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um, so we'll move on to the next step. I'm joined by Doctor Sarah Anita, who is, um, an academic clinical lecturer. Uh, in vascular surgery at Imperial has a significant amount of experience, um, in the field and is, uh, joining us having been scrubbed in all day, So thank you very much. Sara, hand over to you now. Uh, no problem. Thank you, Alex, for the introduction. Hello, everyone. Um, when I was given the title of this talk I mean, you know, you can play it in different ways, but the way I've decided to play it is really to tell you what I've done and perhaps give you some tips and tricks on route, and we may actually answer some of the questions that you've just mentioned about PhDs and time out. And what what's cl is? So I haven't got any disclosures. And so what we'll do is we'll go through the clinical academic pathway just so that everybody understands what is what. And then we'll discuss a bit about PhDs and a c l s. And what happens after that? And we'll talk about a few challenges because there are many in, uh, in clinical academic training and it's just important to be aware of them. So for anyone who hasn't seen this and is interested in doing academic training, this is what you need to know. So you do your medical school. You then have the academic foundation program as an F one, enough to where you have a four month academic block. You then basically get a training number and you get into clinical integrated academic training. You could be an A C f, which you've just heard about, which has about 25% worth of time of academia. And then if you do become a clinical lecturer, you get a 50 50 split. And if you break it down, basically a CF is, uh sorry. AFP is at foundation program level A CF is at old S H o level or call training level and clinical lectureship is after a PhD. So you need to have done 11. You need to have been bivad not awarded necessarily, but at least vivid and be told that you have passed and you need to be a registrar. And that's last four years. If you're being funded by the NIH op and you get 50 50 times So which you can split and we'll go through a little bit more detail in a second. Once you finished your training, Um, you then CCT, you get your certificate of completion of training. And then after that, if you get a senior lecturers job, which is externally funded again, you have 50% academic and 50% clinical. And at that point, only at that point you become you become a tenured academic, which means that you're a permanent member of staff of the college. Um and those are sort of the un broad strokes what clinical academic training is. So a C L is basically a registrar that spends half of their time doing research and is either externally funded or internally funded. Now, this is that is what everybody else is, um, familiar with, which is just the doctors sort of normal pathway where you have F one F two core training, S d 329, and then C c t. And then you're either a g p or a consultant. So this is sort of your standard training without academia, and you can see that they mirror each other so you finish medical school and you do fairly well. And if you were like me, you might feel like this on your first day. Not necessarily be terribly prepared. And the reason I start from here is just because it's quite important when you're thinking about PhDs and when you're thinking about going beyond an A CF and really having an integrated clinical academic career, there are lots of steps to think about, and many of the steps that you take as a junior doctor as an F one F two and call trainee can be quite important. So when I finished medical school, I wanted to be a surgeon, and I wanted to be a cardiothoracic surgeon, and research did not really crossed my mind too much. I knew that it was there. I knew it might be a bit interesting, but I wasn't one of those trainees that had come out of medical school, saying, I want to do the academic Foundation program and an A C F, and then be a lecturer and a senior lecturer and professor, very little sort of interface. Bear in mind that I was an F one F 2/10 years ago and things were a little bit different. And I think the the knowledge and the awareness of the integrated clinical academic pathway is much more relevant now than it has ever been before. And the medical students that come out from medical school now are very different to the medical student that came out when when I trained in terms of a number of publications and, um, involvement with research at really early stages. And, you know, we see we see loads now in our department coming through. So I knew research was there but wasn't really going to spend a whole a lot of time doing it. So I did my undergraduate at Guys, Kings and Saint Thomas's. I had no papers. I had a first from my anatomy BSC but didn't really publish anything. Med school and I then concentrated on becoming a doctor, so I didn't enter the integrated academic pathway at F one F two. I did my surgical and medical jobs. I got my exams out of the way as soon as I could and published a case report, did a bit of work on an observational study, got a second publication and then I did my F two job, and I've put vascular red because that was the job that made me decide I wanted to be a vascular surgeon so clinically, that was an incredibly stimulating, exciting, fantastic job. I absolutely loved it, loved the bosses, and I just wanted to be like them. So that's the job that made me want to become a vascular surgeon. I passed my MRCS part B there. I did a choice week in cardiothoracic and very quickly realized I did not want to be a cardiothoracic surgeon. And I take the boxes that you have to take in terms of audit and was quite lucky. Got a business business case out of my first audit and a few presentations, and I was finally getting to operate. Now, one of the things that, um, I was told when I was in Brighton was that if I wanted to be a vascular surgeon, I ought to do the Northwest Thames rotation in London, and the reason was that one of the surgeons who was there did it and did it as a post CCT fellow. So