a good thing. I mean, it's certainly, I think if you have an interview in person second saying I've done economics that I'm interested in medicine. Um you know, I think I want to be a doctor, but I'm, I'm aware that whole school nowadays are effectively running businesses. If they're a general practitioner, I quite like the note, I think the Notre might want to your G D because like, interaction, people think I find that variety stimulating. I think that would actually look quite impressive. And in fact, I think probably stand out from the habit of using like that. But I think, I think, you know, that's, that's one time a job and then specialist is, you know, as, as the name implies, it's where you tend to do a narrow type of thing. So you're an ent surgery or a psychiatrist with the petition, etcetera. And this cartoon is on this, um I'll see, um just being a little bit flippant first. So, so for example, you know, uh if you, if you're, if you're saying and you're, um, you know, you, you're relatively hardworking, know what should you do? Work? Pencil, patient preference of the patient's asleep. You like, and it's the easiest patient, digital pathology of patient's paralyzed might do in your, I mean, obviously that's, that's absolutely something. But, but there is a certain truth in that surgeons tend to have certain types of personalities, but the ent surgeons urologists, they tend to be quite a breed compared to the orthopedics and the general surgeon. But it's not absolute, but there is quite a bit of truth in this. I mean, when I was more than one of guys year below me, he was in the Blues Boat, 6 ft eight massive guy has become a feeding surgeon failed all these exams. Busy. Very clever guy. But, you know, uh, turn around and he's just a typical for politics, basically. So obviously you don't have to revert to stereotypes. But I think this does make a serious point that within the specialties, that's quite different types of job with different demands on them. So I don't do any on course, for example, that maybe it's under academic. But in radiology, the on call is quite onerous as a trainee. But then as a consultant, athlete Christie, we have a very, very light. So, so it's quite nice. But there'll be consultants of the Christie who are in intensive care will be an order. And if you're, for example, Center Manchester in intensive care, you will do a lot of acute out of hours work to know that might be excited when you're 30 but you want to be doing that to 60. So there are things like this to think about. Um So there are all these different types of careers and as I say, I think this is from the GM. See, you'll see that uh it's probably 50 50 GPS specialists. It's not there, there are things outside about like working public health and then within the different specialties, um medicine surgery still makes up about half or so. And things like radiologist I do is it's just a small center pathologist, small century, etcetera. Um So I think when you're going through medical school, whilst you, you do want to be looking at the difference um attachments and obviously learning about the conditions clearly. Uh But it is also worth it, I think particularly start to get a bit more senior too, very much. Look at the people who are doing these jobs and obviously, you know, they want to be one anthropologist will be simple. But, you know, do you, do you like those sorts of people, do you think? Yeah, I can see maybe atomized of personality type. I've, because I think it's actually made a really good point about like the medical school that probably top of her. This would be where is the medical school? And I agree with that. I think too many people don't do that, don't understand the difference, you know, can different type of campus universities. Uh I was in not in uh last week for something and that is very much a sort of uh walled off campus where you can easily spend a week, just stay on campus, see friends going to lectures. If your Manchester, you're walking through Manchester to get from way left. So there's also Campion. This is really quite different. And I think that's really, really important to understand that. And I think in picking a career, it's important to understand about things like lifestyle and personality is the way that jobs a structuring work. So, yes, it is important. If you think, you know, you're fascinated by the kidney, you might want to be a nephrologist. But for example, a lot, the pathology is quite an academic. Just been a lot of people in the colleges and card always have phds where it's a radiology that you know what does. Although in London more people do. So you might decide like a really like renal stuff. I'm not fussed about academia, radiology, shorter specialty and you could be a renal specialist, radiologist still work in that area. Do you have a different sort of lifestyle? And I need to bears it in to go and assess to go and help some person is in real failure. You can sit at home and look at some scans if someone's in renal failure. So you might still be on call with a different type of lifestyle. So I do think as it certainly is the people when you met him before you're going through, I do think these things are quite important too to think about and, and not just made a bit of a snap decision based on the very obvious in front of you things like, do I like renal or cardiology or orthopedics, etcetera but about your lifestyle. Um so, I mean, radiology, um you know, in the old days, you know, it was x rays and ultrasounds. And so these are just examples of some, some common things which will