Academic psychiatry: mental health research and training opportunities webinar – 27 March 2024

Yes please. Yeah, hi everyone. Welcome to the Academic Psychiatry webinar. We're delighted that you're here. Um, my name is Shti. I'm a child psychiatrist and Senior Lecturer at the University of Manchester. Uh, and I'm here today. I co-lead the mental health mission capacity development theme with Dr. Kate Saunders, who's here. We have a really exciting lineup of speakers, uh, and a really great agenda that we're going to talk to you for the next sort of hour or so. Um, and, um, you know, really talking to you about why child psychiatry, why psychiatry is an excellent career choice and practical ways to build a career in academic psychiatry.

Um, before we start, just want to point out a couple of things. There'll be two links in the chat for you to look at. Uh, we would encourage all of you to sign up to the associate membership of the Royal College of Psychiatrists. It's free, and we'll be posting there lots of exciting opportunities for foundation year three doctors, uh, in act in research. So please sign up to that. The other link that will be posted for you is for the mental health incubator, which is another website which contains a wealth of information and signposts, you know, it's signposting to various opportunities.

Um, so before I introduce, uh, the key speaker, there are some housekeeping rules. Which Clara, would you like to share? Oh, yeah, I can share them. Please keep your video off, um, um, unless you're speaking. Um, if you like, um, keep your microphone muted. Um, and if you lose connection, log back into the session as soon as possible. Um, if you have any comments or questions, please put them in the chat. My colleagues will put them together, uh, and group these questions, and we'll put these questions forward to the panel. We'll also have certificates that we'll, uh, that we'll provide to you for attendance. Okay.

So with that, um, I'd like to introduce first our first speaker, uh, Prof Professor Sabo Dave, who's the Dean of the Royal College of Psychiatrists and he's the Deputy Director for Undergraduate Medical Education and has an academic interest in workforce and health inequalities, uh, with publications in co-production and social justice in medical education. So a very warm welcome to you, Professor Dave, and please, uh, please share your slides and have your presentation. Thank you.

Hi, um, hi Shti. Am I audible? Okay. Thank you for the kind introduction. I think I'm, looks like I'm going to have a little bit of a difficulty sharing my slides. Let's see if this works. Is that visible? It isn't at the moment. Um, no, not yet. Can't see the slides yet. No. Okay. I thought I shared my entire screen, which I thought should have been okay. Well, let's see. That should work, hopefully. H, yeah, I think we'll probably get there in the end. Right, that should be visible. Is it? Yes, brilliant.

Okay, well, thanks for inviting me, Shti, and thanks for the kind introduction. Well, I know there are a few of you already logged in. So, and I'm a psychiatrist. I'm going to start by doing a little experiment. So let's spend, um, a few seconds trying to think of how, how you're feeling right now. Right now, at this moment, you know? So some of you will recognize this slide is from the movie Up, which talks about feelings. Um, and I want you to kind of just focus for on your feelings, and if you feel up to it, just, uh, feel free to put that in in the chat window as well to see, uh, how you're feeling now.

What's feelings got to do with, um, with, with, with academic psychiatry? I think, um, well, the point I wanted to make to you all is that psychiatry is that branch of science, not just a branch of medicine, a branch of science that is really the cutting edge, asking very big questions. And I'll, I'll feature all those big questions in a minute, but this is one of those questions, you know? So how, how do actually, how do we, how do we as human beings recognize what feelings are? We are able to feel them, but how do we label them? How do we get those feelings? How do we just this morning, somebody wrote to me saying they were absolutely a train, wrote to me because they've been reading up about the war, um, in the Middle East and the horrors perpetrated on the hostages and the famine and all of that, and how it was making them feel. How does something that's happening thousands of miles away actually produce a biological change within you? How does that produce an emotional change within you? How does that then change your behavior? These are, in a way, very obvious questions because all it's a very human experience, all of us have had them. But these are exactly the kind of questions that psychiatry is interested in, not merely an academic exercise, which it is, of course. So academic psychiatrists are constantly looking to answer these questions, even at a clinical level. Even as a clinician, you're trying to answer those questions each day, every day in your practice. And so, welcome to the role called psychiatrist. And so when people choose psychiatry, they are choosing to enter a branch of science, a branch of medicine that is asking these big questions.