off I went applied for London and managed to match and That is where I've put Vascular read now because that was the job that really got me into research. That was my first taste of really being involved with research and got me into the clinical academic pathway. So very lucky was that imperial really, really strong academic unit, lots of really exciting research and managed to start getting some papers. And at this point, I didn't think I want to do a PhD, but I knew I had to apply for S t three, and I knew I needed some papers. So I started affiliating myself with a research team. And the more I did, the more I got out of it. Continue that work as a quarter any in the North Wick Park. When I did, vascular general surgery did lots of operating. But I continued all my academic work with Imperial at that time, and by the end of CT to, um, there were a couple of things that I knew, and I knew I wanted to be a vascular surgeon, and I finally knew that I wanted to do a PhD just because of all the work that I had started doing as a corps trainee But then you need to start making choices and the choices. Do I do a PhD now, or do I go for a national training number? And at the time that I was applying, you couldn't differ. You couldn't get a number and say, Can I come back next year? I'll, you know, do an MD or I'll do a Ph. D and come back in a few years' time. You either did an N T. N number or you didn't, and I very much wanted to actually go off and do a PhD. But I got lots of advice from my bosses who were very clear that at the time I needed to just get the cold and ticket and get a registrar national training number. So I did, and I got a Yorkshire scenery NTN. So off I went to Yorkshire for one year as a vascular, budding vascular surgeon. This was the first year the vascular surgery separated from General, um, so there were only I think 20 numbers at that time and very much didn't get to match in London, which is what I wanted. Got to go to Scarborough, which you can see here and spent a lovely year doing general surgery there. But I had already planned my PhD before I went to Scarborough and literally the second or third day that I started my job. I handed in my notice to the Dean Ary for an out of program for research. Which brings me back to the question about Do you need to take time out or not? I know one person who did his PhD part time with his clinical training in another era number of years ago. It is possible. I think you need to be extremely motivated, extremely organized. I think he had a family situation which allowed him to do that, and and also it was obviously, you know, very good, because I'll talk about a few of the challenges between, um, you know, managing your clinical and academic work at the same time. I think now if you're somebody who's got a training number, the Dina, we will expect you to take time out for research, and you can take a new pa, which can be either, you know, full time research if you're completely externally funded or if you need to be on the on court rotor to pay your salary, then you'll have a clinical component as well. But we'll discuss that in a minute. So when I was so in hindsight, when you're considering a PhD, there are a number of things that you need to think about that are really important. The most important things is who you do it with. First and foremost, a lot of people get incredibly stressed about. Am I doing the right project? Am I going to like the project? Am I going to get a nature publication out of it? It's not about the project. A good supervisor can get you through a difficult or an awkward project. If you're with a team or with a supervisor who isn't going to necessarily be very available or support you, you can have the best project ever, and you're going to find it really difficult to get through because there are many things that you don't know and doing. A PhD is very different to clinical work, to be fair, so the team is really key. So what I would suggest is if any of you are thinking about doing a PhD, go speak to different people, speak to the trainees who have done the PhDs. Make sure that they've written up, submitted Viibryd and have been awarded that they haven't just started a PhD and it hasn't finished or it has petered out. See how many publications and presentations they get out of the PhD over 23 years and visit the department and see what feel is there and how many people are around you. What level of support there is? Are there academic, clinical fellows are the lecturers are the senior lecturers. It's just really, really important, um, to choose the right place for you. Next thing. So that's a supervisor. To be fair, the second thing is the the department of the university again, you know, what kind of research did they do? What is their track record? What kind of university is it? Is it, um, you know, just just look and see. Just make sure that you are going somewhere where you will be supported, and the university has a good track record of getting people through. And then what you're doing. I mean, you know, then choosing the project clearly is is important. And because you'll be spending three years of your life usually doing it, so it's quite important that you choose carefully and the things to consider are funding. So the Golden Meal ticket for academia is to get external funding from a recognized charity or funder. And that effectively means the N I H R M R c Welcome British Heart Foundation. If your cardiovascular like me, um, so if you get that external funding and you pay for your own project, that is a massive CV point and it gets you off the encore rotor talking about on calls this pros and cons I had a fully funded PhD. I did no one calls for three years, and I was an S t four when I came out for research. And I think in my next slide Yeah, so there's things you need to think about. So the on the one side you're worried if you're doing it full time research that you're going to lose your hands and you're going to forget how to operate, and you're going to forget how to see patient's and things happen. I mean, when I did my PhD and I was away for