probably mean something to the people who are your medical schools people and six for uh might not mean anything. But in this example here, uh this is, this is all that normal up here. This is, this is concerned, this is basic like infection in the upper lobe of the right lung. Uh This why it comes down here is actually infusions. This is fluid. So this is fluid sitting outside of the lung in the pleural space. So, uh you got the chest wall and they've got lungs as a space space for him. So fluids sitting there sort of shut the lung inwards. Whereas the first example that's good sitting in the long parent chemo in the al the area. So these are different things which complaints look at it similar. And then this is like a classic, for example, there's, there's a, there's an extra liner of that line from you that because posteriorly the left leg is completely collapsed down has probably juicing lung cancer because collapses not reduced lung cancer. So, so in radiology, you know, traditionally, people are looking at pictures and I, I always think it's a bit like um I don't think people have come across where's wally, the Children, people know what I mean by that. That's where you're trying to, there's a lot of uh Crennel seems that these artists drawn and, and his, his character, which you're trying to find a lot of radiology is trying to find that abnormal bit been a picture um or spot the difference when they get to pictures that are based on the same as the difference is is that is exactly can to follow because that's what's used to look like water like that. Is it different? So it's quite visual. It's using some very complex machines about physics and maths to produce pictures and but it's quite a qualitative art approach almost to the medicine. Um and um to show for example, yeah, this this is more high higher ed and tech here. But this is an example of bone scan. So this is where we inject a tracer, which we share that, that's this person to catheterize, that's a catheter bag on the leg. Okay. So it's gets peed out. So that's why that's hot. You can see there are some abnormal areas here okay that that air is abnormal and on the X ray it looks fine. But on the MRI scan, this, this is Papa Boniva is this is what the bone should look like. That's the um federal head and that's the acetabulum. And this bit here is the same signals muscle and that's because that's tumor. So that, that, that is the same as that. So on the EMR we're able to, because the MRI scan, they were able to identify the same. So this is also a pattern recognition of spotting and, and I know which, which bit of someone that is that is etcetera. Most people believe what not, but because we over time get used to the anatomy and we, you know, it looks like we know what common conditions looks like. So in radiology, they are foster country, people are assessing images like this and you can see here this requires years of experience. Uh It requires some understanding. Manasseh me a bit of in standing of physics of how the images are made. Different modalities, experience degree of the key thing. If you've been doing this for 2030 years, you've seen it before, you know what the answer is. You know, it's hard when you're learning uh to get you, there's nothing as a substitute for putting down and pretend it's we have to do. Uh you can see here if, for example, you've done orthopedics interpreting some of the bones, maybe it's quite useful. So my day 96 months or period system general six months urology system to neuro uh such a massive demonstrate. So it's always different jobs actually do. It will help you over the years. Um And so if you're a cancer specialist, Christie, this is the sort of stuff you look at, but it's very visual, it's very different from what I spent most of my time doing, uh which is a quantitative imaging. Okay. So in wanted imaging, uh So this is an example there, this is an MRI and we've just sliced little bit half. So that's actually the liver, okay. Um So this is the liver basically is like here we'll be going across there and in the liver is a big metastases. Okay. So that's, that's, uh, that's, that's spread this, this is, this is, um, a bowel cancer. So this is bowel cancer. It's metastasized to the little, this is a great deed. The, uh, and in the sort of things I do, we do functional imaging where it's very sluggish is so sorry, Tommy. Very well. It's about okay. So we, we do function imaging a lot. So hope you can see that's the same shape as the thing that's outlined and read. Um And this is a map of basically, if you consider this is blood flow it on, that's not quite true. But if you think of this as blood flow, um we've scanned the patient and we've done this in a complex way, were injected some trace. Er we then scan very, very fast and we keep measuring every few seconds what happens to the mask and as the trace er goes through the body and goes through the tumor and we're able to by measuring every few seconds, look at how it changes, were able to understand something about the blood flow. Okay, because it actually traces going in the vessels through the tumor. Okay. So we're able to measure aspects of tumor and you can see there. So if I tell you that yellow and white is more blue is less and reginal range in the middle you can see that there's two bits of the tumor that don't have as much blood flow compared to the other bits. Okay. And then if we, um and we know that that scan twice before treatment, if we then treat patient over the course of a cycle of therapy, you can see that the teammate actually is getting a bit small, but