Just wanted to say a little bit about me. So I think I grew up in Mumbai, and I just discovered today that Shti and I were both in the same, from the same medical school. I was obviously just like one year ahead of her. No, I'm joking, she's, she's way, way, way younger than I am. Um, but this slide is not from my medical school. This is, uh, very close to my home, and it's a textile mill in Mumbai. And the reason again, you'll ask, what's the connection between a textile mill and psychiatry? Well, there isn't really. I think this is the time when, and, and, and yet there is. I think textile mills were closing down. You can probably look at the slide and see that it looks like a, a defunct textile mill. Um, and what I experienced when I joined psychiatry in Mumbai was the poverty that that had brought about, the unemployment that it brought about, and the increase in mental illness that happened at the time. I didn't know this at the time when I joined in as a medical student and joined as a psychiatric trainee, but now I know that the evidence linking poverty, linking polarization, wealth, and health outcomes on a range of mental health outcomes. But you can see on the, on the Y axis that it's not just, it's not just mental health outcomes, it's also physical health outcomes. Is, is, is very significant. And again, I think it's psychiatry which is interested in these kind of questions. How does poverty? How does unemployment? How does that contribute to this level of mental illness? And now we know this, right? Mark M has in this work that if you have more than four adverse childhood experiences, you know, um, your risk of mental illness increases significantly, your risk of physical illness increases significantly. How does that happen? What are the intermediary steps that that lead to this happening? And also, what are the protective factors? Because not everyone who experiences those adverse childhood experiences ends up having these adverse outcomes. And so for me, I think, why did I choose psychiatry? I did not know this at the time. I think I chose psychiatry because, well, mainly because I was fascinated by the mind-body question. And then secondly, because I mean, it was fascinating that you could talk to someone and without the need to use fancy instruments, without the need for fancy diagnosis, you could actually make a difference to another human being. Now, now, of course, I know that that is not an accident. Talking to another human being often, if not always, seems to produce the same kind of changes that other physical treatments do, like medications or ECTs or some other kind of, you know, transcranial magnetic stimulation. We find that often the same areas of brain are are lighting up when when you apply these treatments. And so these are big questions. These are not my big questions. New Scientist, some of you will be familiar with the journal, with the, um, with the magazine. So it sent out a questionnaire a few years ago, just before the pandemic, to all scientists in the world. And this is the list of questions that it came up with. What are the biggest questions in science that scientists need to answer? And this is the question, these are the questions: What is consciousness? What is it to be human? What are the limits of physiology? That was the first question that I put up when I showed the slide around, um, connection between feelings and behavior. What is nature? What is nurture? Will we ever have personalized medicine? All of these questions that ex are questions that exercise psychiatrists. All of these questions that academic psychiatrists are are working on.

So for me, I think, um, um, as a Dean, my role is to actually design curricula, to kind of, you know, set standards, uh, for each and every single trainee in the UK, and also increasingly in the world, because many international trainees are taking our exams. And I think what we're finding is that when you've done that, uh, you want to make sure that the high quality, the high that we set is is maintained. And now that's what we've done. Last year, we introduced a new curriculum which talks about two big lenses. One is personalized care, person-centered care. How do we personalize the care that we provide to individuals? Just, just now coming, coming straight from a meeting, uh, with the rainbow SIG, special interest group of the college, and they were wanting to know how are our trainees learning to personalize the assessments, the treatment they offer to people from diverse backgrounds? The same thing applies to people who have different genetic makeup, the people who have different upbringing. How do we make sure that we're not blindly applying the same NICE guidelines or the same protocol to individuals, but actually personalizing to them? So this person-centered medicine, this precision medicine, is a big, big thing in psychiatry. And the second big lens we have is that of public mental health, which I think is again, a big area of research, uh, and academic activity. I think, well, how do we make sure that the efforts that we engage in as clinicians, as academics, benefits not just one individual patient, but entire populations? And I think there's a lot to be learned around prevention. There's a lot to be learned around population health and data. I, I think data intelligence and digital psychiatry, uh, including obviously generative AI, are are big elements, uh, that are that are coming into psychiatry. So that's where the future is. And I feel that all of you who are on the call are seem to be interested in academic psychiatry, and I feel, I hope that some of you will produce answers to the kind of questions that I've, well, not I, but New Scientist has posted, and which, you know, but these are the questions that I ask myself every day, every day of my clinical work. At least one, if not many, of those six questions pops up in my working life.

So, um, get in touch. That's just a little, um, plug for my work that I'm doing. Just a reminder that in all this we do, we must make sure that we look after ourselves. So I'm a trustee with Doctors in Distress. And whether it's academic psychiatry that you pursue, or whether it's clinical work, or indeed managerial education, whatever, whatever your journey takes you, make sure you look after yourself and that you have fun while you do it. And, um, that's one, one, one another thing that I think the Royal College of Psychiatrists, uh, specializes in. We take care of our people, you know? And the college is a small family. So I'm going to stop there and stop sharing and back to you, Shti.

Ah, thank you so much, Professor Dave, for for that excellent talk. Um, I'm sure there'll be questions which we'll put to you later, later, later on in the, the end of the webinar. Uh, so with that, we have our next speaker, who's Professor Rohit Shanker. He's a Professor of Neuropsychiatry at the University of Plymouth and an Associate Dean, uh, Academic for Academic Psychiatry at the Royal College of Psychiatrists, and he's going to talk to us about psychiatry pathways. So over to you, Rohit.

Sorry, I was trying to unmute myself there. Yeah, uh, it's lovely to be talking here to, uh, to all these trainees, all your trainees here. And, uh, I think Subo's talk was very pertinent. And in particular, I think one of the things which he talked about was about "have fun." And that's the important motto. I think you're going to be here, you're trained as doctors, and the next 30, 40 years you're going to be working as doctors. And it's about the different ways and how you can have fun. So what I plan to do today is to talk you through academics through the vision of cycling. So obviously cycling is very close to the British heart, and everyone likes to cycle. Every school teaches cycling. And I think the biggest issue is about how much do you want to cycle? So people like me, we get on a cycle once every Easter holiday, sort of thing. Now, and then there are people who cycle on Sundays, people who cycle to work. And of course, if you really want to up the game and be at the top level, you've got people like, uh, Sir Chris Hoy, Laura, his wife, or Bradley Wiggins. You've got the big names. So it's all about levels of enjoyment, levels of pursuit, and vigor. Academics is a bit like that.

So before I start, any good researcher always tells where all the money came from, and not just to the taxman, but to everyone else. And none of the disclosures here have any impact on the talk today. And I can definitely confirm that no cyclists or cycles were harmed in the preparation of this talk here. So with that out of the way, the general schema of the talk. I'm going to spend a couple of minutes talking about the vision of why academics is important and you need to continue and think about doing academics in your work, general work, uh, um, continuity, not just about training, the different roots and reviewing the current pathways and looking at where psychiatric training features and what is it that we can entice you with? What is it that extra that we can give you? And I'm going to also sort of highlight the the gaps and the challenges which academics naturally brings. And generally, the timeline of what happens next when things sort of you want to plan in that area. Sorry, my throat's a bit on the wonk.

