International women's day 2018: Meet some of our women members making a difference in haematology

What led you to a career in haematology?

Haematology was my first clinical attachment as a medical student and turned out to be love at first sight.  From Day 1 I loved the fact that we could look at our patients’ blood under the microscope and I have always enjoyed the mix between the lab and the clinical work.  I decided to focus on red cell haematology because I like having a life-long relationship with these patients and there is so much potential to improve their outcomes by providing better care and being involved in research that will lead to novel therapies.

What advice would you give to someone considering a career in haematology?

I would plead with them to consider red cell haematology!  Unfortunately there are too few specialists in this field and we are in great need of enthusiastic and committed new consultant colleagues. Now is a particularly exciting time for red cell disorders due to unprecedented new advances in diagnostics and therapeutics.  It’s a great time to join us!

What is the most rewarding part of your job?

It’s always the patients.  I am continually amazed and inspired by how they deal with their life-long illness.  I find it particularly rewarding when patients come away from a consultation with a better understanding of their condition and treatment, and when I have better understood how the medical aspect of their condition fits in the greater context of their life.  Sometimes it’s up to us to find new ways of organising their care that means it will fit better with their life and therefore improve compliance with key medications.

What is the most challenging part of your job?

At the moment, it is dealing with the uncertainty brought about by pathology reorganisation.  The reconfiguration nationwide of all pathology services means that there will likely be a lot of changes in the laboratory. Until we have a clearer idea of what these changes are likely to be, it is difficult to prepare adequately.  However, change is an intrinsic part of life and I look forward to finding new and better ways of working once the parameters are more clearly-defined.

How do you see your specialist area of haematology changing in the future?

I am particularly interested in red cell haematology - both the haemoglobinopathies and rare inherited anaemias. I am actively involved in the diagnosis of inherited red cell disorders and the current move from targeted next generation sequencing to whole genome sequencing that will be commissioned by the NHS is one of the most exciting changes coming. However, there are equally many changes in therapeutics, from novel drugs for sickle cell disease and thalassaemia and PK deficiency, to the advent of genome editing which will revolutionise how these disorders are treated from childhood onwards.  Importantly, though, haematology is moving towards a more patient-led model of care and I am excited to be part of new initiatives using patient reported outcomes and recognising that patients are best placed to tell us how we should organise our service.

What does being a BSH member mean to you?

I very much enjoy the annual scientific meeting where I get to hear thought-provoking talks and connect with colleagues and form new collaborations. I also get a lot out of the regular update bulletins, which help to stay up-to-date.  The haematology community as a whole is both productive and inclusive, and it is a pleasure to be able to work alongside like-minded colleagues.

Tell us about your involvement with the General Haematology Taskforce.

I am a fairly new member of the task force but it is a pleasure to be able to get involved in the process of writing guidelines.  We all use these guidelines regularly in our clinical practice and it gives me a chance to use skills acquired as part of my academic work to help sift through and assess published evidence.

What is your current role and background?

I am a BSH Trustee. I was co-opted initially during Graham Jackson’s presidential term, when The Shape of Training became a focus and I was co-opted as SAC Chair to be involved in the discussions at Board level, then nominated in 2015.

I have been actively involved in PGME for 20 years. I am passionate that we ensure training in a rapidly changing world is delivered to the highest standards possible. We want to enable the development of capable haematologists, to achieve their maximum potential in the workforce, whilst achieving job satisfaction.

I was a trainee rep initially, then appointed as in the first formal TPD role in my Consultant post in 2003. I have been a member of the London STCs in their various reincarnations over the years. Member of the SAC since 2007, in the curriculum committee from 2009 – 2015 and quality assurance I held the position of SAC Chair from 2011-2015, navigating changes in recruitment and the Shape of Training amongst the usual business during my tenure.

I am an FRCPath examiner. I hold the post of Deputy Head HEE LaSE School of Pathology and have been a member of the executive board since its inception in 2008. I am involved with Professional and Faculty Development and the development of a virtual learning platform.

What has your role in postgraduate education and training brought to the BSH?

I hope it has brought the SAC into the BSH ‘fold’. The SAC works under the umbrella of the RCP. The TPDs / education supervisors (all BSH members) work hard to ensure operational training on the ground is delivered within the programmes as best as it can be, and mapped to the curriculum within the constraints of service delivery and changes within medical education. Currently the SAC reports to the External Affairs Committee.

I hope that by giving the SAC BSH representation this will firstly recognise the work being done, and secondly allow collaboration and dialogue to take place across the whole of the education platform - from school to consultant, so there is a more joined up delivery of haematology training.

Can you tell us about the Shape of Training review, its purpose and what the long-term impact will be on postgrad haematology training in the UK?

The Shape of Training Review is looking at how to manage and develop the challenges in the healthcare delivery landscape in the UK and what the future multi-professional workforce might look like.

The initial driver was the crisis in general medicine. Although a simplistic overview, the reality is that we do not have the workforce we need in the NHS to deliver healthcare in the way we wish.

There was a view that training time in higher specialist training may be shortened with extended CMT and FY training.

How does the work of the BSH around the haematology curriculum tie into the future of haematology training?

Over the last 4 - 5 years the Haematology SAC have worked closely with the RCP. This is to ensure that haematology is understood as a specialty which develops consultants and physicians who integrate pathology knowledge, to deliver care to haematology patients in the various sub specialities, as well as the NHS healthcare system as a whole. This makes us a unique and much-needed workforce.

The most recent iteration has shown no decrease in the length of higher specialist training or dual accreditation. However, we acknowledge and recognise that the changes in the healthcare landscape require us to look at how we will need to adjust training and deliver care long term to a changing population.