three years, Rivaroxaban edoxaban all your dough ax came out and I came out for research where they didn't exist and came back when, you know, And they slightly bypassed me because I didn't do any clinical for three years. And it might seem really strange that that things like that happen because, you know, because of how quickly things evolve in in medicine. Um, and I hadn't operated for three years. Mind you, it was at the beginning of my training. Um, but that still is quite a confidence. Not if if if I'm honest, you worry a lot about what you can or can't do. So that's the one side on the other side. If, you know, like some of my colleagues, they were like, No, absolutely. I want to stay on the encore wrote. I'll do out of hours emergency. Well, it's not that much operating out of our age hours. Clinical creep is a thing. Um, it is very easy if you're within the remit of of clinical and uncles and clinics and this not the other two, you know, be seen as perhaps available because you're meant to be an office doing some research. So you're always there and clinical work then creeps in very quickly and before you know what you're doing, spending most of your week doing clinic and you haven't done any work. And time flies when you're doing a PhD and it's really precious, so those are the things to keep into account. In hindsight, I'm glad that I did it the way I did it, and it was right for me. But that is a personal decision that depends on the individual, so I can't tell you which is the right or wrong thing. But for me, doing it off on call was the right thing. I did a lab based project, and there was no way that I could have been on call for the hospital and on call for the experiments at the same time. Um, but if you do do on calls and you do do clinic, just make sure you prioritize. It might be an advantage if you're doing a clinical project where you need to recruit patients in hospital, you know, for me, that was not necessarily the case, but some of my colleagues did clinical trials, and it worked really well for them, So it depends on what you need to do with respect to topics, the broad things you need to think about. You're going to do something clinical or lab based. Are you going to do big data analysis instead? Are you going to do clinical trials or observational studies? And how will the study fit in? Is the setup available? Is your department already an expert and the You know, running big trials, for example? Or do you need to set up a new experiment? Expertise to deliver a new type of topic that you want to look at? And all of those things are quite important because you may be someone who hits the ground running if you're doing work that's already affiliated with your department versus having to start everything from scratch if you're creating a new line of work and this present cons to both. But it's just something to think about. Um, these are just little bits that people tend to forget about. If you're thinking about doing a PhD or about to do P H. D. G, C. P. License to attend, so you can still recruit Patient's in hospital. Even if you're a college employees, make sure you do all your credit and all your mandatory training during your PhD It it's you know, you can't do your early stage or late stage assessment without them. And just remember, I mean, this is coming from somebody who's now supervising quite a few PhD students and you know it is self directed. There's not much room for what do I do? Can you tell me, What do I do? It's your project. You own it. You decide where it goes. You develop the ideas, so it's a very different way. You're thinking to, um, sort of medical training where you you have constant supervision. Your bosses are there to troubleshoot, but the you know the actual project belongs to you as opposed to your supervisor. But do make sure you have access to them and you can regularly meet them. And I'd say at least once a week with With Somebody is useful to keep things ticking over. And it is a bit of a roller coaster I found at a roller coaster. It is fantastic doing a PhD. It's great for so many reasons. You have time to think for the first time in your life, after having been through quite a lot of hectic clinical training. You get to travel and go to conferences. You get to meet really interesting people. You develop expertise in something that is yours. You get to supervise people, and that's one of the most rewarding things that you can do. And you, the skill set you get in a PhD changes you as a doctor. Um, it that is true of of everyone that I've met. It lets you appreciate the evidence. Look at things you think your thought processes completely different, pre PhD to post PhD. So actually, it's really helpful just to get along in life and and work. It can be tough. It can be really tough. Rejection comes with it. You know you'll you'll be trying to get funding for X, Y and Z, and you're hit rate. If you're doing well, might be 30%. You know that there's a lot of rejection in in research. It can be stressful if there's a lot of stuff going on. Um, but it's also what you make out of it. So what you make of it, so if you want to grab every single opportunity, you get loads. Some people decide that they just want to do the P h. D because they have to, because they can't then CCT without it, for example, and they have a very different view as to how to do it. I have to say I wouldn't, um I wouldn't recommend doing a PhD as sort of, you know, a tick boxing exercise because it is quite a lot of work, but it's if you're interested. It's absolutely wonderful. And yeah, sorry, bad slides. And you do like I mean, I felt I aged after my PhD, um, for sure, because it was tough. But, um, I'm very glad I did it. So in terms of tips, use your friends this, You know, these monkeys are not They're just, you know, because the cute, the whole back scratching thing is key in research. You help yourself by helping others and by getting others helping you and that your your colleagues who will be doing PhD with you are your lifeline. You will have. You will bounce around ideas to them. You will have get them to think about