So the fundamental thing which I think we should never ever lose sight of is that every doctor, that is, each one of you, is a scientist and should always, in some fashion or the other, be involved in research. If you are not, we have failed as educationalists. We have failed as your seniors. We have failed as your mentor, because I do believe the one thing that separates us from everyone else is an inquisitive mind, which has brought you here to make a difference. So it's so important that you get skinned in the game in some fashion or the other. So what I mean by that is that research is not about doing genetics. And of course, it is, but that's the high-end tip of the iceberg stuff where you actually get paid money to do things. And things. Research is very much about the inquisitiveness, the patient that you see, and you wonder, why this? Why is what I have read in a textbook not what it's written here? What's written here is not actually being seen there? So it's about trying to assess, analyze, contemplate, and basically create impressions and challenge logic and be intuitive towards it. So what you do have is as a scientist, as a doctor, you should be able to essentially appraise evidence critically. You have to be doing it at every moment. It has to be an antivirus which is there at work, protecting you, taking in information and assessing it, especially now with all this big OA about social media and information overload. We as doctors, it's essential to teach and communicate science as medical leaders. For that, we have to understand science. We need to understand the process by which it's created so that we can offer it and be very clear where it's. And most importantly, it's about our patients. If we have to give them choice and options and build our therapeutic relationships, you have to have science. And for that, you have to understand science. So it's all of percolates to what else can you do? Of course, we can actually help contribute actively by recruiting into studies to help shape the journey in precision medicine and personalized medicine. What do we mean by that? It's about shaping molecules or drugs to become more targeted towards illnesses or symptoms, or changing environments or changing setups and influencing outcomes by that, which is the personalization of it. So it's sort of, if you think about cycling, and if you ask the question, why cycle? You get so many answers. It's the same here. Why should you do research? Because there are many answers, but you have to do it.

So what are the different roots? So your F2 is starting off. So the one of the easiest, slow-hanging fruits is just look around you. There is a whole research environment around you, just like air. You just have to recognize it. So you can recruit to existing studies which are already going on. There's a research team in every NHS trust, and going and chatting to them helps. If you want something a bit more stiffer, you want a stronger element, you can think of doing a higher degree or writing a paper. So they are challenging, but they also give good satisfaction. And none of these are exclusive. Or you can start thinking about actually creating special sessions for yourself in discussion with your trainers to start. But then you have to account for it, the time spent in which you can actually do small projects, small audits, service evaluation, service implementation, all of which can generate towards research projects or papers. And then there is the gold standard pathway, which is the integrated academic training. So those of you who are really wanting to take academics as part of your future life, then this is something which can be opened up and sort of thought through in a serious nature. But as with anything, with regard to any, any challenges, just like in cycling, people tend to fall down. There's crying, there is tears. My kids are, my my daughter's now learning cycling, so I'm going through that stage. And it is intimidating. It's not easy, and it's not in everyone's interest. So everyone can't become Bradley Wiggins. And that's where you have to align as to what you want out of it. You need a thick skin to wherever you go, clearly. And you have to be prepared for failure. That's essential. One of the things which I really feel a pride about is that for every paper accepted of mine, I get rejected 2.87 times. So I've got around 300 odd papers, but you can imagine how many times I've been rejected. But I wear that as a mark of a sort of up of pride, in a way.

And then let's talk about Academic Clinical Fellows and Lecturers. So this is basically a very competitive scheme across all, all specialities, and it's got around 400 places a year. It's funded by the NIHR, who expect basically the cream de la cream with the hope that they will become top academics, going into generating independent, high-quality research. And the duration for that, and this is where it, it's really challenging, is that they fund 25% of the time for three to five years. But what it doesn't take away is your normal clinical work. So the idea is that you will be doing your normal clinical work in the 75% of time. So you're going to be pitted up in 75% time to do what others will do in their 100% time. And the requirement here is basically early stage of specialty training, which is F1, F2, or CT1 to CT3. And you have to demonstrate outstanding potential. And it is not for everyone. It's really tough, tough, and, uh, very competitive too.

Coming to psychiatric training, why are we trying to sort of sell this to you here? Because psychiatry is in need of you. We need some of the best brains. You are already a best brain because you are a doctor there. And I think one of the big challenges is that psychiatry is losing clinicians who do research. There is a diminishing academic number, which means that we are not going to see a lot of science evolve, which means then that our patients lose out. And that's not fair as a specialty that we see our science go down compared to other sciences. So there is also what I feel psychiatric can offer a brilliant opportunity of unique medical challenges, newer medication, and things, large fertile test bed from neuroscience to psychotherapy. So I work in the area of epilepsy. Now, what's really interesting is 100 years ago, 1924, Hans Berger was the first person who discovered EEG, that's basically the brain waves, EEG to diagnose epilepsy. So it was a psychiatrist who led the field there. We keep forgetting that psychiatrists have been pioneers, and we need to sort of bring out the pioneering spirit in yourselves to help us with this going forward.