In order to do this, we need to be asking questions like: How will our future haematology consultants be working in 2020 - 2030? What will the service delivery look like? What might the mix of the workforce be? How many super sub-specialty posts might we need? In what areas are these needed? All sub-speciality areas of haematology are important in delivering patient care.

How does the work of the BSH around the haematology curriculum tie into the future of haematology training?

The BSH can be used as a platform to shape the curriculum. We need to identify and agree on core haematology knowledge and specialty specific knowledge before we can make any meaningful changes in the delivery of training for the future.

Our broad-based training has held us in good stead so far and as a discipline has enabled some plasticity in the workforce, but it will not be sustainable as we need depth and breadth of knowledge in developing areas to be at the forefront of excellent patient care.

It is the most pressured time in the NHS since I have been qualified, with constant changes and a lack of funding. Now more than ever the BSH needs to bring together its trainers, trainees and specialties to support and facilitate this important piece of work.

I cannot think of any other specialty that is so diverse, interesting with exciting innovative treatments for patient care and it is our duty to make sure it stays that way for the future.

Why did you choose to specialise in Haematology?

I chose to specialise in Haematology for a number of reasons. Firstly, I enjoy the mix of clinical and laboratory medicine and the opportunity to undertake both clinical and basic research. Secondly, it is a very rewarding specialty and you are able to build really excellent relationships with patients over many years. I think clinical Haematology is quite a holistic specialty as you look after patients from making the diagnosis all the way through their treatment journey. It is also a very fast moving field with new drugs and other therapies frequently becoming available, improving outcomes for patients.

What is the most rewarding part of your job?

The most rewarding part of the job is seeing patients who are in remission after intensive treatment getting back to living their lives, returning to university or work, and enjoying time with their friends and family. However, I also enjoy the research aspects of my job, and seeing your work presented or published is a great feeling.

What are the toughest problems you have to deal with?

The toughest problems are having to break bad news to patients and their families. Unfortunately, although treatments continue to improve, not all patients are cured and many patients relapse or have refractory haematological malignancies.

What advice would you give to your younger self at the start of your career?

I have given this a lot of thought and I’m not sure I would change very much. I think it’s important to get a broad range of experience in different medical specialties before entering Specialist Training. Early in my Haematology training, I would say, try to take as many educational opportunities as you can and enjoy it.

How do you see the field of Haematology (or your specialist area) changing in the future?

Increasingly, we will see more personalised medicine with the introduction of novel agents for different subtypes of AML, for example. Next generation sequencing is going to have a major role in developing these personalised or ‘precision’ medicine approaches. In addition, I think immunotherapies are going to have a major role to play over the next ten years or so and we are only beginning to see these agents improving outcomes for patients – there is still a long way to go. With an ageing population, people living longer and with multiple therapies now available for conditions such as CML and myeloma, clinics are going to get much busier and I think there will be an increasing role for clinical nurse specialists in managing these patients.

What was the most influential session for you at this year’s BSH ASM and why?

There was a great session on acute lymphoblastic leukaemia. It covered all aspects of the condition and highlighted the new immunological therapies which are becoming available.

If you could travel anywhere, where would you go and why?

I would go back to Central or South America. I am really interested in the ancient meso American cultures such as the Maya and the Inca and I’d love the opportunity to spend more time there.

Why did you choose to specialise in Haematology?

I chose to specialise in Haematology for a number of reasons. Firstly, I enjoy the mix of clinical and laboratory medicine and the opportunity to undertake both clinical and basic research. Secondly, it is a very rewarding specialty and you are able to build really excellent relationships with patients over many years. I think clinical Haematology is quite a holistic specialty as you look after patients from making the diagnosis all the way through their treatment journey. It is also a very fast moving field with new drugs and other therapies frequently becoming available, improving outcomes for patients.

What is the most rewarding part of your job?

The most rewarding part of the job is seeing patients who are in remission after intensive treatment getting back to living their lives, returning to university or work, and enjoying time with their friends and family. However, I also enjoy the research aspects of my job, and seeing your work presented or published is a great feeling.

What are the toughest problems you have to deal with?

The toughest problems are having to break bad news to patients and their families. Unfortunately, although treatments continue to improve, not all patients are cured and many patients relapse or have refractory haematological malignancies.

What advice would you give to your younger self at the start of your career?

I have given this a lot of thought and I’m not sure I would change very much. I think it’s important to get a broad range of experience in different medical specialties before entering Specialist Training. Early in my Haematology training, I would say, try to take as many educational opportunities as you can and enjoy it.

How do you see the field of Haematology (or your specialist area) changing in the future?

Increasingly, we will see more personalised medicine with the introduction of novel agents for different subtypes of AML, for example. Next generation sequencing is going to have a major role in developing these personalised or ‘precision’ medicine approaches. In addition, I think immunotherapies are going to have a major role to play over the next ten years or so and we are only beginning to see these agents improving outcomes for patients – there is still a long way to go. With an ageing population, people living longer and with multiple therapies now available for conditions such as CML and myeloma, clinics are going to get much busier and I think there will be an increasing role for clinical nurse specialists in managing these patients.

What was the most influential session for you at this year’s BSH ASM and why?

There was a great session on acute lymphoblastic leukaemia. It covered all aspects of the condition and highlighted the new immunological therapies which are becoming available.

If you could travel anywhere, where would you go and why?

I would go back to Central or South America. I am really interested in the ancient meso American cultures such as the Maya and the Inca and I’d love the opportunity to spend more time there.