your study design. They will help with recruitment. If you're going on leave or if you're on well and you can't recruit anyone. They might help you with some data analysis, give you some advice in terms of statistics I got. So as I said, I did a lab based project. One of my closest friends was a was doing clinical trials and we sort of read each other's stuff. And I helped recruit to his trial and he helped recruit ceremony urine to my patient's, um, you know, on days where I couldn't be there and they're actually really, really important to keep you sane and have a chat and a bit of a moan when you're finding things a little bit challenging or difficult in the PhD. And that often happens in the second to third year, and you have to make most of all the opportunities. So when I say that you, you, you get out of it as much as you put in. I mean, I did a lab based project I and you know the project results weren't going to come out until three years after, but in those three years I did a whole lot of systematic reviews. I did an observational study, which was perspective. I saw that the National Institute for Health and care excellence had this nice scholarship going on which taught you a little bit about how nice worked, and you had to do, you know, a few sessions with them and participate in their projects. So I did that. I got involved with societies, um, you know, sort of American Venous forum, European venous four. Um, you know, I did a lot of Venus research. So all the societies that were relevant, um, to that I, um, did, uh, got quite a few publications and collaborations out of it and try to maximize by CV. But remember that a PhD is a stepping stone, so it's a whole lot of work, but actually, it is something that you need to get from A to B. And once your PhD is over, a two B is well, the next decision is Do you want to stay clinical or do you want to stay in an academic pathway? So we go back to the integrated clinical academic pathway. So, unlike the previous speaker who, you know, got in at a CF, you know, wasn't a CF anyway or isn't a CF. I basically bypassed all of this and jumped in at s t four and then getting towards the end of your CL, you need to decide whether you want to go down an NHS consultant route versus a senior lecturer, which is again 50% academic and, uh, sorry to a clinical lectureship, which is 50 cent academic. So an anti child clinical lectureship. So if you can get one of these, then that's the best option. It's a 50% clinical and 50% research job. It is flexible. You can decide how to use your time as long as you use your time in a 50 50 basis. So in my first year, I did six month blocks on and off. In my second year, I did one week on and what will make off. And in my third years, I did 2.5 days on and 2.5 days off, and I continue that in my fourth year you have protected academic time, which allows you to further your research projects, apply for funding with some headspace and co supervise doctoral students, and you have clinical time to train and you have an access to NIH are training and support, which is great Um, for me, it was a question of timing. You need to may be aware if you want to go for one of these as to when they are coming out. Mine came out, I think, at 30 months in my PhD, So it was sort of within the middle of the last year. So I had to finish my PhD a bit early. I was very keen to make sure I was Vibert and awarded so I could go to the interview and just say, I've got my PhD. I'm done. Um, and I had to give notice to the Yorkshire scenery that I was going to, um, relinquish my national training number before I did the interview for the clinical lectureship. So that was a bit stressful because you worry if you don't get the NIH, are cl but But I was lucky and things worked out and that, you know, you get it and you think it's going to be a dream, and it's fantastic and you get your research time. But there are challenges, and sometimes it can be a bit of a poisoned chalice, so the clinical creep aspect is still there. It's very difficult to balance things 50 50 and you're never in the right place because you're never doing enough research. You're never doing enough clinically, um, so balancing that academic work and the training can be difficult. There is some more scrutiny on you at the a R. C P. It is not recognized that you do 50 50 and therefore that's that you do 100 100. You need to be better almost than your clinical colleagues in terms of getting your W, B. A S and everything else to demonstrate that despite spending half the time doing research, you're just as good, if not better, than your other colleagues. And it's not, you know, sort of it's not. It's not sort of because you need to be better than them. But it's just that I have personally found that there is a low threshold to say. Well, you haven't got enough numbers because you're doing too much research. Therefore, maybe we should think about maybe giving you one research day a week as opposed to 2.5, and you don't want to lose that research time, so you really need to be very proactive and inventive and try to maximize the amount of clinical stuff that you can get out of your training. And you do have multiple pressure points. You've got the university. You've got the hospital. You've got funders. You've got deadlines, you've got students. Um, but it is extremely rewarding. Um, as I said, students, I think are are the best because, you know, when your students gets funding, when your students wins the first prize, when your students gets your, you know, the first annals paper. It's extremely rewarding, and you're incredibly proud of them, and it sort of makes it all worthwhile. It's rewarding to see your own project move forward because you're looking after other people, but you need to look after yourself. You still have more opportunities to get funding, and it's you know, you're then starting to make more and more money, which is great. You develop expertise in a specific area and you start getting recognized nationally and internationally for that, and it gives you time to set up for senior lecturer applications. Should you want