“Academic surgeons push boundaries, as we are the first to develop new technology and use them in patients. This is inherently very risky”
As a clinical academic, I have developed a career that is partially science and partially surgery. My current research work focuses on the use of implantable robots to overcome any form of motor loss in the body, with the potential to benefit those who suffer from throat or urinary system ailments and nerve or muscle problems that accompany ageing. I collaborate with teams of both surgeons and scientists from several institutions to develop innovative new therapies for medical issues. The surgery that I do adds meaning to this research, especially as the focus of my research is driven by the real issues faced by my patients.
My work, in collaboration with others, has led to some amazing breakthroughs. But what I am most proud of is having helped to develop the careers of bright young surgeons and scientists. The sustainability of academic medicine ultimately depends on propelling the brightest people into the best places, and I am glad that I have played a role in that. I have done my best to identify those who are performing well (regardless of whether they are clinicians or scientists) then inspire and encourage them to go further, with the aim of eventually leading their own research.
This aspiration of mine has been inspired by my own journey into academic medicine. I initially pursued surgery because I found it exciting, hands-on and loved anatomy, then ended up in Ear, Nose and Throat (ENT) surgery as it happened to be one of the house jobs I was allotted to. In the 80s (when I started!), a large portion of ENT surgery lacked a scientific evidence base. Thus, I was inspired by some of the best ENT academics to better understand the physiology of the patients we were treating – which is why I developed a career integrating surgery with science.
Dipping out to do research was not without its challenges, of course. When I started, clinical academics were viewed with suspicion, as the prevailing view was that you could not be both a surgeon and a scientist. As a junior I was told by some seniors that “I would never be able to cut properly” if I continued to spend time doing research, and that they would not support me in that venture. Academic surgery is like walking a tightrope, as more time on research means less time in theatre, which brings with it the danger of de-skilling. The answer to this lies in subspecialising in a specific field – but getting into the niche is also challenging!
Academic surgeons push boundaries, as we are the first to develop new technology and use them in patients. This is inherently very risky, and so not all our colleagues will see this as acceptable and there may even be institutional pushback. Ultimately patients are very accepting once the risks have been explained to them in an ethical manner, as they will have suffered from an illness that conventional medicine will not have had a solution to. Additionally, these is the issue of work-life balance as you effectively have two jobs instead of one, and end up seeing family less. Being in a split career means income is lessened, and there is always the challenge of finding funding for your research. Put together, academic medicine can be a hard sell to people and their families.
In the face of these challenges, it is even more important to nurture our future clinician researchers. For example, the UK’s National Institute of Health Research has introduced an incubator for advanced surgical technology, recognising that there are myriad structural, financial and career challenges in pursuing this career. Good research is ultimately down to having the right question and pursuing it in the right location with the right team. Securing funding when these criteria are in place has never been difficult, although it may become increasingly so as time goes by.
An artefact that embodies my career would be a lion’s larynx that I keep in a Perspex case on my desk. This was collected by the prolific larynologist Professor Donald Harrison, one of my predecessors, who collected larynxes of various fauna during his extensive travels. This is the organ that I have spent my life studying, and it produces a lion’s roar (the most impressive sound of all in the jungle!) that epitomises resilience, survival, perseverance and strength in the face of incredible challenges – All of which are essential traits to have in the noble pursuit of being a clinical academic.
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