by 12 days it's rather, it's going to be small of it's become a little less hot. Okay. So the blood flow has substantially reduce that and that's in one tube. And if we were to look at multiple tumor's and say different patient's, we can start to quantify that. So I can, you can imagine here, I somehow can crunch the numbers that go into making a map for treatment and then I can get the numbers and the subsequent map. So you can, I mean, if you just imagine, for example that every pixel that's white is 10. If it's quite, quite white, yellow, denied etcetera, you have scale, you will get a summary number across that tumor and we can track in time how it's changed, were able to basically look at how the blood flow is changing time. And what you can see there is that it's going down in all of them. But you can see in the curve over here, the blood flow is going back uh and maybe even over shooting and these ones is going back to where it was at the beginning, resonates is staying down. So you're starting to say here, we can measure things like blood flow or metabolism or hypoxia or those aspects in tubers. And we can use imaging to start to understand how tumor's behaving differently. And one big thing in medicine, the moment is simple personalized medicine or stratified medicine where we try to move away from the notion that everybody with a certain type of cancer, for example. So if you think everybody would say stage for ovarian cancer, we get a certain type of treatment. Can we start saying? Well, actually, can we do different genetic tests? Can we do uh imaging test started to stratify people and say that although people might all fit into a category of the same type of counts of the same extent of spread, that they're still different as there, we need to treat people differently. Because if, for example, we have therapies that or two blood flow, you imagine that if some of the tumor's and sort of therapy, yours are both though you see in some of these tumors, you have an effect, it's maintained still and others, you have an effect and it's lost. So you might want to dose those people differently on subsequent cycles, for example. So this is a lot of sort of imaging I do. And so you know that's using M R that picture I showed where there's metastasis in extra the hip in the past and that's using M R. So we're actually using exactly the same machine, but we're doing something very different. So in clinical practice, at the moment, we mainly radiology made pictures and look at patterns. And in imaging sciences, we very much use the same sorts of machines to create numbers and to stratify people and to measure. If actually you imagine if you get numbers, you can do statistics on it. So you can look at cohorts and start proving evidence of therapy is working better or works. Whereas if you're just looking at pictures, that's quite nasty. So as an everyday, I do two jobs, I do a clinical practice and I do the science and they're really quite different. Okay. Um I'm not going to any labor on this. It's all other than to say when I was training, a lot of this small structured approach to academic clinical training started to come in. Um And I caught the tail end of it. But I think just be aware that if people are interested in doing academia, there are now some much more defined routes to doing that because in the past, it was slightly, you have to just go out and find yourself. So there are now something much more established pathways. And certain times, for example, when people expected your phd, if indeed they want to do one uh much of the majority of men its way to a phd don't give especially people started to go away, confused thinking that everyone doesn't make of yours is a phd. But for people who actually want to become academics, there are some much more structured pathways now about when you do a phd and how there are things like an MD can actually throw every different universities. One thing I think I would say that is that in some universities it's compulsory to do an inter plaintive degree and other universities isn't. So I think if you're interested in and you're still at school, college and you actually think academia is for you, I would add to what Natasha was saying. I would say that, you know, you should be putting down places probably that have an inter plated. Um Well, well, you'll be altitude anywhere, so maybe it doesn't matter totally, but you're probably find you'll have a higher caliber academic students if you're going to the places that it's compulsory. But, you know, here in Manchester, plenty people will do intubating. Um BSC is basically um Right. Um So I'm just going to um do a few sides now where I will partially go through some of the things I do in science. But I said I was gonna whizz through these and I want people sort of take away the ideas that I'm a knock it or, you know, bogged down any details or so I sort of diverge from being like a more like a standard doctor about 2500 phd. So I had to go down to London, go for competitive interview. Get grilled. I mean, was what about 30 then? And you're going down, you're getting real about 10, 15 professors. So it was good or traditional Europe. One on the table. There were sitting out in the end of the table, like staring at you and it's, you know, asking all kinds of silly questions about things and trying to, trying to be difficult, you know, and then they were not easy to get. But I, I got one of, I got one of the grants and so then I, I had several papers. Uh and if you are interested academia, that's, that's the key bottleneck really if you get