Bones of Contention – HIV and Bone Disease Dr Paddy Mallon MB BCh BAO FRACP FRCPI PhD
Clinical Academic role A personal story. Pathway MB BS/BCh MD/DMPhD Intercalated MSC.
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Transcript of Clinical Academic role A personal story. Pathway MB BS/BCh MD/DMPhD Intercalated MSC.
Clinical Academic role
A personal story
Pathway
MB BS/BCh
MD/DM PhD
Intercalated MSC
MD/DM PhD
It depends…..
MDs/DMs• Historically regarded as
highest degree • More clinically/translationally
based• More autonomous/Less
supervised• Completion in approx 2 years
(often part time within training slot) Quality over quantity, possible to do without going OOP
PhD• Most modern universities
promote PhDs as best academic career pathway More /basic science/analtytical/lab based
• Rigid PG monitoring• Standardized minimum 3 year
period (requires OOP funding eg WCAT scheme)– Only 6-12 months research can
be counted towards CCT
It depends…
• Where you are – Cardiff definitely a PhD place
• Instituted PG monitoring and minimum 2y FT period for MD
• People around you – A lot of snobbery. Depends on what you
supervisor has got
Academic pathway combines• Clinical work• Research • Teaching
– Curriculum development– Formative and summative assessment– Undergraduate – Postgraduate
• PhD, MPhil, MD etc
– Administrative roles– Student support/experience
• Innovation and Engagement – Professional roles– 3rd mission activities
Two routes
• Teaching and scholarship • Teaching and research
My route• Natural Sciences/Medicine, Cambridge 1975-78 BA,MA• Westminster Medical school 1978-81 MBBS• House jobs London /West country 1981-82• SHO in Medicine in Cornwall 1982-83 MRCP• SHO in Pathology Westminster 1983-84 MSc
(immunology)
• Register in Microbiology 1984-87 MD• Lecturer in Microbiology Cardiff 1988-91 MRCPath• Senior Lecturer/Honorary Consultant 1991• Reader- Professor
• Initially 5/11 university; 6/11 NHS• New NHS Contract• 4 academic sessions; 6 NHS sessions (1 additional session)
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• 8 month old boy with Wolmans disease (lysosomal storage disease)
• MUD transplant • Did well until sudden
cardiorespiratory arrest
• 30 year old female AML • 21 days post SCT complained on
nasal congestion and pain sinus pain• Necrotic lesion on face
– Asp flavus grown from tissue
• Extension of eroded down tthrough palate and back into brain
• Died with widespread disseminated disease
The plan
Grow Aspergillus in peptone broth for 6 days in constant
aeration
Harvest mycelial mat
Disrupt mat
Afinity chromatogaraohy (Con A) to separtate into water soluble / unbound/
bound fractions
Develop inhibition ELISA
• commerical assay (gactomannan EIA)– Monoclonal antibody– galactofuran side-chains
2000’s
• Establish PCR as a diagnostic tool – Evaluate clinical utility
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All Publications
Real-time PCR
Conventional
Review-type Articles
Real-time
To define a standard for PCR for Aspergillus to define disease and improve diagnosis
Provide optimal methodology for inclusion in a multi-centre clinical trail to evaluate the performance and impact of PCR diagnosis
Evaluate commercial assays and platforms for diagnosis
Antifungal expenditure
Cardiff patients• Dectin -1 Y238X:• 181 patients
– 84 patients with IFD– 97 patients with no evidence of IFD
• Overall incidence of SNP: 20.4% (94.6% Heterozygous and 5.4% homozygous)
• 50% incidence in patients with proven IA• 4 patients switch post HSCT:
– 3 homozygous wild type to heterozygous mutation– 1 heterozygous mutation to homozygous wild type
Innate Immune response to fungi
6, 67-78 2008
Ongoing studies
• Immunotherapy of ID• Looking at other SNPs in Dectin 1 gene• Participating in Individual risk stratification for aspergillosis:
AspIRS Study Septomics Research Centre (at the University of Jena, Germany)
• Screening ICU patients for genetic risk factors for Candida infection
• Development of management algorithm for fungal infection
Teaching and training side
• In addition to a personal undergraduate teaching load a clinical academic will be expected to take leadership roles and contribute to – Curriculum development, assessment, standard
setting, blended learning, Personal professional development, quality standards, fitness to practice
– Postgraduate training and mentoring– Educational supervision of specialty trainees – External examiner roles (other universities, Royal
Colleges )
Third mission
• Professional roles– Royal Colleges– Professional Organizations– Guideline development– Editorial Boards– Major Grant reviews– Select Committees
• Innovation and engagement– Public information campaigns/lectures
Restrictions
• Need to fit in with Universities/Schools research priorities to stay on T&R pathway– Expectation to bring in minimum of 3 times salary
in grant income• Only counts if you are PI
• Need to be REF returnable– Maintain outputs in high impact journals (>7)
• Not pro rata
Teaching and Scholarship
• Pedagogy• Expected to undertake a higher degree in
Medical Education• Expected to undertake direct teaching
activities 40% of time• Can undertake educational research,
pedagogical evaluation and scholarly activity• Cannot be a PI
Lessons learnt
• Cannot do 3 fulltime jobs– No pro-rata element (REF, CPD, etc)– Employers will use 100% unless there is
physical/temporal separation – Make Job plan clear
• 2 employers means that you get fobbed off re infrastructure support (secretarial, IT payment of expenses etc)
• More freedom for meetings conferences etc– “an absence of professors”
Combination
• Clinical work• Research • Teaching
• Innovation and Engagement – Professional roles– 3rd mission activities