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Andrew_WyllieBeanstalk Career: A Story for Trainees

Jack climbed on and on. In time with his breathing, a thought was repeating inside his head: maybe this was a mistake. Meanwhile, however, his hands continued to stretch through the branches for new holds and his feet found support as if on some endless staircase. Above the chanting doubt there were other, seemingly more rational voices. He had been faced with a decision and all decisions imply risk. In the marketplace, of course, the cow would have sold for a predictable sum. Momentarily that had looked like a low-risk path, but then he would have lost an opportunity of unknown, perhaps immeasurable potential.
 
The path he had chosen had no certainty of any kind but held out the possibility of discovery - maybe even in his own vegetable plot - of a new world where nobody had been before. That morning, when he first saw the beanstalk outside his bedroom window, he had felt sure the risk had been worth taking. But now, lost high amongst the huge leaves and bewildering tendrils, with no obvious way back down, he began to wonder. Maybe this was a mistake. And then, in the distance, he saw the castle.

It isn't really a fairy story, as histopathology trainees who have been attracted to an investigative career can affirm. Career choices are full of risk. Often they have to be made at awkward times of life, in competition with the need to complete professional examinations, look after the future educational needs of one's own children, maintain income parity with old classmates in their various specialties. Research is capricious, might yield nothing sensible, may require difficult skills that we lack and need to learn, sometimes leads to a career cul-de-sac. Teaching also can be frustrating, intrusive and repetitive. Examining even more so. To strive to combine all of these with clinical excellence is surely a move as rash as Jack's when he let the cow go, in exchange for a few beans?

Yet the choice to train in histopathology at all is already a decision to move into an investigative environment, learn new skills, summate the results of a variety of observations and articulate their meaning to colleagues. Investigative careers truly belong to us all, for they can be built around clinical diagnostic skills - whether in the understanding of human disease in human patients or in the remarkably underexploited territory of interpreting animal models, of which there now large numbers. Further, although it may be partly true that "technology rules science," purely methodological considerations should never be a barrier to the solution of the questions posed by disease: the microscope is a tool we use but need not be the only tool. New methods and indeed new ways of thinking about disease causation, identification and treatment can all be learned if the motivation and environment are right. The need to refresh the specialty of Pathology and train a cadre of young clinician scientists has been identified by the Department of Health, the Research Councils, major charities, and Government advisory bodies such as the Office of Life Sciences. Millions of pounds have been committed to a variety of schemes capable of nurturing the careers of clinical trainees who want to make discoveries that affect health care.

So how can we find the beanstalk that will take us there? There are a few rules. Finding a role-model or mentor comes near the top of my list - someone who demonstrates the kind of investigative bent you are attracted by and can identify with. Mine was no mysterious traveller, never to be seen again, like the weirdo who took Jack's cow, but a hugely charismatic personality for whom Pathology was the route to both the patient and the cell.  You also need an environment - this sort of career cannot be grasped in isolation, and this is where the 'Walport-style' academic clinical fellowships, clinical training fellowships, clinical lectureships and eventually the more senior clinician scientist awards come into their own: a career escalator giving access to many levels of applied, translational and basic science. Both the College of Pathologists and the Pathological Society contribute to parts of this escalator. Many Medical Schools also have discretionary funds designed to facilitate the pilot studies that make for success in later, more competitive applications. Other needs include a variety of contradictory personal features: self-criticism with self-belief, attention to detail with wide vision, enthusiasm with scepticism, patience with impatience (Jack was a complicated character). But most of all, you need a good question. Have you seen your castle?

Andrew Wyllie
Cambridge
 
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