on to one of these qualities sort after phd programs because it lets you do the research, but also badges you and in academia, you want to get badged as someone who's like in the 18 because if you get the ground like that from CR UK or LLC or, well, whether you stand out because most people don't get. Um, so that is important and it's really important also to just go with the right people. You think the right people. So they were really my three supervisor Allen who top his radio to who is professor Radiology here for me. He retired two years ago. Gordon Jason, I in Boston is just to advertise professor of medical oncology. See, he does a bearing and care excellence uh risky. A great man, Jeff Park who's now who still lives in Manchester is now, you see, L in London who uh very largest physicist oncologist. So that was a great team, all very good people. And that, and you go from starting that where, you know, you've got active aspirations but be able delivered anything to coming out that with stuff that would be seen as internationally recognized work. Um And no, this was a great thing I wrote, which is kind of like he actually little review, but this, this was a little bitty review, which was person to, it was on the message and it just did really well and got cited loss and that sort of starts to get me know. So phds that went well. Um I did, uh we did organize this. So this is a mouse to this, this is okay, this is against this anti basket drug. You can make you see the uh the tumor's look like that before you drink it and you, you sort of whack a whole out of them and as the days goes, as the time goes on, you get more the whole. So we're doing experience spaces to look at how these these drugs are. Tala vasculature work. And so in the mid two thousands, then this was all quite exciting. Uh these drugs start to get into the clinic. So they were likely groups of immunotherapies nowadays. So everything's like obsessed about immunotherapies in 15, 20 years ago, every success about there. Jeff inhibitors, the vascular endothelial growth factor receptor inhibitors and they haven't died. They're still in practice, but they didn't end up doing anywhere near as much as people hoped they would do. And, you know, they say that it won't be successful. It's good for some patient's, that's more that space with immune therapies as well. They beneficial for some people but not everybody. Um So I, I just sort of these sort of mouse expense, things like this with drugs companies. Um and then post phd sort of got into some data science like things and the point of, you know, if you're going to do academic research as a high level, you need to be newer, you know, you got some quite complex mass. But what was interesting, I was very good at maths at school. I thought I was going to do maths university and truthful. I, my teacher who was helping with the UCAS hold just crossed out mass and put medicine down and that's why they're doing medicine. Actually, it was literally teacher holds my thought on the practice thing and then I had to do my part one and medicine that, but I was very good at mass. I realized they're working in sort of in postgraduate science. I'm not even there's with mass and most of you actually work nowadays our masks for physics or computer science people and they are properly with a mass. Um And so one of the things you start to realize, you have to start to collaborate with people who do these other subjects. Um And if you are going to be um interest academia, you often, then there's a many becoming a group leader. So one of the skills is to start to work out how to hire people are good at some of these different disciplines for how to manage and get the best out of that. So here we're basically applying um simple fractal mathematics to tumor. So that that colored blob is a funny shaped Uber. And we're basically looking at the space how it feels space. So we were basically looking at the spatial complexity and the idea is that the more spatially complex tumor is about one. So there's a nice round spherical glob, they tend to not this value is a nasty spikey jacket point of things, they tend to be worse. And the fractal mass lets you put a number on this Jack itchiness of it. There are metrics like how Jack idiot is that come out of a bit with complex next. So we started to show that this potentially had some some value. Um But so, you know, pre critical mouse stuff then doing maths and physics stuff. I think it's important to say also that you will if you if anyone does go down academically. But I think also just when you if you also abstract this to the notion or doing postgraduate exacerbations, you will unfortunately fail things that medical school, you should generally pass exams. Um So, uh I think that's still true. So the expectation is if you work for it, you should pass it when you get to post graduate level, if you're talking about the postgraduate exam. So to become a radiologist or surgeon or GPR, wherever a lot of them have very high failure rates. Um And so you have to then get into the mindset that you may fail exams, which a lot of people are not used to because they probably been the best at school and then they're in conscience in medical school. Um And that was, it's a bit of an old systems. I mean, I, I know when, when I was in my surgical examples of a trick that exam itches love was take to a patient who got say, for example, um bilaterally large kidneys, get me to examine the patient and then take away and then will the person on the causes of her pass Isabella megaly? And then um ask that. So what do