In the next in our series of reflections from our early career researchers, we asked Anneka Mitchell, currently in the first year of her fellowship, to share her experience so far…
What’s been your experience of your fellowship so far?
As I start writing this blog, I suddenly realise that I am exactly 8 months into my Dunhill Medical Trust (DMT) Fellowship. In some ways it feels like I have only just started and in other ways it feels like I have been on this journey for years! My experience of the fellowship so far has been overwhelmingly positive. My supervisors (Anita McGrogan, Mags Watson and Tomas Welsh) at the University of Bath have been an enormous support in both applying for the fellowship and mentoring me through my PhD journey and I am extremely thankful to them for their guidance. I truly believe that having a supportive team is one of the most important requirements to successfully completing a PhD.
I initially found the transition from full-time clinical work to full-time academic study very challenging. The jump from a job that I was confident and comfortable in, to the unchartered territory of academia was daunting, however, I am amazed how my confidence in expressing my ideas and talking about my research has grown in just the first year (writing this blog would have terrified me a few months ago!). I can’t express how important it is to put yourself out there, and take every opportunity to talk about your research and experience.
I think the most positive aspect of being a DMT fellow is the extensive opportunities it provides. This funding has allowed me to completely immerse myself in research. The opportunity to attend both national and international conferences has been invaluable for developing networks, as well as attendance at the Trust’s events for members of their early career researchers’ network, where I have had the opportunity to present and discuss my work with people from many different disciplines. I have also had training in new skills in statistics and computing, which will be of benefit for, not only for my current programme of work, but also looking to the future.
Why did you choose a career in ageing-related research and how do you see it progressing?
Since qualifying as a pharmacist, I have worked in a number of clinical specialities from acute medicine to orthopaedic surgery and have always had an interest in how and why medicines are prescribed and how safely they are prescribed. As I progressed through my postgraduate education in clinical pharmacy, I read countless clinical trials looking at the efficacy of various medications, but when I tried to apply them to the patients I was seeing in clinical practice, I realised that the people included in the clinical trials were scarcely representative of the people we were treating with these medicines. Older people, particularly those with multiple co-morbidities or complex medication regimes, are frequently excluded from clinical trials and I found it troubling how readily we just extrapolate the results to them when making treatment decisions. When direct oral anticoagulants were introduced, this issue really came to the fore for me. I could see that as these new drugs increased in popularity, they were being prescribed to more and more people and the majority of these people were over 75, yet this group represented a small sub-section of the people included in the trials. I decided at this point that I really wanted to research the safety of these medications, specifically in older people, and generate information that would enable prescribers to make better informed decisions for their older patients.
The issues surrounding the under-representation of older people in clinical trials are complex and I think that people are becoming more open to using observational methods to enhance the efficacy data provided by clinical trials and make the data more generalisable. I am keen to promote research investigating medication outcomes specifically in older people, rather than just relying on data from sub-group analyses or statistical comparisons between older and younger groups, and I believe my fellowship will equip me with the skills and training that I need to do this.
How is your research progressing?
I am progressing well with a systematic review and meta-analysis collating data on the safety and effectiveness of direct oral anticoagulants compared to warfarin in people over the age of 75 with atrial fibrillation. It is striking that out of over 300 records identified for full-text review, only 23 met the criteria for inclusion and, of these, only 5 relate solely to older people, the rest have presented minimal outcome data based on sub-group analysis. This review has further illustrated to me how beneficial my project will be in providing information specific to this patient group and I’m looking forward to really getting started on this.
I really wanted to research the safety of these medications, specifically in older people, and generate information that would enable prescribers to make better informed decisions for their older patients
I have obtained the relevant approvals to use data from The Clinical Practice Research Datalink (CPRD) database and initial patient counts for inclusion in my study are very positive with around 50,000 warfarin users and 10,000 direct oral anticoagulant users eligible for inclusion.
I am grateful to the Dunhill Medical Trust for supporting my professional development and my research both financially, and through the network of peers and events provided by the Trust. I’m excited to see where the next 2 years lead!