As an intensive care doctor admitting patients from all specialties in the hospital, I could see progress in other fields of medicine. However, for intensive care medicine, despite our best efforts and many high-quality trials, very few of our interventions work because we do not understand the biology of our patients.
We can manage their physiology very well and we can reduce some of the unintended complications of our interventions in patients. However, we have not been able to get to grips with why patients who, from the doctor’s perspective, appear to be quite similar have different clinical responses to treatment.
I found this frustrating. But fortunately, there was a clinical fellow training programme to help address these important questions. The Medical Research Council (MRC) and GlaxoSmithKline (GSK) Experimental Medicine Initiative to Explore New Therapies (EMINENT) programme was an opportunity to dive into the biology of critically unwell patients to gain a better understanding.
The programme is a unique collaborative network, bringing together investigators from five universities and GSK. It gives unprecedented access to GSK’s resources to take on complex scientific questions that will improve our understanding of disease and support the development of treatments that benefit patients.
1. Opportunity to focus on a research question
Clinical medicine is exhausting. It involves long hours, with lots of interruptions, so it is difficult to sustain trains of thought or see things through to completion. There are so many different priorities on your time, constantly. The EMINENT programme was a refreshing opportunity to just focus on the research.
My fellowship was targeted at acute respiratory distress syndrome (ARDS). ARDS is a life- threatening condition affecting the lungs where they are unable to provide enough oxygen to the blood to support the body’s vital organs. It can occur as a complication of acute illnesses including pneumonia, surgery or injuries from a road traffic accident.
ARDS affects 10% of intensive care patients worldwide and still has a 40% mortality rate despite over 50 years of study. There are no medications that have consistently been shown to help these patients, apart from supportive care which involves putting them on a ventilator and managing the complications.
So my fellowship project was an opportunity to collate data from around the network and its resources and get specific training in data science methods from GSK and people in the network. A chance to try and take on this difficult problem, in this challenging group of patients.
2. Access to drug development resources and training
Being a recognised EMINENT fellow meant I had access to senior leaders, and they knew who I was. EMINENT leaders at GSK helped me open doors; I had access to new methods developed within the network and to dedicated high-performance computing resources.
The network also arranged training at several sites around the country, including training days at GSK outlining the drug development process and pathways. Understanding how industry prioritises and align its processes to get a drug candidate product to market made this a useful exercise.
3. Exposure to a more structured way of working
An additional advantage of being part of the EMINENT programme was that it was ‘work packaged’, so the project goals were very clear to me. My PhD focused on using bioinformatic methods to identify different subtypes of ARDS.
To do this I combined existing biological data from observational studies with data from clinical trials that had been conducted in the UK. I was able to identify processes in different groups of critically unwell patients that explained what was going on in their bodies. These patient groups included those with severe influenza (flu) and others whose lungs had become injured because of a severe infection in their body (sepsis).
Often, research projects can appear open-ended which can make it difficult to know how far to explore a question and what you are expected to deliver. I feel that I benefited from the structure that the work package approach provided.
We are currently working towards confirming our results so that we can use our findings to group patients, based on their biology, in the future. Once we can identify different groups, we could offer them targeted therapies in new clinical trials which would be more likely to improve their care and outcomes.
4. Fresh perspectives from working with people outside your field
When undertaking a PhD or any research project, it is easy to disappear down tunnels. Without regular, objective feedback you can get lost or side-tracked. Repeated independent scrutiny is always helpful and this was one of the benefits of the EMINENT programme, in addition to all the networking and collaboration opportunities.
The breadth of experience and research across the network provided me with many new ideas and strategies to tackle problems I encountered during my research. Thanks to this experience, I have continued reading widely and seeking feedback from others who might not be directly affiliated with my field of study. This has helped me develop my research by drawing upon a range of ideas and perspectives.
5. New skills to use in the clinic
I absolutely enjoyed every moment of time in the EMINENT network. Research is hard work, but I have learned so many new skills and I am a much better doctor for it.
My interactions with colleagues and patients are different because of my time in research. I find that I am now less concerned about the minutiae of treatment algorithms and processes. I pay more attention to how staff and patients feel whilst trying to navigate the healthcare system.
The way in which I read research papers, appraise new interventions or changes to care processes has also changed. I feel more confident questioning assumptions and have a better understanding of research methods and statistics.
6. Combining research and clinical work for patient benefit
After graduating from my EMINENT fellowship and PhD I secured a National Institute for Health and Care Research clinical lectureship in intensive care medicine. Here I am building on the findings from my PhD by developing my methods on integrating clinical and biological data. I am now applying these to other groups of critically unwell patients, for example patients suffering with traumatic brain injury following a car accident or a fall.
I hope the network continues to thrive and would encourage other clinicians and researchers to make the most of its collaborative resources and expertise.
Find out more
The EMINENT network is not funding any more clinical fellows but is keen to explore new research collaborations across three aims and in four key areas. If you’d like to get involved, find out who to contact.
All MRC-funded fellowships are open to industry partnership.
If you’re interested in collaborating with industry, all of MRC’s grant schemes support such submissions using the MRC Industry Collaboration Framework.
The MRC experimental medicine programme is open to applications from early career researchers. This aims to support and fund experimental medical research in humans that will significantly increase the speed and efficiency of translating medical discoveries into healthcare.
Top image: Romit receiving a poster competition prize at the Academy of Medical Sciences’ Clinical Academics in Training Conference in June. Credit: Academy of Medical Sciences
Romit trained in medicine at the University of Cambridge and Imperial College School of Medicine. His clinical training has encompassed core medical training, anaesthetics, intensive care medicine and working in Sydney, Australia for a year.
Romit completed his PhD investigating how we can use bioinformatics to better understand biology and develop new therapies for critically ill patients in 2021.
He was appointed to a National Institute for Health and Care Research (NIHR) Clinical Lectureship in intensive care medicine at the University of Cambridge. He has completed his clinical training in anaesthetics and intensive care medicine and continues to pursue gaining new insights in critically unwell patients to help improve their care.