you find that patient? And of course, the triggers say, of course, this version had, you know, a bunch of large kidneys. But I did enjoy talking about maybe, you know, and whereas even I would get a medical school finals that would do that, but I should like to do things like that just to try and make it fail and, and why they do, I don't know. But in academia you get sort of, lots of things like this as well. So it's very hard to get grounds. So you're putting something that's really good, doesn't get funded and it's quite demoralising and you're, and even just on the basic study level where you do a study, it's a good study to submit it. You get reject it for no, particularly harder study on Monday. It's a good study. The reas don't understand. It just get stressed. It's really annoying. Even when they are going to accept a study that the letter comes back saying unfortunately is completely unacceptable. It's good Friday base salad. It's horrendous, but that's actually a good letter. That means they love it. And so you do have to, I think in all forms medicine get used to dealing with some degree of rejection, which is a bit, uh, and you get it a bit late so, basically very successful for the year. So it's a bit and, uh, I think in academia is terrible and I, I had a particular when I had the worst interview of my life and it was like a screen. Uh, it was just awful and I don't think, I mean, I think it was okay and then as I got to use something it wasn't great. And the last time I got home just think, oh, I was just awful. Wasn't. So, I'm never going to get funded again. And it actually was a springboard to probably my biggest achievement in, in academia. But you've got to learn to cope that and there's a small line often between that screen to sort of some sort of heavenly, you know, wonderful thing. Every loves it often then little margins. But you have to, you have to get used to that, I think in, in academic medicine, certainly. But I think also probably generally a medicine. That's the case. Um So I had one of my studies, which was, it was a good study. It wasn't a major cancer breakthrough in my opinion, but the Express thought it was. And so I got this rare this before the Donald became present. So I know it's, it's nice uh front page on Express where it's Donald cables and actually myself, it's quite, quite hot seat to me. Uh So this, this, this is a good example way something's getting to the press that shouldn't do. It was, this was okay study. But anyway, it made front cover of cancerous PSA which is a good um journal that it's um it also snapped on the Express. That's quite probably the first ever got something on front of the Express and cancer research on the same day. Imagine. Um So, um in academia, it's really important uh for teamwork and um it's also that's also true, of course, in any sort of practice. But I think particularly academia is really important. So, you know, not all this is a little bit old as most people have moved on. But I have a lot of, I have had and still have a lot of computer scientist type people. Um So I think, like use arts, math, uh physics, physics, physics, maths, physics. And then I have these two, uh Diego went that biologists, uh medics who do phds, uh bothers a mass technician, um, and a science communication person. So quite a sort of, uh that's why uh Majesty when I got given moment. And so you got some quite diverse people. And you know, and so for example, sometimes we do sites, communications, I think that schools. Um and so I commander arrange those then sort of the people to come along and do that and all these people who individually specialist, what's quite interesting is the arm is uh is back with job now is extremely good. And Michael who is a scientist, Kristy uh phd's is doing part time uh is a question as well. Is interesting to people saying, so he's not a, he's not a doctor, he's a NHS scientists is interesting that some people are leaders, the majority of people you work with and sort of the science disciplines aren't and they want to be very good at doing their job. But so I would say one thing as a doctor is, you will almost certainly have some sort of leadership role or have leadership parties coming out your career, whatever. That is. Certainly what I do. I think you've got a small business where I have to get money in and these people work for me and if I don't bring the money and they get paid, it is not. So I have to do things like that. It's very clear that you are sort of in charge and leading it. Um, but I think even if you are, for example, you know, in a, in a certain part of the hospital, you are having good aspects of it if you're the doctor. So it sort of goes about saying if you're medical, you know, an oxygen practice, you'll often carry with the practice. People tend to sort of get to the top of leave things. There is maybe a little bit of sea change in some of that nowadays with medicine. So in my day, there was a very clear career structure. If you got off that career structure, you single yourself out as being a bit sort of deficient to some extent. I think nowadays it's not quite the same that everybody just goes and becomes first year qualify and then just keep on going, going, going. There's a bit more of a different attitude now. And I think sometimes people online and jobbing doctor for a while. But I think at the end if you, once you get sort of a bit more fixed on what you do as a career you have to end up the. Um so I think teamwork, leadership, you know, with Tash mentioned it in the applying to medical school should be mentioned in