FIRST PUBLISHED IN ISSUE 55 (2000)

 

This article is based on Anna Crown’s very well-received talk entitled ‘PhDs/MDs and how to survive them’, given during the 190th Meeting of Society in November 1999, as part of the Young Endocrinologists Symposium.

My aim is to help medics embarking on laboratory-based research. My own experience, and my observations of medics in the lab, form the basis of this article. Perhaps the most important advice is that you should only undertake research if you want to; to do it because you think you should is a recipe for misery and disaster.

The laboratory has a pyramidal hierarchy, from professors at the top, through senior lecturers and lecturers, to post-docs (who have completed their PhD theses, and are the equivalent of SHOs or SpRs), to PhD and BSc students. Technicians are also an integral part of the lab, and by no means necessarily at the bottom of the pyramid. Unlike the 3- to 6-month jobs of many junior doctors, the contracts of lab staff are usually 1–3 or more years long. Sensitivity to the interpersonal dynamics of the lab you join is vital. Unfortunately, on your first day, you cannot necessarily expect people to regard you neutrally. They may have had bad experiences of previous medics in the lab. You are probably being paid more than a scientist of equivalent seniority, as you embark on work for which you will be seen as almost totally untrained.

It is vital that you appreciate quickly how much you have to learn. If your most recent lab experience is A-level chemistry, effectively you know nothing. You will have to be taught how to weigh chemicals, how to use a pipette, how to make up solutions and so on. If you are too arrogant to learn these basics properly your experiments are bound to fail. Don’t assume that you can extrapolate from your medical or surgical experience of sterile technique to a cell culture hood without explicit instruction. There is plenty of scope here to ruin both your own experiments and those of others. It is hard to recover from that sort of unpopularity. Be humble, and get someone friendly to show you how it all works! In the early stages, it is also good to ask somebody to check your experimental designs, to be sure you have included appropriate controls and to avoid unnecessary frustrations. Although you are used to working independently, your lab work will need fairly close supervision to start with. Remember that no-one is there to set up or finish off your experiments. This includes routine work like looking after your cells in culture, and menial tasks like washing up. It is simply unacceptable to be ‘bleeped away’ half way through something. Later, when you are competent to reciprocate, there may be scope for some give and take. Do not become the flatmate from hell, leaving the sink full of washing up, finishing off chemicals, or leaving radioactive waste lying around for someone else to dispose of! I have also observed that gory ‘Doctors’ Mess’ talk does not usually go down well in laboratories; scientists, sensibly, do not see the funny side of patients being found dead on the toilet.

My last ‘negative’ point: remember that there is often a period of despondency shortly after you start your research. You move from a busy schedule to an apparently empty one. It takes time to get going, and even longer to get results. Scientific research lacks the immediacy of clinical medicine. You don’t get the instant gratification of making someone better. Conversely, if a technique is not working, it won’t go to ITU or die, so you just have to tussle with it.

Moving on to the positive side of the transition. Get fully involved in the lab – enjoy it! Go to lab meetings and journal clubs, and don’t chicken out of presenting genuinely ‘scientific’ papers, including the ‘Methods’ sections! Abandon the Doctors’ Mess and go to the lab tearoom instead. Here you can get to know people. Labs can be really friendly; you may even get a birthday cake and a card if you’re lucky – something I have never known to happen on the wards! If things are slow to get going, turn this to your advantage. Use your spare time to get acquainted with the relevant literature. Improve your IT skills. Do a statistics course. Most grants allow for one clinical session a week. If you do not have to provide a service commitment, you can take advantage of your uncluttered timetable to attend speciality clinics that interest you. I would, however, suggest that other than this one session, and the occasional acute medical take, you should abandon clinical work completely if possible whilst doing your thesis.

There are many other ways to enhance your research experience. It is useful to make contacts both locally and elsewhere. Find out who is doing similar or related work, seek advice, and set up collaborations. Get involved in ‘off-shoot’ projects which may well be productive in unforeseen ways. Attend meetings, submit abstracts, present posters and give talks.

Remember that as a clinician there are small ways in which you can be helpful in the lab! Biomedical scientists like to set things in clinical contexts, so you may be called on for thumbnail sketches of diseases. Perhaps you can see potential clinical applications of work that have not previously been considered. You may be used to provide a phlebotomy service or to gain access to other human material. Your personal clinical advice may even be sought, or you may be needed for first aid. You are bound to be taking a lot from your lab; it makes sense to take up any opportunities to reciprocate.

The return journey to the wards can also be difficult. Facts that used to be at your fingertips seem to be lurking somewhere in your mid-brain. Friendly, familiar faces who you relied on for favours may have moved on. The challenge is increased if you are trying to combine research with continued clinical training, under the new Calman regimen. My only definite recommendation is that you try to finish writing your thesis before you return to the wards. It is much more difficult to squeeze it in afterwards.

Finally, I would suggest that you will optimise your research training if you have both a scientific and a clinical mentor. As I was told early on in my research, it is all too easy as a clinician scientist to impress scientists with your clinical acumen and clinical colleagues with your scientific genius, whereas one’s aim should be to be respected by scientists as a scientist and by clinicians as a clinician.

ANNA CROWN
Bristol Royal Infirmary (correct at the time of first publication)