Dr Amy Coulden is a Specialist Registrar in Endocrinology and Diabetes, currently at the Queen Elizabeth Hospital Birmingham, and a Clinical Research Fellow within the University of Birmingham’s Institute of Metabolism and Systems Research. She’s a recent alumna of the BHP Starter Fellowship, having completed it between 2021 and 2022, and is now taking time out of clinical training to undertake a Metchley Park Clinical research fellowship investigating the role of ganglioside GM3 in acromegaly – a rare endocrinological disorder characterised by a growth hormone secreting tumour in the pituitary.

What attracted you to apply for the fellowship?

I have also been interested in research, ever since I did an intercalated BSc during my medical degree which involved four months of experience in the laboratory that I thoroughly enjoyed. I have also enjoyed clinical research and being involved in projects that can help instigate change, such as audits I did in my early training after qualifying. I was not aware of the fellowship before it was alerted to me by one of my consultants who thought I would be a good fit.

I knew that I was interested in doing a PhD or MD at some point during my registrar training (in Diabetes and Endocrinology), but I was unsure what I would want to study or whether or not it would be a large undertaking given that my research background was pretty limited. I thought a one-year fellowship would be a perfect way to experience research life for a year, while not taking a large amount of time out of clinical training.

The project that I have is excellent with a fantastic opportunity to work with some world renowned researchers, which definitely attracted me to doing the fellowship.

What were the benefits of fellowship?

It’s allowed me a ‘taster’ what both clinical and basic science research is, as well as giving me a qualification of an MSc at the end. It has reassured me that the research world and career is definitely for me and I am currently applying for funding to convert my MSc into a PhD!

I have learnt so much! Firstly, skills in the lab, from tissue culture, to using ELISA and qPCR. I have learnt skills in writing- both for publication but also for grants/ fellowship application and interview skills- all of which have been invaluable.

I have learnt how to organise my time, especially as research often does not go to plan. Balancing different projects and learning how to use the downtime when there is not much going on in the lab has been a challenge but has improved my organisational skills.

Were there any challenges during the fellowship?

My challenges are probably very common! Firstly, research takes time – often much longer than you expect and this should be factored in when planning. There are often delays, for example many of my reagents that I need for experiments have taken far longer to arrive than anticipated which delays the project. Sometimes the results you get aren’t what you are expecting, and this often means changes to your protocols and additional repeats. And sometimes things go wrong!

While these have been frustrating, they have taught me so much about planning and execution of research as well as troubleshooting.

How much clinical work did you do while undertaking your fellowship?

I have not done too much clinical work, mostly because the focus of this year was to be a pure research year. I have attended a couple of clinics a month but also regular MDTs and endocrinology meetings as well as the regular teaching training days. I have opted to do ad hoc locum shifts in General Internal Medicine every few months to ensure I don’t deskill.

Did the fellowship help with your clinical practice?

I have done many additional projects this year outside my main fellowship project such as case reports, poster presentations and reviews. This has allowed me to research and review certain clinical conditions and as a result I’ve improved my knowledge around these. The clinical work that I have done during the fellowship (such as fortnightly pituitary MDTs and clinics) have helped me in clinical practice.

Do you feel that the fellowship has helped you with your career development and aspirations?

Absolutely! I knew that I wanted to explore research but I was nervous about taking a large amount of time out of training of do a PhD or MD if it wasn’t suited to me. This fellowship has confirmed my love of research and how I want my future career to look. I am now starting an academic clinical lecturer post in August and applying for PhD fellowship this Autumn- neither of which would have been possible without this fellowship.

What would your advice be to anyone thinking of applying for a BHP fellowship?

If you are interested in research, but don’t have much experience or you are unsure if you want to embark on a longer degree but would like a ‘taster’ of research, this is for you!

Pip Nicholson is a clinical lecturer in haematology at BHP founder-member the University of Birmingham, and completed his BHP Starter Fellowship between 2015 and 2016. His research is currently focused on translating tyrosine kinase inhibitors to be used as anti-platelet drugs, and investigating the mechanisms of vaccine-induced thrombocytopaenia with thrombosis. He holds research grants from the British Heart Foundation, Wellcome Trust Translational Discovery Fund, the NIHR and a number of pharmaceutical companies, and is also chair of the HaemSTAR Network. He spoke to BHP about how his experience of the fellowship had led him to this point in his research career.

What attracted you to apply for the fellowship?

The fellowship was announced at a really opportune time for me. I’d just had a discussion with my now supervisor about the idea for the research and we’d been puzzling over how we could fund my salary to allow me to be released from my clinical duties. One of the limitations with other fellowships is that they require such detailed background and large amount of preliminary data. This means that doctors without a research background are effectively excluded from getting their foot on the first rung of the research ladder. While competitive, the BHP fellowship (or ITM fellowship as it was known then), didn’t require such extensive background information and the preliminary data required was a reasonable amount that could be generated by someone without any dedicated research time.

What were the benefits of fellowship?

The fellowship didn’t come with any significant strings attached such as teaching requirements. This meant that I could get on with the job of learning techniques and quickly generating further data to submit for larger, prestigious fellowship applications to support a full PhD.

Were there any challenges during the fellowship?

The main challenge was getting a full research fellowship application written and submitted in time for the various deadlines. To a clinician, a year to learn new skills and develop preliminary data seems like a huge chunk of time (my experience is that clinicians in training are happy if they get an hour to work on our own projects!). But the research environment is very different and long periods of time are required to learn skills, iron out issues with laboratory assays, and gain ethical approvals for the work.

