It might never have happened if I hadn’t applied for the wrong job.

I was in the familiar position of looking for a local NTN, with none on the horizon, so I applied for an SHO3 post in endocrinology. To the credit of the interview panel they saw right through my pretence that this was vital training for a fledging geriatrician, and awarded the job to someone more suitable. I was amazed when one of the panel telephoned me later to ask if I had considered research. I guess my CV had a slightly academic feel: I had had a summer job with my father, a chemical pathologist, which had led to a publication about nutritional status, and I had done a BSc in psychology, but on the clinical treadmill the possibility of a period in research had not crossed my mind. I was immersed in a busy medical post, and at a stage when few geriatric trainees were considering research. However, this academic painted an exciting picture of research life, and suggested some people to talk to, whose interests might be relevant to geriatric medicine, and so my journey began.

I realised that what I enjoyed about geriatrics - the huge range of clinical problems, the multidisciplinary work, the feeling of making a difference – meant that research projects in almost any specialty would be relevant. I spoke to several people, all happy to discuss potential projects with me, and so I came to hear about the Scottish Mental Survey 1932. This had led to an ongoing collaborative project between a geriatrician, psychologist and a psychiatrist, looking at cognitive change across the lifecourse in people born in Scotland in 1921. They had just identified birth records for some of this cohort, which included birth weight. The Fetal Origins of Adult Disease (Barker) hypothesis was just gaining popularity, and the group was interested in finding someone to look at early life influences on cognitive change and cerebrovascular disease.

Tailor made for me
I still can’t believe my luck. I could never have designed this project alone, but I could not have imagined anything better suited to my experience and career path. The fact that this idea was well-developed meant that we were able to submit an application for an MRC Clinical Training Fellowship which I was lucky enough to have funded, providing a salary and expenses for three years of full-time research.
While applying for this fellowship I also finally got an NTN, and started doing general medicine in a district general hospital. If my plans had not been well advanced by then I’m sure I would have given up; we all know how difficult it is to take research time in these posts, and I would have had neither time nor energy to start the process from scratch. Luckily, everything went smoothly, and I started my research at the beginning of my second year as an SpR, and am due to return to clinical training in year 3 in just a few weeks. For me, this was an ideal time to take a break from clinical duties and welcome relief from the intensity of general medical take.

Acquiring research skills
The time has flown by. In the first two years I made a big effort to attend formal training courses in literature searches, computer packages, writing - all free to university employees. I would definitely recommend this, as it can be easy to complete a research degree with a great deal of knowledge about your project but few transferable skills. I also completed an MSc in epidemiology (part-time over two years) which gave me a solid grounding in research methodology and advanced statistics. Many PhDs now require you to do an MSc by research in the first year, and I followed a similar model en route (hopefully!) to an MD, basing my dissertation on the first phase of my data collection. If you don’t want to do the full degree many institutions will allow you to sit in on some modules. I handed in my dissertation two weeks before the birth of my little boy - a bulgingly visible deadline to work to! It may be a bit of a cliché, but taking maternity leave during research meant I had more flexibility, and that my absence did not increase other people’s workload. I have returned to work part-time, three years have turned into four, and I have enjoyed the balance between home and work life. Juggling the two jobs has sometimes been challenging, but I thoroughly enjoy both my roles.

Taking time to think
Many people feel that the research and clinical worlds are very different, and I have certainly noticed many differences as I moved to full-time research. The main one was the slower pace of life: it takes time to absorb literature, to generate ideas, and to write. Having made a decision not to do any on-call, I also enjoyed having more time to do other things, like a bit of undergraduate teaching and picking up some old hobbies, not to mention spending time with my family. There were also lots of similarities. In my clinical project, the main pleasure was the patients/subjects, and it was a refreshing change to see 80 year olds who were all basically healthy, some almost too busy to keep appointments. There were, of course, the boring bits, the form-filling, letter writing, data checking and entry, but somehow these were much easier to deal with because they were ‘my’ boring bits! I have surprised myself by actually looking forward to doing statistics, and enjoying presenting my data at conferences. I look back at these four years and don’t regret any of it.

Destiny in one phone call
My story is only one example, a change in direction triggered by one phone call. There are as many routes into research as there are people doing it, and as many potential projects as all our imaginations can devise. From planning health services, through understanding the epidemiology of diseases, to unpicking biological processes; from years of full-time experiments to reading and writing a few hours a week, there is something for everyone. Most importantly, research should be done ultimately to improve patient care, and in my mind is an integral part of clinical training, rather than an alternative. I have loved immersing myself in the world of research for a few years, but now the challenge for me will be to try and combine clinical work with my research interests. There are always more questions to try to answer and more patients to assess and treat, but never more hours in the day!

Susan D Shenkin
SpR in Geriatric and General Medicine, South East Scotland and
MRC Clinical Training Fellow
Susan.Shenkin@ed.ac.uk