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REFLECTIONS
DOING A PhD IN THE MIDDLE OF RESIDENCY..
I was gobbling down some lunch in the operating theatre pantry when my boss
came to me and said: “Aaron don’t disappoint me, do a PhD.” To be honest, my
initial reaction was: “Huh… really arh?”. Deep down in my heart I had mixed
feelings about it. Would embarking on such an endeavour be worthwhile? What
would become of my clinical skills? Wouldn’t it be such a great career setback?
“Just focus on the science Aaron; God gave you the brains, the talent and the
capability to do a PhD. It would be such a waste if you had not. Sometimes you
got to rise above the mundane routine of day-to-day work and see the big
picture for our division and the hospital.”
That conversation between my Division Head and I took place approximately
a year ago. My Division Head, A/Prof Yeo Tseng Tsai, deserves great credit for
his exemplary vision of building a full-fledged clinician-scientist driven
neurosurgical unit in NUH. Mission-driven, he made every effort to turn this
vision into a reality. At that point of time I was starting my fifth-year of
neurosurgery training, and had successfully published 10 manuscripts. I had
considered the option of pursuing a PhD, but was not entirely convinced that it
would be the best thing to do given that I was already quite close to finishing
residency. I was married with two young children, and had to support my in-
laws as well because they lived with me. Several senior clinicians had also
commented on the drawbacks of pursuing research in the midst of residency
training, and their advice further sapped the faith I had in a research career.
Prof Yeo swatted those fears away. He was truly convicted. He broke down
doors, overcame administrative hurdles, pulled strings, found funding, all so
that I could embark on what would for me become a life-changing experience….
One afternoon a few months later I found myself sitting with Prof Yeo at a small
table in the Department of Physiology at MD9 just across the road from NUH.
Opposite me sat A/Prof Lim Kah Leong, the newly appointed Head of
Physiology, accompanied by his most senior postdoctoral fellow Dr Chai Chou.
Prof Yeo and Prof Lim had a long-lasting friendship dating back to the time the National Neuroscience Institute’s (NNI’s)
Research Department was established in the late 1990s. Prof Lim had just joined NUS after relinquishing his role as Deputy
Director of Research at NNI.
*For internal circulation only.
All rights reserved*
NUHS RESEARCH RESIDENCY PROGRAMME
Quarterly Newsletter
Issue No. 13 ● March 2019
Resident’s Corner
By
Dr Aaron Foo
(Neurosurgery Residency Programme, R5)
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“Go ahead and fail; failure will make you a much better scientist “
“Kah Leong, I need your help to train this guy in science. He is a smart guy and he will complete the training. He could be
your future collaborator.” Those were Prof Yeo’s words. Prof Lim was very accommodating. In parallel with the government’s
goal to promote translational research, he was very supportive of clinicians cross-training in science. Prof Lim turned out to
be another wonderful boss with a great passion for basic science. He very generously allowed me to join his research team,
which was a huge blessing because it exposed me to a very high standard of scientific research from the very beginning. A
few weeks after I joined his laboratory Prof Lim was conferred the President’s Science Award (Team Category) for being
part of a team that discovered an early biomarker for Parkinson’s Disease. This was one of the most prestigious awards
conferred in the local scientific scene, and here I was - a new member of his lab! Only then did I realize how lucky I was to
have been inducted into his group.
But not all the going was nice and rosy. Adapting to the PhD curriculum proved to be a demanding task. I used to believe
that if I succeeded at neurosurgical training (which involved doing up to 10-12 calls a month with no post-call most of the
time), no other challenge would faze me. I was sorely mistaken. Although trading my surgical scrubs for the lab coat provided
me with a lot more control over my time, the amount of effort required to excel at scientific work was paramount to that
needed for neurosurgery. I did not do well in my first semester and got an academic warning. I made some careless mistakes
in the lab (like forgetting to put some solutions back in the fridge after using them, causing them to spoil) and became the
routine suspect whenever something went awry. Whenever I went for department seminars, I failed to understand even
one-fifth of what the presenter was talking about. My experiments failed to produce the results that I had hoped for. For the
first few months, I felt like a house officer again, ascending a steep learning curve.
But hey, what is science without some hiccups right? A/Prof Mikael Hartmann (Research Director, University Surgical
Cluster) once told me: “Go ahead and fail; failure will make you a much better scientist.”
And so I responded. I made some adjustments and did some experiments… and made some more adjustments and did some
more experiments… and made even more adjustments and did even more experiments. I used up the reagents in the lab so
quickly that every time my lab manager opened the -20 degree Celsius fridge she saw that the blocking agents that were
topped up just the day before were again depleted.
“Aye, you drinking the reagents arh?” she used to joke.
“No, he uses them to shower.” my colleagues would laugh.
