Case study: Medway respiratory and intensive care consultant talks about his path in research and why others should consider a research career

What is your clinical role?

I'm a respiratory and intensive care consultant at Medway NHS Foundation Trust. My time is divided 50/50 between respiratory medicine and intensive care medicine. Working at a district general hospital means a lot of my time is in clinical service delivery.

How did you start your research journey?

I started my research journey because I began to take some interest in trying to find answers to problems. I come from India, where the air quality is poor, and many respiratory diseases come from air pollution - outdoor from vehicles but also indoor from biomass fuel-related air pollution. It struck me that a lot of chronic obstructive pulmonary disease (COPD) in India occurs in women especially because of poor air quality indoors. I started reading about it and then I did a few small projects with a health economist at the University of India. We took some measurements in people's homes, particularly around exposure to children. She subsequently published papers with her local team because of what we started. I moved on from that team and when I started my consultant job, I wanted to carry on working on research.

I wanted to do some training in order to understand research methodology so I decided to do a Master's in Public Health at Harvard University. I had to be in the UK most of the time, but over two years I went to Harvard for three weeks a year to be on-site, and have concentrated time with people who were in roles such as statisticians and epidemiologists. The course put me on fairly strong ground to have a better understanding of research methodologies.

Which COVID-19 trials did you work on?

Having done my Master's in Public Health made me quite sensitive to what was happening around the world. Early, in the first or second week of January 2020, I was already following what was happening in China and reading up about it as a few case reports had already been published in The Lancet and The New England Journal of Medicine (NEJM). I had a feeling that something big was happening and that it was probably going to be a respiratory pandemic.
As soon as I saw the RECOVERY trial protocol, I wanted to be the Principal Investigator for the trust because I have a foot in both respiratory and intensive care. I knew that I could probably recruit many patients and be involved with their care directly. We recruited people by going around the ward and as we did not have research nurse resources in our team, I had lots of Foundation 1 and Foundation 2 doctors, senior house officers and registrars trained to take consent from patients.

During the first wave, I was in touch with friends in India who were doing things differently from the UK and were asking me questions about my two specialties. In India, everyone who had COVID-19, or was suspected to have COVID-19 was having a computerised tomography (CT) scan. A friend of mine told me that he was carrying out 400 scans a day! Then I thought about who was doing the quality control on the scans as you can't be doing a good job on all 400 scans. I worked with a researcher at the Indian Institute of Technology about using CT scans to automate the diagnosis of COVID-19 with particular emphasis on CT automation of CT severity. A hospital in India gave us 450 CT scans of COVID-19 patients to analyse.  This was my first chance to take an idea of mine, test it and generate results. I also did some work on automating some electrocardiogram (ECG) diagnostics and the results are now in a manuscript ready to be submitted for publication.

Why should research take place at a district general hospital?

A district general hospital setting is most likely the place where you are going to apply the results of the research in the treatment of patients. We need patients recruited from district general hospitals, because without them, results could be influenced by selection bias resulting from recruitment only from University hospital setting. You may have a perfectly designed treatment, which works well in a university hospital setting, but it might fail in a district general hospital setting where resources are different. Health inequalities may be more prevalent in the patient population served by a particular or group of district general hospitals. For example, the Medway area has evidence of poorer socioeconomic status in some of its population, compared to, for example, neighbouring areas such as Tunbridge Wells. This can lead to differential health outcomes with patients from Medway having a lot more disease burden than their neighbours do. Therefore, it is important that more clinical and epidemiological studies are based in a place like Medway.

Conducting research is not only in someone's academic interest, but it is actually for the patient’s benefit and safety. Research active hospitals are more likely to deliver better patient care and more likely embrace newer and better ways of delivering that care. This is a huge driver for me. We should see each patient as a potential recruit for some kind of study - that is the ideal situation, as every patient brings with him or her newer information. It doesn't always have to be an interventional study, it could be observational study or data collection.

What advice would you give to others considering a career in research?

The first thing is to identify a topic that fits your interests and is close to your heart. Research should not be something to just put on your CV. If that is your only motivation then we might not as well not do it.

Take the initiative to understand the research process. Make time to be trained properly because the training that we gain in our clinical training year or in medical school is often not sufficient. Without the proper training, doing justice to your research question is not possible. It is possible to produce bad research, for example, if you are not aware of the biases that can be generated in a particular study, the results will also be biased and misleading. As a start for a junior doctor, undertaking Good Clinical Practice (GCP) training which can be done online may be a good stepping stone, and then getting involved with ongoing studies at their hospital to gain experience in research consent and recruitment process. The NIHR Associate Principal Investigator (PI) Scheme is an excellent opportunity to formalise this process for the interested. A well conducted project, at the end of the day, is great teamwork and can be fun. For example, the newly qualified doctors in their Foundation 1 and Foundation 2 years who were working on the RECOVERY trial had no prior experience of a trial and now they know how to consent a patient and are having a greater interest in doing their own research. Finally, you need to decide if you want to undertake formal training in research with an academic degree if there is deeper motivation to conduct studies on an ongoing basis.