What can you do? So if there are 400 places in the in the this thing, ACF pathway, and it's highly challenging across all fields and very competitive, but that shouldn't stop people from thinking about research. It comes back to the fact that if you want to keep healthy, you want to do cycling, it's the same sort of thing here. Do try psychiatry research in different ways. So you can identify a mentor in a topic of area or interest, join the academic faculty in psychiatry. There are people out there who would support you and help you and connect to the established academics in universities in your local area, or even now, because of Teams and Zooms, outside that you can get engaged in a small way by collecting data. Uh, many F2s have published with me by just going into records, collecting data when the call out comes, and then helping understand how the larger project works. Become visible. Join your local research team. They'll ever so willing to have have you on board to be a PI or a co-I, and you'll understand how research implementation works, works, and how money plays a role in the whole greasing of the process. Build your area of interest. If you see something interesting and, uh, uh, and you will start writing it up, and what you will find is that there will be other people who have had similar sort of interests, and bringing it together would be a very first small eon to grow a big walnut tree. I'm, and it's something which happens time and time again in our profession. Apply for a small grant. There are charities out there which will happily give 5,000, 10,000 based on what you want to do in a small area of work. And of course, you need some mentorship in all these things. And definitely, there is always that opportunity to go for ACF or do a PhD or an MD, which you should take, or a Masters to take your interest forward.

So to sort of summarize in this sense, it's basically you've got the formal route, the ACF and the A, and the academic clinical lecturers and higher degrees. But don't forget the non-formal route, which is basically less effort, less structured, and paced at your own, this thing. So you can actually pace yourself and be able to fit in what you want to fit in as what you want to do as research. But it also think about supporting research implementation. It's very important that there are networks already which which are in existence at trust level and the college level. The college R divisions and the faculty academic faculty will be very helpful. The NIHR will be very happy to engage. And, uh, there are other schools which are there which will help you with that. And most importantly, think 30 years. You're you're not the uss bolts, you're the more far us if of, um, of the medicine world. So you'll be going there. And what skill set do you need to keep you happy, to keep you entertained? It's not just all about money. I can say that now I'm at the other end of the career, knowing that you're going to pay my pensions, but still, it is about skill diversity and what would you like and what range would you like to do? Now, coming again to psychiatry and my own personal, this thing, experience. This is the sort of area where I play around with. This is my playing field in people with intellectual disability. We work across a rainbow and spectrum. It's a very broad church. We, we do genetic research, we do medication research, we look into big data trends, and we are working in generative AI technology and apps. So we are working, creating robots and all sorts of interesting things which we play around with. And the idea is to develop psychiatric medical strategies linked in with social environmental changes, complex care needs, so that we can then personalize holistic care and co-production working with patients is a delight, and they bring in their own unique blend to it because it's about their care. And this is something which I have learned a lot from patients day to day. This is the sort of model that we adopt when we actually work for our, this thing, in my area of epilepsy, intellectual disability. Lot of it is about moving away from conventional models of hospital-based learning. It's about understanding how to predict illness before it even happens. If it happens, how do we keep it short? And how do we turn it around with any medication? So prediction, prevention, personalization, and participation, very important. And that's where tech is coming in in a big way. So that's my end. I think questions are in the end. Thank you very much.

Thank you. Thank you, Rohit, for that, for that talk. Excellent analogy with the cycling and academic psychiatry. Um, so, um, without further ado, we have our next speaker, uh, Dr. Kate Saunders. Uh, Dr. Saunders is a clinical academic Senior Lecturer at the University of Oxford and she co-leads the mental health mission capacity development theme. So Kate, thank you for joining us. Please share your slides. I think I still has my slides actually, rather than me, but not, sorry, I, I sent them through. So let me, that looks, that looks more like it.

So, um, hello everyone. It's lovely to to be here. As Shti said, um, I'm one of the co-leads for the mental health mission. And for the last, gives me seven, eight years, I've been a training program director supporting academic trainees right from sort of foundation through to, uh, CCT. So it's, um, lovely really to to have the opportunity to to speak in this, in this context. Wonder if we can move on to the, the next slide. Um, I think a lot of what's already been said, uh, Rohit has said a lot of what I was going to say, should I say, um, really, but I, I don't think we can underestimate the importance of of actually doing things you're interested in. And I think if you're thinking, well, you know, I'm not quite sure what to do, I should just step back. What, what are the things that motivate you? What, uh, said about the specialty that's got you interested in the first place? What are the interesting clinical conundrums, or indeed educational, because that forms part of research, doesn't it? Um, that that you're interested in? Because actually, if you're going down any aspect of clinical, the clinical academic pathway, be that formally or informally, it, you know, it's hard work at times, and actually that motivation is very much driven, I think, by by interest. And so actually, you know, having that confidence to to set out and say, what is it I want to ask? What is it, you know, what is it I'd like to to understand, understand more? My, my doctor was all about, um, distinguishing bipolar disorder and borderline personality disorder. No one in my department has really done any research in involving people with, um, been given a diagnosis of FY disorder, but actually it was something I was encountering all the time clinically and became, you know, something I felt was was worthwhile researching. I was fortunate to be supported in that, but, um, I think my, my motivation around that was was very much driven by the fact it was a, it was a question that I was interested in and wanted to to answer.

