Going Into Research
by Alasdair Maclullich

Like most iatroblasts*, I started university without knowing exactly what career I would follow, but through various family influences, I started medical school predisposed to the idea of doing research.

I was also eager to find out more about the brain. I know this sounds a tad geeky, but I’m afraid it’s true. In the first term I put my name down for a psychology tutorial group. We did a small study on relationships between neuroticism, type A personality, and ischaemic heart disease, and I found that I liked the process of searching the literature, reading journal articles and doing a bit of writing.

Trawling dusty corners
A BSc in psychology followed. In the first few weeks of this I was taken aback by the amount of controversy and debate going on beyond the world of pre-clinical medicine. It took time to realise that arguing around a position, rather than reproducing facts, is central to doing a science degree and, of course, being involved in scientific writing and research. Having got over this hump I had a great time as a psychology undergraduate. I spent hours and hours lost in the dusty corners of the library and, worryingly, enjoyed it rather a lot. Two years later I did a research elective in the Institute of Psychiatry and this convinced me emphatically, that I wanted to do academic medicine.Towards the end of my medical rotation I was approached by a local academic geriatrician, John Starr, with the idea of doing a project on the associations of variations in cortisol levels with cognitive ageing. I liked the mixture of psychology and biology and went on to secure funding, starting a PhD about a year later.

Hard lessons and all-nighters
The PhD project combined neuroimaging, cognitive testing, and various measurements of glucocorticoids, in parallel with quite a bit of lab work, mainly in situ hybridisations and radioimmunoassays. It was a bit of a stretch to fit all of this in, especially since I am not quite a virtuoso administrator. I learned through a few hard lessons and more than one all-nighter, that research involves a bit more planning than is the norm as an SHO in medicine! But it was an exciting and enjoyable time. The diversity of tasks gave me a good education in a few areas, from molecular biology to cognitive testing, and I picked up some generic skills as well.

Towards the end of the PhD I was lucky enough to get a Clinical Lecturer/Honorary SpR post. In this job, I have been able to continue my research work in parallel with clinical training. I have also been very involved in teaching and examining, in medicine and also in Honours courses relevant to my research (Neuroscience, Endocrine Pharmacology). Because the academic and clinical components of my job are quite different, it does sometimes feel like I have two jobs, and now and again there are clashes. Sometimes I have had to be firm about maintaining my research sessions: a few afternoons can add up to an all-important publication a few months down the line. But I have been fortunate to have worked for understanding senior clinical colleagues throughout my training and, generally, I have not had the restrictions and difficulties that I know some other junior academic physicians have experienced.

There are lots of reasons why I am continuing in academic medicine. I take pleasure in the process of following up something that has caught my interest, developing some ideas, turning these ideas into projects, producing new data, and putting it together as a paper. Other things I like are the variety, learning about favoured subjects in depth, attending conferences and meeting colleagues from other countries (and health care systems), not to mention the involvement in education. Furthermore, I really enjoy the combination of doing research and being a clinician. The frequency of the three D’s (dementia, delirium, and depression) and stroke in our practice means that geriatrics is one of the best specialties to inform research on the brain. One of the main areas of my current research efforts is delirium, and my interest in this has come directly from seeing it so often on the wards. When reading up about it, I am struck by the remarkable lack of knowledge about its pathophysiology.

Finally, because research underpins virtually all advances in understanding of psychiatric and neurological disorders, I certainly never feel that my research work is irrelevant to the welfare of patients. Those of us in geriatrics who take time out for research do so for a range of reasons. After an MD or PhD, some will choose an academic career, and others will re-enter clinical practice armed with the benefits of a research training. My choice to do research and then to stay in academia has been driven by a strong and long-term interest in the brain and its disorders. My research work complements my clinical practice well. I’ve been fortunate to have excellent mentors along the way, and importantly, I’ve done my clinical training in an environment which is highly supportive of academic trainees. Pursuing an academic career is not as clear-cut as clinical training and there are challenges to overcome. But if you find yourself habitually reading journals and tracking down ‘that crucial paper’, or getting into long discussions about the whys and hows of your favourite areas of clinical practice, I would strongly recommend giving academic medicine a try.

* iatro = doctor; blast = undifferentiated cell. Therefore iatroblast means ‘medical student after a curry’ - The Editor