Like many of those who have featured in this column before me, my reasons for going into research were a mix of interest and serendipity.

For some time I have had an interest in the legal and ethical side of medicine. From memory my first choice of career, after I realised I was unlikely to become an astronaut, was law. This changed fairly quickly but I suppose that early interest persisted.

Often in the care of older adults, something more than medical knowledge is required to help with many of the problems they face. During my training I have learned, and continue to learn, the skills required to assess and manage these problems as an ongoing part of my clinical life. A desire to have a better understanding of the legal and ethical aspects of some of these problems led me to look for an opportunity to carry out research this area.

The opportunity arose in the form of a distance learning course in medical law and ethics run by the University of Glasgow. This is a three-year course that covers the major areas where medicine and law interact, and leads eventually to an M Phil. The topics covered in the first two years are diverse, going from medical negligence to product liability via consent and, at some point, human cloning! The last two years allows one to focus in greater depth on a specific area. During this phase I have now reached the stage where I am completing a dissertation on my main area of interest: how the law determines whether or not adults are capable of giving consent. I have enjoyed it greatly and have benefited from the different views in these areas, being able to screen out the intensity and necessity for pragmatism, inherent in the clinical situation. It was enlightening to spend time reading in what way legal academics, philosophers, and in some cases, patients, attempt to formulate answers to some of the ethical dilemmas commonly faced in clinical practice. I have found that having increased familiarity with the basis for the diverse views that are held, has helped greatly when faced with some of these views in practice.

Doing a law degree was a bit of a culture shock. Research in this area is different from research in the life sciences. Structuring arguments and analysing legal rulings, as opposed to structuring experiments and analysing results, become the important issues. This involves a change in mind set that is challenging, but rewarding. Many of us in the medical profession enjoy thinking through problems. Studying medical law provides a good deal of satisfaction in this area.

Academic Medicine
Around the same time that I became aware of the existence of the M Phil degree, an opportunity arose locally to apply for a clinical lecturer’s post in medicine for the elderly. My decision to move from a specialist registrar position to a more academically slanted post was swayed by my impression that this would provide more protected academic time. Other holders of similar posts will be aware that this may not have been a particularly accurate impression. The more academic post, however, did provide significant advantages. Firstly the fees for my degree were covered. Other less blatantly pecuniary advantages also followed. One was a two edged sword. As clinical lecturer I was expected to continue progressing through my training towards an eventual CCST. I therefore had effectively two masters: the JCHMT and the University. This was an advantage, as both required evidence of, thus necessitating, progress. The downside was the considerable pressure generated from trying to please both. A further problem I faced was the difficulty I had trying to convince the JCHMT to accredit some of my research time against geriatric training, leading to significant time pressures when that request was denied.

Working for the University has certainly helped keep my academic life diverse. Although my main interest had been in how decision making capacity is assessed, opportunities in other areas have arisen. I did not slot into a pre-existing research project and so most of these opportunities have involved working up projects from an early stage. This has provided a realistic impression of how difficult getting things up and running can be. It is extraordinarily rewarding when things work out and more than a little discouraging when they do not. This, I am reliably informed, is a fairly realistic description of academic life. Teaching opportunities with the University have also been broad and rewarding. The University runs an excellent training course in teaching methods that is aimed at new lecturers in all disciplines. I learned much from seeing how other disciplines approach teaching.

Time
Since I moved into academic medicine, time seems to have moved faster. I am currently preparing for what I hope will be consultant interviews and feel that the 10 years or so since I started my house jobs have shrunk into as many months. Early in my SpR training I attended an excellent basic research methods course run in Aberdeen (I urge anyone with an interest in research to attend such a course). This stressed being realistic as regards how much time you have for research and assessing how much you can expect to do in that time. I received excellent advice that I would have been wise to pay more attention to. It is notable how busy the final year of training is with trying to tie up, and write up research, that has been started, completing the clinical component of training, all the while keeping an eye on the job market.

The degree I took lasted three years, part time, a duration that appears fairly standard. Registrar training currently lasts approximately five years, and I would advise others, who are thinking of completing a degree, to try hard to start at the beginning of their second year. I spent my first year in a district general hospital before moving to what would eventually be my base hospital for the remainder of my training. It was probably a false economy in my case, to try and avoid overloading my first year in a new hospital. Things do not get quieter with time.

Worth It?
Absolutely. Despite the significant time commitment I feel that doing a degree during registrar training has been an excellent experience. If these courses are well run, as mine was, one is likely to progress relatively smoothly through the course. In contrast, my experience of small projects squeezed into time cleared from clinical commitments has been less satisfactory, although not without value. Developing a special interest, in my case law and ethics, has the potential of moulding a whole career. It is surprising how many exciting opportunities have arisen already, due to being known to have this interest. We all wish to help advance, and in some way change for the better, the care of older adults. Research into an area regarding that care that we find particularly interesting, I hope, will prove a good way to increase the chances any career will attain that goal.

Martin Wilson
Clinical Lecturer and Honorary SpR
Department of Medicine for the Elderly
University of Aberdeen