So, wonder if we can have the next slide. Wonderful. This, um, is the sort of complexity of the mess of the formal, um, training pathway. I'm sure you're, you're familiar with this, but of course, there are academic opportunities at every, at every, um, level. And it's often presented in this way with a sort of a bit of a linear progression, really, where you might do an intercalated degree in medical school, get on to an academic foundation program, get into an ACF at core training, then an AC, do your PhD, then into becoming a clinical lecturer. Of course, the reality is is very, very different. I know very few people who've actually, um, kind of gone down this pathway in a, in a linear fashion. It's much more likely that people will do aspects of this and then go back into their clinical training full time, um, and then perhaps pick up a research interest at a, at a later point. Um, and I want to encourage all of you, really, to to see it in that way, that these are things that, you know, you may come to at different points in your training, and there is no one kind of correct way of of doing that. Um, you know, I think probably of the panel, we've all done our academic work at different times in our careers and, and, you know, with, with different kind of journeys along the way. And I think we, it's important, I think, to to hold on to the diversity of ways that you can come into this. The other, I think, important thing, and Rohit has, think, has already highlighted this, is is there are many ways into academia, and they're not always about getting a PhD and being a formal clinical academic. I would entirely agree with him that actually all doctors have have academic interests as part of what we do. And, um, you know, I think there is an argument that we need to reframe a little bit of the, the nature around this, because there were lots and lots of people involved in academic work, but wouldn't be like perhaps, you know, truly and I employed by by a university, uh, formerly, um, but those, those colleagues are just as valuable and doing such important work from, from the clinical perspective. So when we talk about clinical, I think it needs to be a very inclusive and diverse, um, uh, kind of set of of criteria that that brings all those, those people in.

I could be have brilliant. Okay, so look, how did you, how did you prepare yourself to get? I think the first thing that we can't emphasize enough is the importance of being good clinically. Taking on work in addition to your clinical training, actually, you need to have a good set of clinical skills and be clinically competent. Um, also means you're, if you're good clinically, you're probably going to ask better research questions, because actually you understand the clinical, um, setting and the clinical challenges that are being faced every day. I'd really encourage you to make connections with people at all levels, um, because we will all have, depending on levels of seniority, we've had different experiences, and no one single person will have have, you know, no one single person's kind of trajectory will necessarily be right. There are a lot of different ways of doing things, and I think you get different perspectives from different people at different points, uh, within their, within their kind of, um, seniority. Do think about how you build an academic portfolio. It's given lots of lovely examples about how to do that, um, already, and I think, you know, it's seeing the opportunities and, and, and thinking a bit, a bit creatively. It's not, it's not just about that, that traditional route. Self-sufficiency. Yeah, Rohit talks about the number of rejections. That is part of, of, of life, certainly if you're applying for grants and putting papers in. And there is something there about having a, um, I suppose, a way of understanding that and dealing with it. I very much see those things as being formative. So you learn, I think, for every rejection, you learn a bit more about how you might write a better paper or construct a better grant. But it's the time that goes into it and the effort. It can sometimes feel, I think, you know, very disappointing at times when things don't go the way you hope. So I think there is something important there about about kind of having that self-sufficiency. And linked in with that is, is, you know, the perception of obstructions. I'm, I'm, I'm very aware that there are changes in, in, in training, particularly foundation training, that have just been announced, which may have quite an interesting impact on academic training. And, you know, very much my role with supporting trainees locally, how do we find ways around that? How do we find the opportunities that those changes, um, may, may provoke? Again, I'm repeating everything Rohit said. He did it in much, much nicer terms with this, with this analogy to do recycling, but this, the idea of having a longitudinal plan is key. It's about trajectory rather than absolute position. You know, things will evolve and change. And just because I don't know, you're not successful in that ACF, doesn't mean that you don't can't go on to to be a successful clinical academic. It is about having that sort of long-term view rather than, um, just thinking about the, the immediate.

Wonder if we can have the next slide. I said, um, so if you haven't come across it, please do, um, sign up and look at the mental health research incubator. This has been led by one of my colleagues, Kathy Creswell, and is a fantastic interdisciplinary platform for anybody who's interested in mental health research. There are lots of, uh, PACE studies, there are lots of opportunities to link up with with other people. There is this Grow Research and Development program where you can apply for small pots of money to start doing some work, um, and it's just a fantastic site, really, to just get some insights from others, um, and as I say, that interdisciplinary element is, I think, what makes it quite unique. So it's not just about medics, it's about people from, from a multitude of disciplines who contribute to mental health research, and we know that our research is much better when it's done in that interdisciplinary frame. So please do, um, look that up. I's just posted that the link, which is, which is wonderful. I wonder if we can move on again. I, but that's going backwards. That's interesting. We can keep going.