to go for that and again at the end, you still have this, um, you know, option of whether you want to go down in H s or college and I'm not going to go into that much detail about senior lecturers job because we don't really have much time. But at that point, you do need to decide whether you want to apply for a senior lecturers job and then commit to having that 50 50 time and all those pressures that come with it, you know, further on as a consultant. So in terms of challenges just to finish off, balancing things was was challenging. I found it challenging. Um, I felt like I never had enough time to do either things. But you manage, you learn how to do it and you, you just push yourself and and that's that with craft specialties, I think funding. Sometimes there's a problem, especially with senior lecturers job, because they've relaxed things slightly that, classically, they often wanted people to do one day of research. Sorry, one day of clinical and sort of four days of research or three and two, and you just can't do that as as a surgeon. It just you just don't get training at all. And as a senior lecturer, you don't get to do any operating as a consultant, so that's not really an option. And there's sometimes there's not much acknowledgement. Um, if you change hospitals, they can maybe be less protective of your academic time. They'll they'll think that you're more clinical. I don't think there was ever a year where my pay was, you know, a normal or right. At the beginning of the year, there was always either banding missing or HR forgetting that I was a trainee because I was an academic and therefore I wasn't on the payroll and again protected time, as I've mentioned. But it is possible as long as you're organized, as long as you prioritize things for you, and as long as you support of your friends, of your bosses and colleagues of people at home, because they are the people who keep you sane and that's it, because I think we're running out of time. Um, so a couple of questions. Did you manage to maintain lab work close, PhD, having a few days a week research practice? Is it doable? Yes, So my work so that my I had a problem, because as soon as I finished, so I got into my third year of my CL. And then the final year I moved hospital, and that's when Covid happened and the labs just shut and patient's didn't come in. And I did my research on, and I'm doing my research on patient with varicose veins, skin changes and venous leg ulceration. And they were the one group of vascular patient's that were kept out of the hospital with Covid because they're the only people who weren't losing legs or dying. So it was so so. That was the challenge, really. But actually yes, with sort of 2.5 days a week. Once I came back, then to Imperial, it was in my final year. A. I started having more students doing projects that were on basic science and therefore could move things forward with me co supervising them and be I had I had access to the lab and and was able to start doing some more experiments, so it is possible. But as you move on and you get more responsibilities that the time in general to do that becomes less, um, good clinical practice. It's basically a course that you need to do if you're going to do anything research related or if you're going to see CT. And if you go on the If you Google NIH are good clinical practice, it will come up and you click on the link and register and you do it. Um, there is no format to what is done in the PhD. It depends. So if you haven't got ethics and it's a new project, you might spend your few months trying to get ethics, ethical approval, trying to get some money to fund your PhD, that sort of thing. Um, if instead you're hitting the ground running because you already have ethics in place and your externally funded, then you can start recruiting on day one, so it depends on what where you are with your project. Um, CLS should not prolong training, so I was not prolonged. I have heard of people who have it is based on a R C P assessment, which is why I say you need to be better than everybody else. So because if you have less numbers than everybody else, is very easy to say. Oh, well, they're an academic. They only do it half the time. Let's extend them by a year you can do. There's nothing wrong with being extended at all. But if you're ready clinically and you think you're at the right level and you can do the stuff, then I don't see the reason to extend you a priority just because you're doing an academic job. Actually, you know, you do. You work very, very hard. And to me, it feels like penalizing someone. Um, you know, just because they've decided to to do that, Um, there was a room. Well, not a rumor, but there was There was some conversations about all academics being extended a couple of years ago, but I don't think that's happened because I I haven't been extended. And neither has anybody else who have worked with recently. Um, please give. Oh, sorry, Alex. Go ahead. I think the last two maybe not specific to your talks are they look like more, more generic question, which I'm happy for us to address at the end. Um, if that's okay with you, Unless you wanted wanted to say anything in particular on it, you know? I know. I don't think so. It's, uh I agree with quite, you know, I mean, one is on A C s anyway. Um, but yeah, well, thank you for the questions. We will. We will answer them, but it will be at the end. Um, and thank you very much for an extremely interesting talks are, uh I'm sure you'll have more questions coming in afterwards, but they'll they'll try and reach out to you over email. Or we'll also have a Q and a session for five minutes at the end. If, uh, you'll be able to join us for that. Or if not, it's It's, uh, fine. Thank you so much for your time. Try and make my way home with the tube strikes. Good luck with that. Yeah, exactly. That's why I'm still at work. But I will. I will try and call in from my phone. And then, if there's any of that, come up, I'll try and join on my phone if I can. Extremely interesting talk. Thank you very much for your time. We'd like to move on next to another talk