the interviews bit for the people sort of college. There are reasons why these things are looked at are important. Okay. Um So then I got more papers that sort did. Okay. Um uh This is what you have to do is as an income is absolutely published papers, just keep guessing papers out. And you know, what, what do we do? I mean, I'm not gonna labor it. But basically, you know, we, we look at measuring option levels and tubers as well as measuring blood flow before I started doing which is uh this uh sort of parameter here we're looking at uh so this one here, we're looking at auction levels and we started to realize that there was a disconnect sometimes in this area here because I'm with option blood flow very naturally free to say. Uh We started to hypothesize that we could use MRI to measure option levels in patient's. And this, this is something people have been trying to read about for a long time because we think that you guys have the option to do very badly. So that's sort of my main area of interest. And so we even, we started this, I mean, that's published in 2009. We were doing that a few years before we got to publish Um And I've spent a lot of time in the last 15 years um doing this. So mouse experiments taking pathology and imaging, seeing how they correlate uh initial experiment, a multiple cohorts looking at uh plotting relationship between them are thin and pathology thing. Um And working out what's the best way to crunch that data and then starting to apply this inpatient and doing various different steps looking to say the data repeatability. So sometimes we do test that, you know, we do one day to another day, you're taking the answers yet. Starting as the steps, we do research to look at the quality of the days you turning out to various studies like that and starting to get a sense, we're not our measurements, changing patient's which which they do. Um And so we can then start to take that forward into subsequent studies. A workout can we use is the plan which patient's are hypoxic and maybe change in their therapy, forgiven radiotherapy, which patient's are hypoxic and maybe more interesting which patient's rapidly stopping hypoxic in the tumors, uh radiotherapy. So we're starting to get this now in the Christian single them are Linnox. So this is a machine that's um both a radiotherapy deliverer. So it's called a Linear Linear Accelerator and um an MRI scan. Er um So these are the sort of interest we get. So looking at the layers of hypoxia, uh Juma's so that's, that's good, that's bad on the scale. And so you start to map this one clearly in patient. Uh So, you know, that's taken 15 years to get to the uh because lots of tech involved, it's very difficult without fly, I suppose. So, perhaps yesterday we had uh we had a article and uh in the eye which is a newspaper in the UK and also physics world sort of promotion, some of that um work which is nice to seize um getting good attraction. Um But, you know, I think it's important to emphasize that, you know, in a research career does take a very, very long time, it takes an awful for people to help you, you know, a bit of a sense of the timeline. Uh uh how long it's gonna take uh a national network which tries to get a lot of multiple centers. Again, there are a lot of people of different solutions you have to work with. I'm just gonna skip. That's like um so um I think, and then, and then even if we get this to work well, we don't have to get into healthcare system. So we have to somehow integrate the research that we're doing and get it into existing health care system. So for example, get it uh compatible with standard manufacturing too. Acts get the days we do integrate with different diagnostics, work out how we can run the stats and the appropriate outcomes in real time rather than taking off against much on their laptop, for example. Um, so I think I'm going to, um, pretty much finish. Um, they're actually, um, the last, last Main Targets. A actually, which I think Ties Max is in the national say also. And the first thing I ever got published was called Ernest was the BMJ. And I don't if they still do this, but it's quite a good thing if you are interested in academia, some journals take chronic called Fillers and that's where you can write a little piece of something. And it's literally cause they've got a bit space on the page and I saw this patient on a Friday who's where his, who came to clinic and looked terrible and he died, I think on Monday, you know, so we're missing him from clinic and he looked at all for me and he had uh cancer and it was interesting talking to him because his, so he knew it was going to die. He came to click and I was gonna die quite news. I don't never had that before. Someone actually basically comes and says I'm ill and diastology. Um And he said that and his fear he didn't want to have post Mawson. So he, what I used to find out from him was the only thing he was really bothered about is not having a Postwar. So, um and when I said, well, look, I'll be the one signing your death certificate. And I don't think we've got a diagnosis. A, I don't think we need to a postmortem. He was relieved and you basic dominate. Um And I made this, I used to think about that and I suppose I make that that point again because um as a Christian scientist doesn't academic, you are both from, this is the last one, uh therapy as well. Uh I do. Um you, you are both the scientists and the doctor. So, although you might focus on the science aspect and that makes you unusual compared to most doctors, you still need to go back to being a doctor. I