Case study: "These early research experiences showed me the breadth of research that one could do in public health"

Dr Kyla Thomas, Clinical Director at the National Institute for Health and Care Research (NIHR) Clinical Research Network (CRN) West of England shares her path in research with us.

I have wanted to be involved in research since I was in medical school in Trinidad and Tobago. My first experience of doing any research was a third year project where we looked at the microbial quality of bottled water. At the time the use of bottled water was taking off and there were some concerns about whether it was safe to drink. So we did this project and we found that 5.2% of the 344 bottles we sampled contained coliforms (bacteria like e-coli that you’d find in faecal content) and was unfit for human consumption. That was my first experience of any kind of research; there was a microbiology slant to it as well as a public health perspective.

My interest in Public Health started to develop more and I thought that I would like to have a research career. That wasn’t an easy career option in Trinidad as there were less research opportunities. Also, although you could do training in the standard specialties, like surgery or medicine, there was no clear specialty training process in Public Health. Also, it wasn’t really clear how one could become a public health academic.

The second specialty that I really enjoyed in medical school was obstetrics and gynaecology. For me, it included a combination of having to implement public health measures, so all the important things you’d have to do with mums to enable the best start in life for their babies from a population health perspective, in terms of not drinking, not smoking, but also there’s a lot of general medicine in it and surgery. During my elective, I carried out a gynaecology audit looking at women who had cervical cancer and their age when it was detected. There was no routine cervical cancer screening programme in Trinidad so it was ad hoc whether someone would present for screening and often we’d end up finding the cancer at quite a late stage which made it difficult for the patient's prognosis and treatment. That really bothered me as our local women were suffering needlessly. I thought if we picked up the pre-invasive stages of cancer, we wouldn’t have such high mortality and wouldn’t have so much morbidity as a result of it. I realised that the lower mortality rates we saw in other countries were mostly due to national screening programmes and not more advanced treatment.

I applied for the Rhodes Scholarship when I was in my final year of medical school training. Fortunately I was successful, so I finished my medical degree and came to Oxford to do my MSc research project “Epidemiological investigations in cervical cancer.” I did that for two years and then in the third year of my funding Oxford introduced an MSc in Global Health Science which was their MSc in Public health equivalent. My MSc dissertation was gestational age assessment in Karen newborns in Thailand. During this time I also worked with researchers based at a Karen refugee camp in Thailand. These early research experiences showed me the breadth of research that one could do in public health; I was doing microbial bottled water quality one time, then I was doing cervical cancer epidemiology another time and I was now doing research that involved working in a refugee camp on the border of Myanmar. I thought that was amazing.

As I’d graduated from medical school and gone straight into doing research, I recognised that I needed to go back and do my internship/foundation training, get full registration with the General Medical Council and get into a specialist programme. So I went and did my two foundation years with the Oxford Deanery, completing the usual rotations (Medicine, Surgery, General Practice) but also Respiratory Medicine, Gastroenterology and Immunology. In each rotation, all I could see was the public health issues the patients had, for example COPD was caused by smoking and so many of the cancers were also associated with smoking and/or alcohol misuse. The public health issues were just always in my mind. We’re dealing with these people right at the end, why didn’t we do something to stop them from getting there in the first place? I just kept thinking I really need to do public health specialty training, but I wanted to do research as well. So I applied for one of the NIHR Academic Clinical Fellowships (ACFs); they were really good because you got to have a day a week of your time to do training in research. I was fortunate that I got invited for ACF interviews in the three places that I applied. Bristol was my first interview and I took the job when it was offered. I have never regretted this. It was an absolutely wonderful specialty training programme, and it still is one of the best training programmes in the country.

I started my research at Bristol looking at suicide epidemiology and self harm. I used that to develop research skills for myself on top of the MSc research I had done in Oxford. My successful Doctoral fellowship proposal to the NIHR was in pharmacoepidemiology, particularly regarding the neuropsychiatric safety of smoking cessation medicines. At that time a new smoking cessation medication, varenicline, had been launched, and there were concerns that it was linked to increased risk of suicidal ideation, suicide attempts and suicide. My proposal was investigating the safety of the drug using different study designs to see if those concerns were actually founded. I completed my PhD with Commendation and also completed my specialty training in public health as an NIHR funded academic clinical lecturer. Since then I’ve completed more NIHR funded HTA grants on the effectiveness and safety of smoking cessation medicines and electronic cigarettes. My findings have been used in the National Institute for Health and Care Excellence (NICE) guidance in terms of recommendations for public health practitioners and smoking cessation services. Of all the work I’ve done, I think this project has had the highest relevance nationally and internationally, and my work was recognised by the Society for the Study of Addiction in 2019 where I was jointly named Researcher of the Year.

I think public health research is really important because of the extent of the lives that can be saved and the big difference you can make to help improve people’s lives. When you think about the lives that have been saved by public health measures, even going back to the importance of proper sanitation, clean water, and limiting overcrowding, these are quite basic living conditions that have made a huge difference and saved countless lives. There’s no subject area which wouldn’t benefit from public health research.

One of the things I’m passionate about is how we do research, especially how we support local authorities to be more evidence-based and to make more use of research in their policy and decision making. My colleagues at the local authority do such interesting work and it’s just trying to see how we can answer topical research questions and widely disseminate those findings so that they can benefit more people.

For me it’s really exciting that there has been an increased recognition of the importance of public health research and the need for research to happen at a population level. The national recognition and understanding that we need local authorities to be research active organisations, and for there to be investment in that, is such a positive thing that could potentially make a huge difference to local populations. We’re not just describing health inequalities, we’re actually coming up with interventions to help address them including focusing on how we address the building blocks of health (housing, education, employment etc).

For anyone interested in getting involved in public health research the NIHR has a lot of different resources. I’m part of the NIHR public health incubator and we’re doing a lot of work to create opportunities for people who come from a public health background and also for those who don’t, because everyone can be involved in public health research. My main piece of advice would be to ask questions, if you're a public health registrar or a public health practitioner, think about relevant research questions in your own practice, then think about how you might want to address those questions and then look to see what resources are available that might help you to do that.

The NIHR is a wonderful organisation and I feel privileged to also be part of the NIHR as Clinical Director of the CRN West of England. My interest was peaked at the time when they were talking about expanding into public health and social care settings and supporting local authorities. I applied for the role and remember thinking I could help with this and I could bring the skills I have from working across systems in public health to the CRN director role, which is responsible for all the different specialties, not just public health. Public health research has acted as a gateway to make me think about other roles and leadership roles in research delivery.

The NIHR has put a lot of investment into Public Health Research. I wouldn’t be where I am without the investment of the NIHR; as an academic clinical fellow, a doctoral fellow and academic clinical lecturer and even now as a postdoctoral fellow I’m still funded by the NIHR. So the NIHR website is a good place to start, contact people, ask questions and make use of the opportunities that are available, you won’t be disappointed.

Interested in finding out more about a career in research? Find out more about Your Path in Research.