Keeping Translation in Mind During Our PhDs
At the core of the Translational Neuroscience programme is the aspiration to train us, basic science students, to consider clinical issues at all stages of our PhD projects. This was a focus when we were putting together proposals at the end of our 1st year, when we met with the programme directors to ensure we were keeping a translational element alive in making our plans. Now that we are immersed in our PhD proper, however, it would be easy to switch off and follow the well-walked path of other basic research students. The essential aspects of a PhD – gathering data, optimising experiments, putting together lab meetings and journal club presentations, planning your next steps – are time-consuming on their own.
So how do we keep the translational focus in mind during this busy and important ‘implementation’ stage of our work, without becoming overwhelmed?
Part of this focus comes from extra requirements of the Translational Neuroscience programme. We are expected to keep up clinic visits, for instance, so as not to lose the contact with patient groups cultivated during our first year. As a formalised output of these visits, we have to produce a case study: for presentation in our 2nd year, and as a written assignment in 3rd year. These require us to identify a patient in clinic, or a small group, or even individuals within anonymised population cohorts, and study their medical histories alongside lifestyle and biological factors in order to better understand the aetiology of diseases relevant to our projects.
Rebecca: I conducted a case-control comparison of individuals from a population cohort who had experienced severe childhood trauma and remained well, versus those who had evidence of lifetime diagnoses of depression. I looked at sociodemographic, cognitive, and genetic factors which might differ between the groups in a qualitative description of what additional lifestyle factors might promote resilience after childhood trauma.
Despite choosing individuals from a cohort for this case study, I have attended general psychiatry clinics this year, meeting individuals with a range of psychiatric disorders and gaining insight into the progression of their treatment over time. Due to the sensitive nature of the experiences I am interested in, it did not feel appropriate to write my case report about individuals I met in these clinics. I am, however, looking forward to attending clinics in neonatal intensive care and neuropsychiatric lupus clinics later in the year. From these it may be possible to identify and follow an interesting case with a different form of childhood stressor (preterm birth), for instance; or perhaps a case with evidence of an inflammatory contribution towards psychiatric illness, which is another area of interest within my research.
Caoimhe: I was given the opportunity to meet a single patient that had been referred to the research consultant and senior nurse that I work with. This patient was unusual in their presentation of haemorrhagic stroke (which I am studying for my PhD) and the opportunity to speak to patients really motivates me to continue my research, especially when the lab works get tough and overwhelming! Another big take home from meeting with patients is how interested in research many of them are, and how grateful they are to be given the opportunity to take part in research studies. They are often fully aware that ongoing research will not improve their own diagnoses, but it is very humbling to hear their enthusiasm for helping future patients suffering in a similar way to them. I will be continuing to meet patients suffering from haemorrhagic stroke throughout the three years of my PhD, allowing me to understand this disorder from a patient perspective, which most scientists are not fortunate enough to be exposed to.
More fundamental to our research projects themselves, all of the students on the programme have selected a disease, or a group of diseases to focus on. Therefore, all of the research being done has been primarily driven by the disease area we have chosen to study.
Rebecca: For me, this allowed me to pursue an area of personal interest. I have previously worked in both clinical and research environments with a shared focus on early traumatic experiences and mother-child bonding. I feel that this experience helps me keep in mind clinical issues that might be more important to the quality of life of those affected by childhood adversity, when planning and conducting my research. In my own time I attended a community screening of RESILIENCE: The Biology of Stress & The Science of Hope, put on by a Cumbrian initiative group trying to promote awareness of childhood adversity in public services. I am interested in following the growing awareness of childhood adversity as a public health concern, and would like to engage more with similar initiatives closer to home.
While some of us are motivated to keep up with current issues in our area of interest outside the lab; others are able to use translational lab techniques and experimental design to maintain the clinical focus in our projects.
Caoimhe: One such option given to patients with haemorrhagic stroke is to donate their brain for research. I am extremely fortunate to be able to work with post-mortem human brain tissue that has been collected by my clinical colleagues within the Edinburgh Brain and Tissue Bank. A key way to insure a translational focus throughout our PhD projects is to incorporate a combination of methods that span basic and clinical research. For me, that includes an animal model of stroke, and human brain tissue from stroke patients. This allows me to confirm any findings from the mouse model in human tissue, whilst also understanding the immune response to haemorrhagic stroke in human brain tissue, which will infer future experiments in the mouse model. Additionally, my supervisory committee is made of a basic scientist, two clinical academics; one specialising in haemorrhagic stroke and one specialising in neuroimmunology, and a neuropathologist. Therefore, the design of my PhD project encompasses a wide range of expertise and ensures that a translational focus is maintained throughout my entire project.
So what do we get out of keeping this clinic contact up throughout our PhD?
It can be motivating, to understand the devastating effects of these illnesses on people’s lives, and to understand how our work may contribute even incrementally towards treatment strategies in the future. It can even be just a welcome change of scenery to sit in a clinic and interact with patients, after long weeks in the lab. While it might sound to some like a lot of extra commitment, or a distraction from research, we have enjoyed the opportunity to think about our research in the context of the patient group that it concerns. Many researchers, most especially PhD students, are never given the opportunity to meet patients living with the disorder they’re studying. This patient perspective that we have been taught from the beginning of our programme has trained us to approach biomedical research from a different angle. For example, when reading the literature, we can critically analyse whether the outcomes from a study are translatable to the human condition, and if so, are they going to improve the quality of life of patients affected by the disorder? We also attempt to design our experimental studies, for example those involving rodents, to be as robust and reproducible as possible, so that our results might be more likely to improve the lives of the patient group that it concerns in the future.
Rebecca Madden & Caoimhe Kirby, 2nd Year PhD Students