mean, that's sort of understanding of the compassion and kindness, which I think they were made your point for the interviews. They want to see people who are clever, but also adopt those other skills. And I think that's very, very true. And even as an academic, what stands you out from being a medic rather just academic is the fact you still got that link to the practice. Okay. And so I think it's important to sort of finish on that point to make that clear. So I'll probably stop there. Um I'm very happy taking your questions. I'm conscious. People might want food. So I'm going to stay around for a little bit over food from people to ask any questions that I don't know if wanting time, any questions now or does anybody have any questions? Yeah, I'll run over with the mine is it going on? Yes, you can shower out what your opinions on, uh, Korean radiology or? So, the question was what, what I think of a, I, uh, is it a threat to maybe generally medicine? Uh, radiology? I don't think as I do do some, a I type research. Uh, I mean, I think it will replace some things we do, which is good. Uh, it won't, uh, there are, there are people who say like we always want to exist in order to pass recognition but that, that won't happen. Uh So there are some things, for example, which are very subtle recurrences, which how are things going to miss or if it's conceived such as picks that some people, we should think of everything. So you either get false negatives or false positives. So, but it's useful uncertain. Uh In fact, I mean, what one area that we use in, for example, we're just as a tool is when, when rather just conciliate uh all of my ass holes rather just draw around all roundly. We can now on the brain which would actually recognize where the boundary between the tube and not you should be, we can check that and the men. So we use the tool, it doesn't replace it. But I think there's not an analogous point. They're saying if you look at say you break the rest, um it's still really, really useful to get played till of the wrist and that will let us generally speaking, see, have some rain risk yesterday. And if so what time rate is it, sometimes you might not need to a CT to find the surgery and you might get some patients where you just can't find anything. You think that must have breaks, it, it might be, there are chose what we're very through. So it's basically very subtle fraction that just haven't broke the process. So you just can't see it on the, on the radiograph. But the point is you've got other tests that come along, but they haven't displaced some of those really useful ones. And then, and then like another example for Palm embolus we used to use, it could be huge into medicine scan, which was city type test. Now we do CT examinations and that has wiped us out. So I think they're examples where advances in technology tend to get rid of things, but it could be with the greatest in the first place and where something's really good has value, you might modify the way it's tough, but I still think it will stand. Thank you. Does anyone answer any more questions? Uh Yes. Uh Thanks. I was just wondering regarding the kind of ethnic issues. Kind of, are there any decisions but kind of hard decisions? You have to make any kind of moral dynamics that you encountered as a doctor? And what was your thought process to try and work through them as just as a doctor was an academic as an academic. Uh well as an academic. You, that's obviously if you're adopting, you're basically dealing with patient and colleagues, aren't you? And I suppose like major but cat, his colleagues, um, as an academic, you're dealing sometimes the patient. So I have the research that you like. I mean, in the old days I would have reduced the patient's, see if a salad is doing that, but some people do it for me. But um you don't see much of patient. So you basically got colleagues, you're dealing with who maybe they work for you. So I suppose in the first example, um I mean, I'm, I'm the worst person to ask that too because I'm an academic and the radiologist who only does cancer. Gemini works home reporting it. So I, I haven't seen a patient room for us a decade. Um But yeah, I mean, ethical issues, I suppose um probably the one that comes up most for me is probably deem with colleagues. I think people not at the medical student interview predict, you know, you might get it, you might, you might go this as a sorry. Annali is dealing with difficult colleague. I think that's hard as you do get difficult colleagues. And when we appoint consultant posts, the key thing with the key thing is not, this is the best radiologist in the world that they're usually good. But is this something you want to work with? For the rest of your target. Uh because you can, you can not appoint someone. It's very hard to get rid of people when they're imposed. And I, so I think doing difficult place, we've had a few of those and I think what you normally have to, there is, you know, if, if someone's just complete, pay them some reasonable things, you have to basically, you know, share that with people escalated to lie matter. So there's some quite boring and it's based on quite set ways which you deal with. But I, I think for me, the sort of ethical and managerial things, it's more about colleagues that probably things come up rather than patience for me. But I'm at one end of medicine. So, thank you. Question any thought this to be our last session, if anyone's football. No. Okay. So basically now we're going to go to lunch, um and that starts the same room and it will come back and talk.