I became a GP in 1997 and was appointed professor of primary care at the University of Bristol in 2013.
As a child, I was an avid Lego® player and reader of ‘how things work’ books. I was state-educated and did not enjoy school until my ‘A’ levels. I enjoyed the conceptual challenge of mathematics and, in 1985, was offered a place at Birmingham University to study maths and psychology. My results were better than I expected, so I withdrew and applied for medicine, securing a place at Sheffield.
I was initially disappointed by the course because of the lack of conceptual challenges. I was expected just to absorb lots of knowledge. Later, as I took responsibility for patient care, the application of knowledge became the interest. I did not intercalate (an additional year on a medical degree to explore an area in greater depth) and the closest I came to research was writing one essay and hearing lectures from professors.
After graduating in 1991, I trained to be a hospital physician (MRCP 1995), then did a year of paediatrics (Starship Hospital, Auckland, DCH 1997) before ‘seeing the light’ and applying to the Sheffield GP vocational training scheme (VTS).
The Sheffield VTS was excellent. We were supported to prepare for membership of the Royal College of General Practitioners, which, in 1997, included demonstrating our critical appraisal skills and our knowledge of current research. It was the year Paul Little published the first of a series of papers reporting a randomised controlled trials of delayed antibiotic prescribing.1 My curiosity was reignited. With my new-found critical appraisal skills, I wrote a letter to the BMJ critiquing the trial, but deciding that wreaked of arrogance, I instead emailed the letter to Paul. He emailed back telling me how he would have responded, starting a career-long collaboration and friendship.
In 1997, I could say I was “interested in research” but little more. I was married to Gillian (now a GP in Bristol) and we were expecting our first child. My VTS advised I ‘get a partnership, get my feet under the desk, and then consider research’ – well-meaning, but terrible advice.
Instead, I wrote to every UK department of primary care expressing my “bona fide research interest”. The response was overwhelmingly supportive with offers ranging from “3 months funding to give you a taste” (Ann-Louise Kinmonth, Cambridge) to “would you like to apply for a four-year 50/50 clinical/academic post to do your doctorate?” (Robin Fraser, Leicester).
Not for the last time, Gillian showed her faith in my “interest” and agreed we move to Leicester. Four years later, with my MD (PhD equivalent for medics) close to submission, she agreed we move again, this time to Bristol for a Clinical Lectureship. And the rest, as they say, is history.
Reflections on my pathway into research
First, I mentioned Lego® because I think it taught me how to create something new, using imagination and bricks. I think there are parallels in research – imagination and curiosity are needed to define hypotheses, and a broad portfolio of skills to build and deliver studies.
Second, I was given the chance to “try academia” based on zero training, two minor publications2 3 and an interview where I offered my enthusiasm. I’m not sure that would happen today.
Third, the VTS advice can be seen to be terrible in hindsight. By the time I applied for my research grant it was almost unheard of for someone without a doctorate to be given funding.
Fourth, my training was sequential: clinical and then academic. In contrast, today’s aspiring clinical academics acquire their clinical and academic skills contemporaneously. I’m not sure which is better – each model comes with pros and cons, and both coincide with the challenges of learning how to set up home and (for those of us lucky enough) to parent.
Finally, while I am the first to acknowledge that research is not for everyone, I continue to enjoy the combination of patient care, research, and teaching. Research questions are constantly arising from my practice: when I find there is no relevant evidence to inform a management decision; and when my patients and clinical colleagues ask me questions I can’t answer. And at the University, one of my key roles is to maintain the patient relevance of our academic activities. One question I am often heard to ask is “please tell me how I would explain this to a patient?”
1. Little P, Williamson I, Warner G, et al. Open randomised trial of prescribing strategies in managing sore throat. British Medical Journal 1997;314(7082):722-27.
2. Hay AD, Ball M. Computed tomography in first uncomplicated generalised seizure (letter). BMJ 1995;310:1007 doi 10.1136/bmj.310.6985.1007a.
3. Hay AD. ‘Minerva’ photograph section. BMJ 1995, 310, 610.