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by Simon Lambden, Academic Clinical Lecturer

Critical care is a great specialty in which to train; technical and non-technical skills are tested every day, and it is increasingly clear that the delivery of high quality care is dependent upon effective team interactions at every stage. During the last decade, critical care has become safer, and better at limiting the damage caused by supportive therapies. However, the development of new treatments has not kept pace, and no drug for the treatment of sepsis has retained a license for clinical use. We may be able to address this challenge by developing a cohort of clinicians with academic training, which could increase the likelihood of successful translation of novel discoveries to clinical practice.  The Walport report of 2005 recognised the need for this pathway, and out of that grew the National Institute for Health Research (NIHR) Integrated Academic Training Pathway for Clinicians.

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There are no fixed rules regarding how that time is scheduled, except that ACLs must complete their clinical training reaching the same milestones as all other trainees.

I have recently been appointed to an NIHR Academic Clinical Lecturer (ACL) post, which represents the last step on this pathway for junior doctors. Between 2010/2011 and 2016/17, the NIHR tell me that 15 CLs have been appointed in anaesthesia or critical care. I am one of three currently employed by the University of Cambridge. The NIHR funding offers 50% clinical and 50% academic time, for up to four years. There are no fixed rules regarding how that time is scheduled, except that ACLs must complete their clinical training reaching the same milestones as all other trainees.

I have relocated from London to join the University of Cambridge Critical Care Research Group.  Our goal is to build a world-class research group, bridging basic science and clinical research to take mechanistic insights from the laboratory into robust human studies.  The group is led by Charlotte Summers, whose main interest is in mechanisms of acute lung injury.  The two other Clinical Lecturers are Andrew Conway Morris and Alasdair Jubb, focussing on nosocomial infection and epigenetics respectively.  In addition, the team contains a number of PhD students, Clinical Training Fellows, research nurses, and non-clinical scientists.

My work is in the mechanisms that drive the development of vascular dysfunction in sepsis, which follows on from the research I started during my PhD at the MRC Clinical Science Unit in London/UCL. Starting at Cambridge has allowed me to develop a new collaboration with a world class basic science group as we try to understand the reasons why some patients develop vascular dysfunction following infection; this involves working with animals to understand the biology and test new treatments, and with patients on the ICU to explore the role of the pathways we have identified.

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The many competing demands can be hard to co-ordinate, but having ownership of the projects is incredibly rewarding

The challenge of the ACL post is in developing an academic career in parallel with clinical training.  At any time, the ACL is expected to be writing research publications, preparing and submitting grant applications, presenting at meetings, all in addition to conducting their own experiments and undertaking clinical training. The many competing demands can be hard to co-ordinate, but having ownership of the projects is incredibly rewarding, and there are highly skilled people at every turn who are keen to support the progression of my work.  In addition, my research activity has given me the opportunity to talk and collaborate with leaders in critical care outside my group, which has offered real insights into the development and future of critical care, as well as helping me refine my own areas of interest.  Most of all though, the ACL post has allowed me to come to work with a motivated, high quality team which understands that collaboration and a supportive environment are critical to success; an approach that I hope will make identifying new treatments and discovering which patients benefit from them more likely.

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You can follow the group and/or contact them to get involved in their work at:

http://anaesthetics.medschl.cam.ac.uk/ccg/

Twitter: @Cam_ICUResearch

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