While a year is sufficient time to generate data if you are focussed about things, the deadlines for the full research fellowships didn’t fall nicely near the end of the BHP fellowship and meant I had to put in applications before they were really ready. Towards the end of the fellowship I was still left wondering whether I had any ongoing research funding and this led to quite a lot of anxiety. I was fortunate to be placed in a well-funded lab where the brief shortfall in funding between finishing my BHP fellowship and subsequent funding from a British Heart Foundation Clinical Research Training Fellowship could be picked up.

How much clinical work did you do while undertaking your fellowship?

I very much wanted to keep my ‘hand in’ clinically, and so I did continue doing some clinical work. I was worried that if I didn’t, I wouldn’t be safe to look after patients when I returned on a more regular basis. So, I undertook in one outpatient clinic a week at the Queen Elizabeth Hospital, and I also did daytime on-calls at weekends at about a 1 in 5 frequency. In hindsight I think this probably slightly hindered my progress in the lab and actually my clinical skills probably wouldn’t have suffered significantly if I’d just stopped doing any clinical work for that year of the BHP fellowship.

Did the fellowship help with your clinical practice?

It definitely helped me identify the area of subspecialist clinical practice I wanted to do long term (i.e. thrombosis and haemostasis). It also gave me time to delve more into the clinical literature of this sub specialist area in order to better understand the pathophysiology and existing treatments and where the current limitations are in our knowledge.  I also gained experience in dealing with ethics applications and working with NHS Trust Research and Development departments which have been a useful skill.

Do you feel that the fellowship has helped you with your career development and aspirations?

Without a doubt, if it wasn’t for the BHP fellowship I can’t see how I would have got my foot in the door of the clinical academic world. I’m now a clinical lecturer, chair a national research network and am in the process of applying for intermediate clinical research fellowships to support me in a consultant role and as a senior clinical lecturer. I wouldn’t be in this position without that initial year of funding that the BHP fellowship provided.

What would your advice be to anyone thinking of applying for a BHP fellowship?

Talk to people who have successfully been award the fellowship and have completed it and moved on to higher research degrees and other fellowships. Ask them to look at their successful applications to use as a template. Talk to them about their experience of the fellowship itself. Identify a supportive research environment and speak to various members of that research group (e.g. PhD students and post-doctoral researchers). They are the ones who will be able to tell you what the research training in that group is really like. Don’t just rely on your impression of the supervisor!

Shaun Thein is a Clinical Research Fellow in Respiratory Medicine at the University of Birmingham, and undertook his BHP Starter Fellowship between November 2020 and November 2021. He’s currently in the second year of an internally-funded PhD, investigating neutrophil dysfunction in COVID-19 patients, as well as undertaking a PGDip in Medical Education. He took some time out to share his experience of participating in a research fellowship during the pandemic.

What attracted you to apply for the fellowship?

I applied for the BHP Starter Fellowship as I had developed a project during my academic clinical fellowship (ACF), but due to the time restrictions and COVID-19 redeployment, I hadn’t accumulated enough pilot data for a strong fellowship application. The BHP fellowship allowed me to collect more data to present a stronger case.

What were the benefits of fellowship?

The main benefits of the fellowship have been the long stretch of dedicated academic time and funding. This has allowed me to recruit patients in a block and have more time to become involved with other projects. I was able to defer finishing the modules I completed as part of my ACF, giving me the option to submit for an MRes if I was unsuccessful in my clinical research training fellowship application.

In addition, I was able to access the support of the College of Medical and Dental Sciences, attending a Scriptoria workshop, statistics courses and weekly seminars.

Were there any challenges during the fellowship?

Due to a further COVID-19 restriction, patient recruitment to the clinical trial my project was linked to was suspended.  As a result, I shifted focus to use my skillset in another project, investigating COVID neutrophil dysfunction.

Unfortunately, I was unable to secure funding after interview, so it was challenging to find a way for me to continue my research and PhD.  I was fortunate that my supervisor was able to internally fund another year of research for me to complete experiments and patient recruitment.

How much clinical work did you do while undertaking your fellowship?

I did extra out-of-hours shifts at a local NHS Trust to supplement my salary, as there was a significant drop when not doing on-call shifts. I continued this throughout my fellowship as it also helped me to feel more confident in maintaining clinical competencies – especially procedural skills.

Did the fellowship help with your clinical practice?

There was significant patient recruitment as part of my project, involving screening, reviewing imaging and consenting patients for research. I have also been involved in helping with clinical trial research as part of my group. Together this has helped me gain confidence in this aspect of clinical work, and I will be more proactive in recruiting patients and advertising clinical trials in the future.  However, being away from day-to-day ward and clinical work will always generate a degree of anxiety when returning.

Do you feel that the fellowship has helped you with your career development and aspirations?

Yes! It has given me the opportunity to complete a PhD, which I would have not been able to do otherwise, and has enabled me to be involved with clinical research trials and work with leaders in these fields. Being released from an on-call rota has also allowed me to pursue other personal developmental opportunities. For instance, I completed a PGCert in Medical Education and I am continuing with the PGDip this year.  I have also been appointed as the Chair of the British Thoracic Society Specialist Trainees Advisory Group.

What would your advice be to anyone thinking of applying for a BHP fellowship?

There is no reason not to!

However, it is important to apply with a project plan, supervisor and supportive group, and to think about alternative plans and contingency plans if funding applications are not successful.

While a year seems much longer than the 3 month blocks in the ACF, it goes by very quickly – the more that you can hit the ground running, the more you will be able to get out of the year.