Okay, so how do you build that portfolio? Well, there is lots of scope for being opportunistic. The interesting clinical problem, the unusual placement, most chance encounters, actually. There's a new technique that arrives, and you know, using spare time you have whilst on on placement, offer to they're thinking about, yeah, I've just noticed that, I wonder, I wonder if, um, and I sometimes those, those ideas and opportunities come when you're when you're least expecting them. But it's, I suppose, being having that level of preparedness, being ready to to think about things, read about things, and question things. We're living in an interesting age, I think, particularly with the rapid use and, and of, of digital approaches in mental health, which I think bring with them a huge, huge opportunity in terms of things like phenotyping and more interesting outcomes, of giving our patients control over their, over their data. But there was lots of opportunity within that, isn't that to think differently about how we might deliver things. Wonderful. Again, apologies, it's lots of repetition. We should have perhaps coordinated better. Right, here tonight. Do approach a local R&D department. You will all have one. My experience is that often trusts are really keen to involve people in, in, uh, projects that they're being approached to deliver. Um, they will have a good oversight of everything that's going on in your, in your area. So do, um, get in touch with them. They're also very good about guiding you about possible, if you're wanting to kind of take a, a project forward within your trust. There are sources of, of lots of useful information in relation to that. Do you have a think about training and some research methodology? So increasingly, particularly people working in the data space, being able to code is a useful skill, for example. And actually, there are excellent resources online now that you can, you can, um, work through that will give you the basics of coding in something like R or Python, um, because actually, if you've done a bit of training, you can then bring, you know, you bring a skill set to any, uh, research group that you might join, and that is hugely, um, useful, actually, that if you can bring something, um, to contribute from the outset. Do have a look at funding schemes. There are lots available. Just, this is an example from the, um, college website of some of the earlier career funding that's that's there. So do get familiar with them, because some of them have quite specific, uh, requirements and are targeting very specific kind of groups of trainees, um, but this is a space that is evolving, and I think it's, you know, very exciting. Things like MQ, which was a charity, but didn't really exist 10, 15 years ago, but it actually was set up very much to support mental health research, recognizing that there was a real need. So do, do have a look at that. The other area where I think there is, there's opportunity is exploring those datasets that are already, already available, and there are quite a significant number. Um, most, many of them are, are you, you're able to use without, without payment. Um, you may have to put in a formal application, but actually they mean you can get going with answering some questions without having to do the primary data collection, because that can, can sometimes be, uh, quite, quite, quite burdensome. But actually, if you're interested in getting involved with things like the APMS, the Adult Psychiatric Mobility Survey, great dataset, actually, sort of a research assistant who was interested in ASD and personality disorder and has done some secondary analysis in that context, and it has produced a lovely short paper as a result. So do explore some of those things as well. The other thing I've put in, this is a bit of an old tweet now, but I just want, I do think it's worth saying because we never talk enough about it, I think, is, is for all the all the publications and, and successful grants that you will see, any clinical academic has on their CV, there will be a much, much, uh, larger, um, number of things with which they don't tell you about, which is the grants that have been knocked back, the peer reviewers that have, have, have, you know, have decided the paper's not worth publishing. There's all of that. And I just want to sort of mention that because again, we don't talk enough about it. Um, and it can, I think, feel particularly early on in, in your career, that's those, those setbacks are, are significant. But actually, all of us have had them. I imagine everyone on the panel has their own set of stories around, around that. Um, so this is, you know, it's, it's about, it's about that trajectory and that longer term journey, and, and seeing these things as opportunities, far as a reason to to stop getting, getting involved. Great. I've mentioned the incubator already. Just thought I put it in twice because it is such a fab site. I think if you click again, as, um, encourage you all to, uh, think about, yeah, looking at the college. I think those links are already in in the chats. Um, I'm thinking about how you can, can get involved. I think that's pretty much all I was, was going to say. So thank you.

Excellent, Kate. Thank you so much. I think it was worth reiterating some of those points that Rohit made. So I think excellent points, practical points, uh, for everyone to take home. So with that, we have our very last speaker. I'm really delighted to welcome Dr. Johan Dy, who's going to talk about her own PhD journey. She is a consultant, uh, child psychiatrist and an H senior research fellow in Cardiff. And her research is, uh, in, uh, young people with genetic syndromes who are at high risk for neurodevelopmental and psychiatric, uh, neurodevelopmental conditions and psychiatric disorders. And, uh, yeah, over to you.

Um, let me just try and share my slides. Can everybody see those okay? Yes. Thank you. Lovely. It's not showing as my slideshow there. There we go. Lovely. So, um, I know time is short, so I'm not going to, I'm going to hopefully be brief so we can leave lots of time for questions at the end. But I thought it'd be really helpful just to reiterate some of the points that the previous panelists have made, really, by just describing some of my own personal experiences and my own career journey, which will touch on some of the different aspects, um, you know, about the training schemes, um, that have been mentioned before. So, um, just, yeah, briefly, just over again of the research opportunities in psychiatry, thinking about some of the pathways and my experiences of those pathways. Um, I'd like to end with some hints and tips, um, and really, then it's over to you to to ask questions of the panel, um, that may have arisen as we've been speaking. So we're really fortunate in psychiatry. We're a very academic discipline, and that doesn't mean that you have to be a formal sort of academic and a formal training path, but there's so many opportunities to find out about what's happening in this rapidly evolving field. So there are taster days and weeks that I know some of you, um, have been on. There are a number of summer schools hosted by a number of different universities and psychiatric departments that you can, the opportunity to attend perhaps during some study leave, um, and as part of a lot of training schemes, there are actually special interest days allocated during your training where you can spend some time with research groups or even different research groups, getting a flavor of the sorts of opportunities that there might be. Of course, you're always welcome to attend conferences and courses, and the Royal College hosts a number of excellent conferences with with special sessions often, um, that are dedicated towards trainees at the early stages of their career. Uh, the other panels already mentioned, you know, got opportunity to take part in standalone research projects, collect data, um, to help with ongoing projects, perhaps in your, in your health board, your trust, or your department. Um, and of course, there are formal research training routes as well. So when it comes to thinking about, um, the sort of formal pathways, we've already mentioned the academic foundation program, the ACF scheme, clinical lectureships. It's also worth noting I'm based in Wales, and there is an integrated clinical academic scheme in Wales, um, known as the Wales Clinical Academic Track, which has some advantages over the uncoupled schemes, um, if anybody's interested in hearing more about those, I can always have a a chat offline about those as well. But as, um, the previous speakers have said, you know, there's more than one way to skin a cat. There's more than one way to create a clinical academic, and there are all sorts of alternative career pathways. It's not a conveyor belt. You haven't lost the opportunity if you don't get on a foundation training and become a clinical academic, um, at the end. There are all sorts of different routes, um, and most of us, I would say, have had quite a circuitous and scenic journey to our final destination.