My transformation from clinician to scientist continued. I came to the realization that I had gotten too comfortable with
clinical medicine; science plunged me back to ground zero and demanded that I leave this comfort zone. At night I would
spend time reading to my daughter, and once she fell asleep I would go into student mode – staying up to read, write and
consolidate. I ploughed through Kandel & Schwartz (the basic neuroscience textbook) page by page, and started to look at
papers in Nature and Cell instead of Journal of Neurosurgery.
Has it been worthwhile for me so far? I must say that the intellectual growth I have experienced in the past six months has
been astounding. Never by doing another 5-10 more years of clinical work would I have developed this new perspective for
dissecting a problem nor this grounding in the basic neurosciences.
Does it make you a worse clinician? No I don’t think so. In fact, achieving a profound understanding of the biological
processes that underpin diseases makes you a better clinician if anything. This understanding comes from being able to
comprehend upstream basic science research; it is not something that one could acquire even by seeing another 1,000
patients with a similar condition.
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Most importantly, embarking on this journey has allowed me to develop newfound respect for my scientist colleagues who
are superior to us clinicians in so many ways. The need is mutual – clinicians need scientists for their basic science research
and scientists need clinicians to translate their work into therapeutics. Respect is quintessential to any successful
collaboration between the two parties.
So here’s my advice to those who are contemplating to take up a PhD and/or the clinician-scientist path:
1) Sometimes life plays tricks on you. Taking the path less trodden does not necessarily spell doom. In fact, many a
time, you might find the most unlikely road leading you to your next passion.
2) Find a great mentor. There are currently not many clinician-scientists in Singapore hence there are more naysayers than believers in the ranks. You need someone to inspire you to stay strong and rise above criticism in order to succeed.
3) Firm up your clinical training before you embark on research. I believe that the best time to embark on a hiatus
from clinical practice is halfway through senior residency. This is especially true for surgeons. The window for research training, set between residency years 4 and 5, was dictated by my Division Head based on his fellowship experience at the University of Toronto Neurosurgical Unit, the most successful academic neurosurgery unit in the world. After actually testing it out myself, I could not agree more. Why is that so? Because it takes time to chalk up your surgical logbook. If you look at learning from a neuroscience perspective, it takes numerous repetitions before the performance of a complex action becomes ingrained in your muscle memory. Once the memory is consolidated it will not be forgotten. This applies to learning how to drive, ride a bike and type on a keyboard and can be applied to examining patients and learning a surgical procedure. When I left full time practice to pursue science my surgical logbook had approximately 900 neurosurgical cases. I had performed sufficient repetitions of some of the simpler procedures for them to become entrenched in my procedural memory. I still do 3 to 4 calls a month nowadays to maintain my clinical competency and guess what? I think I am still improving, albeit at a much slower pace, in terms of surgical skills. I do not think this would be possible without the foundation that I had built by doing the numerous on-calls during my three-and-a-half years as a full-time neurosurgery medical officer / registrar. Leaving clinical training without having consolidated this body of skill and knowledge will only lead you to struggle upon your return to the system after a long hiatus.
As I write this I find myself sitting on a small bench in the animal facility, observing my mice go round and round in circles
in little buckets – demonstrating the asymmetrical rotatory movement characteristic of successful lesioning of dopaminergic
neurons that comprise the nigrostriatal tract. A smile of triumph appears on my face. This is my first taste of success after
half a year of performing animal experiments, and it feels… ecstatic.
Contributed by Dr. Aaron Foo
Course Assessment
Write an essay on hypothesis testing in clinical research
Deadline: 30 April 2019
Include in your essay (not limited to) the following points:
i) errors in hypothesis testing
ii) the relationship between hypothesis testing
and the p value
iii) the role of chance
iv) sample size calculation
v) limitations of hypothesis testing
- Word limit of 1000-1500 words
- It is recommended to use your
intended research study as an example
to address the listed points
- Your work will be checked for
plagiarism upon submission
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Click on link for more information on grant call
Deadline till 22 April 2019 ExxonMobil-NUS Research Fellowship for Clinicians
Eligibility: Registrars, Associate Consultants, Consultants
Award: 60% protected time, S$20,000 consumables
Clinical Trial Grant – Industry Collaborative Trials (CTG-ICT) Scheme (Open Call) The aim of the Clinical Trials Grant (CTG) is to enable the clinicians to carry out clinical trials for the development of novel therapies, interventions and diagnostics, focusing on healthcare needs.
Funding Opportunities
Research Residency Notes
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Remember to arrange our
clinical roster for the following
training dates:
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13 Apr 19
4 May 19
1 June 19
6 July 19
3 August 19
21 September 19
5 October 19
2 November 19
7 December 19
Contact Us Programme Director:
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Programme Coordinator:
Peishan Tan@ [email protected]
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