RELATED PROJECTS

Translating neuroimmunology for innovation in clinical research and services

others in related specialties

Dr Charlotte Allan, CL in Psychiatry

Dr Ivan Koychev, CL in Psychiatry - Old Age

I have always wanted to be a clinical academic – the role is something unique and different to either alone. I had previously done an AFP, core medical training, and a NIHR ACF in Psychiatry – the theme throughout being neuroimmunology. 

The Wellcome DPhil scheme for clinicians hosted in Oxford had enabled me to go out of programme to embark on a DPhil. My DPhil research was on NMDA receptor-antibody encephalitis in the laboratory of Professor Sarosh Irani. This was a transformative opportunity that provided clinical and laboratory experience in this disease area, but also opened up other translational leads. 

Given the timing of the DPhil relative to my clinical training, an NIHR CL was a timely option. It enabled me to:

• complete clinical training with generous protected time to develop further practical pilot data, and
• build networks and identify what sort of balance would best suit me as a future consultant. 

Like other CLs, my time is split 50:50 between clinical and academic work. Psychiatry training appropriately values extended periods of time in a team to appreciate the nature of the conditions and interventions. Consequently, hybrid clinical-academic weeks have been the main structure, which has recently moved to alternating weeks. 

My main research interest is exploring cervical lymph node fine-needle aspiration as a potential measure of meningeal lymphatic drainage in health and disease. This builds upon a pipeline I developed in autoimmune encephalitis, but expanding the clinical focus more broadly across neuropsychiatry. Ongoing links with radiology, Professor Irani’s autoimmune neurology laboratory, and the opportunity to build a collaboration with Professor Klenerman’s laboratory have been headline benefits of remaining in Oxford. 

Additionally, I have been able to consolidate work on neuroimaging, immunology, and clinical characterisation of NMDAR-antibody encephalitis. The clinical component has borne:

• a joint neurology-psychiatry teaching seminar for Year 5 medical students,
• educational talks to NHS organisations, and
• the co-founding of a national working group on improving recognition of the condition, together with neurology, emergency medicine, and user groups. 

As for many aspiring clinical academics, the central draw of the clinical academic training path is the ability to traverse both the clinical and the academic domains and harness bi-directional insights. The CL, whilst not perfect, remains a gold standard in attempting to do this.

The main downsides have largely been generic and unavoidable. There had not been psychiatry CLs for some time prior to my appointment. This meant much personal leadership on outlining the role to clinical teams and peers. However, with the appointment of others, we have collectively built experience and developed fair boundaries and expectations, hopefully to the benefit of the scheme in future. Indeed, these negotiations are to some extent as central to clinical-academic training as the more usually emphasised aspects! 

I had no doubt that Oxford could continue to offer a dynamic and nurturing clinical-academic environment. However, at this career stage, there are arguments both for continuity and change. The ACF presented the challenge of preparing a doctoral application alongside core training; similarly, a CL is focussed on preparation for fellowship grant applications, whilst acquiring higher level competencies. This brings unavoidable uncertainty. Therefore, sticking with a proven, broad team, from clinical supervisors through to laboratory colleagues and OUCAGS’ over-arching structures, was a strong pull.

May 2023