So with that, so think about my career journey. So I started medical school way back when in 2000 at the beautiful Christ Church in Oxford. Um, so I was fortunate during my undergraduate training to to really get involved in in a reasonable amount of research. Um, and as part of that, I did a BA in Physiology, um, which integrated into that was a project looking at fMRI and studying chronic pain. And this really opened my into, you know, the potential of research to really look objectively at what are quite subjective human experiences. And although I didn't want to go on to become an anst or a specialist in pain, um, it really opened my eyes to the opportunities in psychiatry of using tools such as neuroimaging to try and understand, um, these disorders. So I then did join the academic foundation program. It was in its infancy, really. I think it was the second year that had been running, and that was at, uh, again at Oxford, so working at, primarily the John Radcliffe Hospital, but also at the Warneford Hospital, which is the psychiatric unit. Um, and as part of that, um, I had the opportunity to take part in another neuroimaging study looking at

Diffusion imaging in patients and children, in fact, with obsessive-compulsive disorder. And that led to an application for an academic clinical fellowship, which was successful. However, partway through that academic clinical fellowship, my research interests have changed a little, and I became quite interested in genetics, and in particular, understanding why some young people seem to be at a particular high genetic risk of developing neurodevelopmental and psychiatric disorders.

So I moved from Oxford to Cardiff to join this integrated scheme that I mentioned previously, the WCAT scheme. While I was on the WCAT scheme, I applied to the Welcome Trust for a clinical research training fellowship to fund a PhD project. And that was studying children with a rare genetic disorder, um, known as 22q11.2 deletion syndrome. And I used a range of imaging, uh, techniques to try and understand why these children have such high rates of ASD, ADHD, and schizophrenia. Um, that led to my PhD, and at the end of my PhD, I entered CAM's higher training. And at the end of a very, very long, um, period of training, I eventually CCT'd in 2022. So if we look at that trajectory, that's 22 years of training. It's a long haul. I think the analogy with cycling is a very good one. It's, it's a Tour de France rather than it is a track sprint.

So, what am I doing now? Well, I've got quite a range of different interests, and I've really, through my career, developed, I suppose, like a lot of us, a sort of portfolio of different interests that really means that what I'm doing in the clinic is relevant to what I'm doing academically, and sort of vice versa. So I'm a consultant child and adolescent psychiatrist. I specialize in children with intellectual disability. So I provide medical input to a service, um, specialized for looking after children, um, with a moderate to severe intellectual disability. I also am a psychiatrist with the All Wales 22q multidisciplinary clinic, so providing holistic care to patients with the specific genetic syndrome. Um, and we've also recently established the first, um, psychiatric genomic service in the country. So that's the All Wales Psychiatric Genomic Service, which is hosted at Cardiff University, and I'm the CAM's consultant who provides input to that team. I'm also an MRC Senior Research Fellow. So I've got ongoing research projects at Cardiff University, still focused on children with high genetic risk syndromes, but looking for final common pathways across a range of genetic risk syndromes. And I'm actively involved in lots of teaching, both undergraduate and postgraduate. Uh, I'm also involved with a project with Genomics Education England to try and develop educational resources for psychiatrists. Genetic testing is becoming, um, more commonplace in psychiatry, and we're trying to develop resources to try and help clinicians to try and understand when it might be indicated. And I do lots of committee roles. I do some work with the Royal College of Psychiatrists and the Royal College of Pediatrics. And it's fair to say that although I am very, very busy all of the time, I'm never, ever bored. I think that's the beauty of psychiatry, and the beauty of academic psychiatry, is you've got so many opportunities to do such a range of different things. Um, and, you know, if you can get things just right and follow your interests, um, all of these different, um, facets, I suppose, interlink so that you've got a really very, very interesting career, but with a sort of focus on on what your interests are.

So Kate alluded to this now, we talk about, you know, here's my lovely career journey. I got on this pathway and then this pathway. And what we don't talk enough about are all the rejections. So what I've tried to map out on this timeline is on the top, some of the sort of negatives that have happened, sort of from a career perspective. You know, rejections for fellowships, rejections for grants, paper rejections. But also bearing in mind that we're humans, and we have lives outside of work as well. So, you know, along my training path, a number of different life events happened. Got married, had children, long period of illness, multiple house moves, city moves, bereavements, COVID hits in the middle of data collection. So all of these things will have an impact. Um, and no one expects you to be a robot and expects you to be a machine. We, we know we all have things that happen in our lives at different stages, both in terms of our personal lives, but also, um, in terms of our careers, that can provide setbacks and maybe make us change direction a little bit as we try to balance work and life.

So more sporting analogies. Marathon, not a sprint. Tour de France, not, not a cycling sprint. So, you know, from a work perspective, it's very tricky to balance clinical and academic commitments. It's difficult to have rejections, but it's commonplace. You know, we've all experienced it, and sometimes it's what bonds us, some of our discussing some of our difficult times as well. And we have lives outside of work. So my hints and tips would be to get some hands-on experience early, really to find out if academic, um, medicine is for you. If you enjoy it, it's really important that we enjoy what we're doing. You know, it's a, we're going to be a long time in our careers, um, and there will be tough times. But if you enjoy the work, you are interested in what you're studying, then that makes those difficult times much easier. Talk to different clinical academics at different career stages to get their perspectives. We'll all have slightly different experiences, different journeys, um, to try and get a range of views. Um, mentorship is crucial. I've got a number of different mentors who I've encountered through various stages of my career, not all psychiatrists, and not all, not all academics, but they've provided lots of really sound advice when things have been tricky. Um, I've mentioned focusing on things that really interest you, and having things that enrich your life outside of work, and be that sport, um, uh, theater, drama, art, whatever it is, something that enables you to have a distraction, um, from the tough times in work. And make sure you take regular breaks. Make sure the laptop is off. Make sure the phone is off. Um, and so that you have some quality time with your families as well. And expect rejection. It's, it's just part and parcel of what we do. And, um, importantly, if you're keen to continue in the career, never ever give up. There are always opportunities out there. It may not be what you mapped out when you're in your 20s. Things might be very different. Um, but, you know, continue your interest. There will be a way. That's all I had to say before we move on to the Q&A. But I hope that's, um, yeah, inspired some questions from the participants today. Thank you.

