Chair's Column: The Golden Era of Research: How can we maximize our impact?
In his keynote address to us at the 2019 Department of Medicine Annual Day celebration, David Naylor spoke about the golden era of medical research in which we find ourselves today: where everything is converging.
When I was training as a clinician-scientist, I learned clinical epidemiology. I imagine my basic science colleagues were similarly training in a focused field of research. But times have changed.
I recently met with a colleague in the UK who calls himself a digital epidemiologist. He uses digital technologies and big data to study, for example, the relationship between weather systems and osteoarthritis flares (cloudy with a touch of pain). Similarly, we have seen the emergence of the fields of molecular epidemiology and genetic epidemiology, which are integrating omics, digital technologies and data analytics into long-standing research disciplines. As Naylor said to us, there is no greater potential for a "stunning breadth of research” than now! However, this cannot be accomplished if we don’t diversify. We need to join hands across the breadth of this great University and beyond.
Under the leadership of our Vice-Chairs of Research and Quality & Innovation, our department has been doing just that. We have created and continue to spawn cross-institution, cross-discipline research networks. The example in this edition of DoM Matters of the virtual care network is just one. But, as always, we can do even more.
In our five year review, the external reviewers applauded our partnership with computer science and challenged us to form more collaborations with our top notch basic science and other University departments. Within the last few weeks, the inaugural lead for the Temerty Centre for AI Research & Education in Medicine (T-CAIREM), Muhammad Mumdani, spoke to the caliber of the University’s departments of statistics, mathematics, computer science and engineering. Within the Temerty Faculty of Medicine, we of course have outstanding basic science departments — immunology, physiology, molecular genetics, and pharmacology/toxicology to name but a few — along with our fellow clinical departments. While many of us have strong relationships with one or more of these groups, just think what we could do if we were to formalize these relationships more fully?
The discovery of insulin in 1921 and its subsequent translation to a treatment for diabetes is a spectacular example of what happens when we worked together. As we head towards the 100th year anniversary celebration of the discovery of insulin and the impact it has had on the world, it seems the perfect time to remind us all of the need to cross disciplines and silos in our work.
Why we need you?
The convergence of research fields highlights more than ever before the integral role of the ‘physician scientist’ (PS) — I would say clinician scholars, but for the sake of this discussion I will use PS — in connecting the dots between basic or fundamental sciences, clinical trials and population research. In our new strategic priorities, we have highlighted once again the critical importance of not just generating new knowledge through our scholarship, but taking that new knowledge and applying it to advance health and health care. That translation of scientific discovery, to better and longer health for all, is critical. Let me be bold and say it — this just cannot happen without you. As Naylor noted, it is our role to be the “great integrators.”
What do I mean?
Never before has it been so important that academic physicians are fluent in multiple disciplines of science and medicine, e.g. applied physiology, omics, machine learning and statistical modelling, digital platforms, and of course clinical practice. When I meet with medical students and residents these days, it is not atypical that the individual has a background in computer science or mathematics and now wishes to utilize those skills to advance treatments for cancer and other diseases. As we recruit young academics, we are increasingly searching for teams of mentors who provide this cross-disciplinary balance and can push our faculty to think across silos of science and medicine. And it is happening.
When I assumed the position of Chair, one of the recommendations from the five-year review conducted just prior was to remove the APD of clinician-investigator (CI) because it was seen as an impossible role. As I look back at our decision to not abandon this academic role, it is even clearer to me why we needed it. In fact, these are the folks who are at both the coal face of clinical care and science. We need our CIs more than ever to help with this integration. As I observe the overall rise in recruits in the CI role I wonder whether this is their motivation, conscious or unconscious, too! The bottom line is that all of us in academic medicine play a role in this golden era of research.
Just within our department, we have the capacity to identify key questions in clinical care; hand them off the folks who can study them and find answers; ensure the answers are handed back to the clinicians who can test whether the findings can improve care or outcomes; and then hand off to those who can influence policy and clinical practice to ensure everyone in society has the potential to benefit. When we couple this amazing bench strength with that of our University partners, just imagine where we can go!
While 2021 will be a celebration of 100 years since the discovery of insulin, it should also remind us of the critical role we play as academic physicians — all of us — in “discovery.” As everyone who is anyone knows, the best research questions come from interactions with our patients and their families. It is for this reason that we must continue to sustain and grow the pipeline of “integrators.” You have unique attributes that lend themselves to this role: an innate ability to tackle complex problems and solve them; intense curiosity; and overwhelming devotion to your patients and their wellbeing. Thank you for using these talents to create a healthier, happier, more equitable and safe world.