Case study: Your Path in Research - Neil's Greenshoot journey
Your Path in Research – we speak with Dr Neil Hoye, a Consultant Nephrologist at South Tees Hospitals NHS Foundation Trust who took the first step on his research journey by securing Greenshoots funding.
Tell us more about the SIMPLIFIED trial...
I received NIHR Greenshoots funding to ring-fence time as the local Principal Investigator (PI) of the SIMPLIFIED trial. This is a NIHR Health Technology Assessment-funded study investigating the Survival Improvement with Colecalciferol in Patients on Dialysis.
Vitamin D deficiency is common in kidney failure, and is a strong predictor of death from cardiovascular disease, infections and cancer. Dialysis patients typically receive active vitamin D compounds, since it used to be thought that only the kidneys activate vitamin D. However, it has been show that blood calcium concentrations increase with therapy and this type of supplementation may paradoxically make vitamin D deficiency worse. International treatment guidelines now recommend that kidney patients receive inactive vitamin D (known as colecalciferol), since we now know that every organ activates vitamin D as required, even in kidney failure. Colecalciferol has been used to treat vitamin D deficiency for more than 80 years. It is cheap and safe, even at high doses. However, this approach has not yet been tested in a trial. We are currently testing whether supplementation with colecalciferol increases survival (saving 4 or more lives for every 100 patients treated) in UK dialysis patients.
Are you continuing clinical work alongside your research?
Absolutely! Although I was very happy to receive this award, I remain a committed clinician, working in a busy NHS trust as a full-time general nephrologist and fostering my personal interest in haemodialysis. I have also been deployed to COVID-19 wards throughout the pandemic, leading medical teams as we care for many unwell patients alongside those with specific kidney disease issues.
What are your career ambitions?
I am keen to progress as a clinical researcher, particularly through increased exposure to haemodialysis trial work. I am building my research skill set, and have joined and contributed to trials at various stages, but also very much want to successfully write my own grant application going forward. Seeing a trial though personally from inception to publication is my next main aim, although in time I am also hopeful that research will form an equal part of my working week alongside clinical medicine. This will hopefully lead to further opportunities to be a PI and Chief Investigator (CI) trials and link in and collaborate with local, regional, national and international colleagues and ultimately be able to stand on my own two feet as a fully-fledged, independent researcher.
What were you doing before you became a researcher?
I qualified in medicine from Newcastle University in 2005 before commencing my post-graduate training in the North East. A move back home to Yorkshire in 2007 to pursue internal medicine and then subsequently nephrology training ensued, before an out-of-programme research placement in 2013 in New Zealand really whetted my appetite for further academic endeavours. This carried forward into my fledgling consultant career in Middlesbrough, where I was PI of my first trial in 2019.
What inspired you to become a researcher?!
A number of factors. Frustration was one significant component if I’m honest! As a nephrology trainee, when I was learning for my specialty exams, I started to appreciate how thin the evidence base was for a lot of what we do, particularly in comparison to other specialties. Not knowing what to do in different clinical scenarios irritated me, I have always prided myself on trying to provide the best care for my patients but increasingly felt my hands were tied by a lack of certainty. I was keen to progress our knowledge base and was drawn to scientific study, impressed by the rigour and demands that it necessitates and the outcomes one aspires to.
I have been fortunate to have learned from a number of supportive mentors, who are inspiring by their very nature. Through their tutelage and support, I have been able to dip my toe into the exciting world of research without getting overwhelmed. I am already very grateful to many different people whom I have met.
What do you enjoy most about research?
Collaborating with fantastically skilled and like-minded colleagues. As a medic, I have reasonable breadth of scientific knowledge, particularly about the kidneys, and know how to apply scientific findings to gain clinical benefit. Working with “proper” scientists however, seeing their meticulous approach, their vast depth of knowledge and experience is inspiring. I have learned a lot from many colleagues in only my brief research career thus far. It is particularly rewarding, and I have formed many firm friendships with this experience.
Have there been any challenges?
Very much so. It’s a lot of hard work, over and above what is commonly perceived. In my brief research career thus far, for example, I have encountered major research governance deviations, and had to spend a lot of time and effort attempting to remedy things. Research is sometimes perceived as glamourous (well, I was briefly under that impression anyway); I no longer think this, it is a pursuit for committed and hard-working individuals who are motivated to advance the knowledge base we hold.
What advice would you give to someone setting out in research?
Take your time, try not to run before you can walk. Don’t take on too much initially, get a good mentor to help guide your journey. Work hard, be flexible, be confident in what you know but respectful to the many people you will meet who will know more. Look after yourself, and prepare yourself for a long, arduous but ultimately rewarding research journey!