Reflections And Awards Of A Supervised Intercalated Student

The First Meeting

This is an honest and reflective summary of an opportunity which challenged me immensely. At the start of a ‘year out’ of medical school, to conduct research as part of an intercalated BSc in Population Medicine, I had a number of questions which required self-introspection; how much work will I have to put in? Is this going to positively impact my career considering I’ve elongated my studies? and how am I going to write a dreaded two-part dissertation in addition to my modules?

Having secured a project in which I was genuinely interested, I organised an in-person meeting with my supervisor, Dr Joanne Euden, and co-supervisors, Dr Philip Pallmann and Dr Emma Thomas-Jones, from the Centre for Trials Research (CTR). I think many students feel nervous at the start and want to make a good impression, especially after a quick google search of their supervisors’ credentials (we all do this). Thankfully, the team set their expectations clearly, answered any questions I had, and I felt motivated.

We had a title: Antibiotic prescribing in hospitalised patients with COVID-19 as a function of inflammatory markers in wave 1 vs wave 2: A Systematic Review. I admit at this point, I was panicking a little, only just having realised what a systematic review entailed. I had done previous data collection and clinical projects, but with far less formal structure. I went away with some background reading, and the first of many scheduled Microsoft Teams meetings. That night I sat at my desk dissecting the first paper and probably highlighted half of it. It would be a couple of months until I fully grasped the topic.

Why Did We Do This Work?

Less than 10 % of hospitalised patients with COVID-19 in the United Kingdom (UK) during the first wave of the pandemic had bacterial co-infection, yet 75 % were prescribed antibiotics, contrary to NICE guidelines. Antibiotic stewardship is important in preventing short- and long-term negative outcomes including adverse drug reactions and antibiotic resistance. Hospitals have been using biomarkers heterogeneously in antibiotic prescribing decision-making.

The relationship between antibiotic prescribing and biomarker use has been explored in previous studies, but here we presented a narrative synthesis which stratified and compared themes within UK studies by the pandemic time-line, the first UK study to do this to our knowledge (PROSPERO reg: CRD42022308756).

In addition, I did a spin-off literature review looking at cardiac and thrombo-inflammatory biomarkers in the triage and management of COVID-19 hospitalised adults.

Reflections

On reflection, the last 9 months have been a steep learning curve. As I found out, ‘real’ research is not always smooth sailing. It takes time, you need to be interested, and a little pressure from your senior research team and the set deadlines is helpful to ensure that you make progress.

With regret, I spent a lot of the first few months comparing my relatively “complicated” topic to my peers’ projects which affected my productivity. In all honesty, trawling through hundreds of papers filled me with self-doubt and I felt overwhelmed. It took me a couple of attempts to clearly define my literature search, often finding myself down the rabbit-hole of biomarker acronyms and their values.

I now look back at my project diary and come across Dr Euden’s phrase verbatim “you get as much out as you put in”. Perhaps cliché, and I am not sure why I wrote this down at the time, but when I found interest in the papers that I was reading and set myself targets, the quality and quantity of my work improved exponentially. Those hours spent building the base knowledge were not in vain, and I have a huge colour-coded excel table to prove it!

Pace yourself, but not too much. It is important to not underestimate how much self-directed work is required and I could have done a little more at the start. However, the modules in my degree helped me immensely with the background knowledge of research methods.

Having responsive supervisors is a blessing and perhaps pot-luck, but I owe a lot to the team who were understanding and took the time to guide me with constructive feedback and signposting. I believe that taking responsibility for the work you produce (or not) and seeking advice regularly shows your dedication. I am especially grateful that when I was almost nocturnal during the Ramadhan fasting month, my 2:00 am Friday night Teams uploads were met with 3:00 am responses and suggestions, definitely not a requirement on their part, and I hope not a reflection of my usual Friday nights. This process taught me to respect my colleagues’ time commitments despite the depersonalisation of work relationships post-covid. Although antibiotics are important, so is sleep and down time.

Outcomes And Awards

With the support of my co-authors and mentors, and a personal obsession with detail and colour matching I have won three awards with this work:

• “Best Poster Prize” at the 36^th annual Cardiff University Postgraduate Medicine and Dentistry Research Day (as an undergraduate).
• “Second Prize Oral Presentation” at the Cardiff Medical Society T.E Edwards Prize.
• “First Prize Poster” at the prestigious British Society for Antimicrobial Chemotherapy (BSAC) Spring Conference 2022. Not only was this an amazing opportunity for networking with research professionals, but it put my work into context. I recognised the papers of many authors which I had come across in my reading and referencing.

We produced some interesting results, which may underpin future research and have translational clinical worth. I look forward to the process of submitting the full manuscript to a peer-reviewed journal and continuing to work with my supervisors, who have taught me invaluable lessons. More than a few sleepless nights later, I’ve added a few stars to my CV and a genuine interest in research which will definitely influence my future career choices.

– By Saif Abbas Chatoo