Clinician scientist training: ‘You’re trying to carve out your own path with few examples to follow’

“We are in a unique position,” says Dr Jessica Okosun, from Barts Cancer Institute in London. “We act as a bridge between the clinic and laboratory research.”

As a clinician scientist, Okosun splits her time between studying a type of blood cancer and working as a doctor who diagnoses and treats blood conditions at St Bartholomew’s Hospital.

It’s an 80/20 split between the lab and the hospital. And the mix, Okosun says, gives a chance to see the key challenges in treating and caring for patients with blood cancer first hand, which drives her research.

“You recognise the problems in the clinic and then you try and take those problems to the bench in the lab and attempt to solve them. You wear two hats I guess, straddling both worlds.”

This unique perspective means that clinician scientists play a vital role in cancer research. But gaining this valuable mix of skills is a long and often challenging path, with many clinicians not continuing in research after completing the first major bit of scientific training, their PhD.

This is particular true for women. A report by the Medical Research Council found that while around half of junior clinical fellowships were awarded to women between 2007 and 2011, only 1 in 10 senior fellowship holders were women.

We want to make sure that clinician scientists get the right support, enabling them to stay and work in both the lab and the clinic. So we’ve changed the programmes we offer to train clinician scientists, adding more options and making the programme more flexible.

Okosun says the changes are a positive start.

‘It’s a balancing act’

Okosun’s interest in research sparked when she first was studying to become a doctor.

“I was always very scientifically minded – during medical school I would take any opportunity to be in the lab,” she says.

After finishing her medical degree, Okosun began training to become a haematologist but paused it halfway through to do a PhD. After completing her PhD and her specialist training, she now splits her time between the clinic and the lab, supported by a Cancer Research UK Clinician Scientist fellowship.

Looking back, one of the biggest challenges for Okosun was figuring out how to become a clinician scientist. She says that it wasn’t very clear when or how to do things.

“If you’re a non-clinical scientist there’s a more traditional and streamlined pipeline – you do a PhD, then a post doc and then you look to become an independent researcher by seeking out a group leader or faculty position. The route is a bit more meandering for clinician scientists.”

The lack of senior clinician scientists that Okosun saw during her training was a barrier. And that shortage is more acute for women. Out of about 50 academics at Okosun’s institute, only 2 are female senior clinician scientists.

“It’s a challenge when you’re trying to navigate how to get somewhere but you can’t see that many people who have successfully done it, so you’re always trying to carve out your own path with few examples to follow.”

She thinks that mentoring has a key part to play.

“Having very focused mentorship programmes is very, very important. It’s something that Cancer Research UK have taken on board and are actually doing very well.”

The new programme will offer support before, during and after training, including support and mentorship from senior clinician scientists. The hope is that this network will help clinician scientists make the leap into a research role after their PhD, rather than returning to a full-time clinical role.

“You have to make the clinician scientist career journey attractive so that people will want to continue down that road,” says Okosun.

And that means considering more than just jobs.

‘You can’t just uproot in the same way’

“As clinician scientists, we can be up to a decade older than non-clinical scientists who are finishing their PhD, we’re usually in our 30s. And you can’t just uproot in the same way because you have your clinical training and may have other personal factors like mortgages and family to consider.”

Jessica says this is something people haven’t always appreciated in the past. Clinician scientists already have a career, so it’s difficult to up sticks and move for the next research job after they’ve finished a PhD. Funding during this period is also another barrier.

And by the time Okosun was ready to apply for a fellowship she also had a family to consider as well.

“When I was applying for my fellowship from Cancer Research UK, I was applying knowing that I was about to have my son. And I was looking to see if there was any flexibility in terms of undertaking the fellowship part time, but at the time that option did not seem to be available. And that might put people off.”

To make sure everyone knows what options are available, the new programme will feature our flexible working policies more prominently. These include providing support during parental leave as well as helping people return to work after time off.

The new programme will also provide a more diverse range of training options. This includes the option to combine medical training with a PhD, which first became popular in the US. But it’s gathering momentum in other places too, including the UK.

‘There are multiple paths to the same goal’

Jessica says she knows several colleagues and friends who did a combined training programme, often called an MB-PhD, whilst studying in Cambridge.

“I have to say that the majority of them have stayed very strongly in academia – so I think the model works because you’re getting people into research from that very early stage of their training.”

The figures look encouraging too. A recent survey of graduates who combined medical training with a PhD in the US found that 6 in 10 were in full-time academic roles. And almost 8 in 10 were still active in research.

“I’ve always been a big fan of the principle of equifinality – the idea that there are multiple paths that lead to the same goal. And I think that’s why it’s important to have several and flexible training options so that people can step onto a clinician scientist route at different timepoints.”

“Everyone approaches their career in different ways so giving people options means that you’ll attract different people, which can only be a good thing.”

Katie