Tran, that's excellent. Really candid your experience, PhD journey. Thank you for sharing that. Um, so, yeah, just, um, I don't know if there are any questions. I can't see any questions in the chat. Um, if people have any questions, feel free to put them in the chat. Um, please, please can I remind you again, um, to encourage you to sign up to the associate membership of the Royal College. It's free, and we'll be posting lots of exciting academic opportunities there, with, with a foundation year three post, for instance. Um, and, um, Dr. S already shared the mental health incubator again. You can sign up to that and receive their newsletter. Okay, so, uh, thanks, John. Would you stop sharing, uh, so we can have all the panel members? Um, and, uh, if you've got any questions, like I say, please, uh, feel free to post.

Okay, so we've had one question. So I'm going to read it out. Uh, so from, this is from Jess Morris, and she's asking, uh, she was wondering what a typical work, typical week might look like, um, how accommodating employers are, allowing you to build your time around clinical or research commitments. Uh, so, yeah, I don't know, perhaps, uh, Kate or Rohit, would you like to answer that? Perhaps I suspect we've all got a slightly different answer, would be my, my, my guess. Um, I think so. I have an educational role, so because I spend quite a bit of time, probably like some other panel members, teaching and supporting trainees. Um, but within that, the rigidity of the, uh, of the sort of term time and and things, um, I think I have, I'm very fortunate to have quite a lot of flexibility. Um, I just want to pick up on one thing that John was saying, really, about looking after yourself. I think that flexibility can sometimes mean putting boundaries in place is, is, is more tricky. Um, I think I would reflect on when I had a, I had a joint, um, consultant and academic post for a couple of years, where that was actually, I have to say, quite difficult. And trying to be clear about where I was and what I was available to do at particular times of day took a bit of work. It's, it's definitely doable, but I think it does, it can feel quite hard. I think it goes against our natural instincts to say no to clinical things, but actually, if you're being funded for academic work in that time, sometimes you do have to actually say, I'm sorry, but, you know, Mondays and Tuesdays are my academic days. I'm not contacting. But on the whole, I think people are very supportive. Um, yeah, sometimes just grateful. Thanks, Kate. Do you want to add to that, Rohit, at all?

Oh, thank you. I mean, it's quite an interesting one, isn't it? Because I think with clinical work, you have provenance, basically. People have trained for it. We know how good they are or experienced they are, and we'll get their bank for the money. The main thing, I think, in research is nobody's going to give any time without actually knowing what you're going to get out of it. So it's sort of an investment at times. So if somebody has published in medical school or done some work, somebody I would be, or the team would be more willing to actually accommodate a bit more time, whereas somebody comes along and says, I want to try a handle on that. You think, why you? Why not somebody else? I think there is all these things, and it is about the proof of the pudding is eating it. And I think I can dare say, I hope I'm not the only one, but everyone on the panel here, we've all spent evenings, nights, writing grants, writing papers, because that, there is a sadistic element in research where it all builds towards a climax, whether you are on a holiday or not, you have to submit your grant, you have to do things. And I think to some degree, even in your training, there is that expectation that you're just going to help move your research alongside your clinical work without any extra added time or anything there. But it is about, I think, building relationships, very importantly, because I think if relationships are built, that will give flexibility and opportunity. Thank you.

Okay, uh, there's another question here. Um, what is the process for applying for an ACF? So you will apply, um, as a core trainee, usually. You apply separately from the application to core training, and those interviews are usually earlier than core training, but you will need to clinically benchmark, I think, which is important. So, uh, that's, uh, H as it will be, is now run, run that process. Uh, yeah, so look out for the adverts. ATCs are NHS employees, just to mention. Academic lecturers are employed by higher education institutions. So that sometimes throws people because they're expecting something to appear in the NHS space, and it's actually a, um, a university appointment. I don't know if others have anything to, to add to that, but usually we're, we're shortlisting and interviewing locally, but would be the same across the country, sort of November, December time to start the following August. I just said the process in Wales is a little bit different, a slight different scheme. So it's coupled. So generally the training is from the point at which you enter right through to CCT, with a three-year PhD sort of built into it, which is, is one of the benefits. There are some disadvantages as well, but just keep an eye out for those ads separately as well. And I think the same would be true for Edinburgh, used to be certainly anyway, for the Scottish schemes. Well, thank you. I noticed, thank you, Rohit, for putting the link in the chat to those ACF schemes. That's excellent.

Okay, so I don't think we have any other questions. Um, if people have any other questions, you have your last opportunity to place it there, but we are at time as well. So, um, yeah, so with, with that, um, shall we, shall I like to just extend, um, a warm, um, you know, just say thank you to the panelists for joining and for your excellent talks, and thank you to everybody on the webinar for joining. We will be sending out certificates, uh, to you, and I hope that some of you who've been successful at at, uh, securing research, you know, research taster weeks, I hope you enjoy them. Uh, so thank you very much, and thank you for joining today. Bye-bye. Bye. Thanks, Rohit. Bye. One. Thank you. Oh, thank you so much. Thanks, Claire. Thanks for, um, organizing it all. Thanks, Patricia. Thank you.