BLOG: The Varied Role of a Research Doctor

In this blog we hear from Dr Angharad Everden, Research Special Registrar in Haematology at Royal Cornwall Hospitals Trust, as she describes her experience of moving to Cornwall specifically to pursue a research post.

This is the first year that there has been a Haematology Research SpR Clinical Fellow post at RCHT. Despite the COVID19 pandemic, research has continued to be a growing area within the Haematology Department with recent new enrolment into many trials including RAINBOW (a trial looking at a rare form of lymphoma called Waldenstroms), REGENERON (a cutting-edge BiTe antibody study), ASCEND (a novel therapy in haemolytic anaemia) and the Novovax COVID19 vaccine trial in which Dr Tucker, Consultant Haematologist, is sub-principal investigator. This is providing Haematology patients in Cornwall with access to cutting edge therapies and helping to make significant contributions to research in Haematology nationally.

Research that makes a difference

My role in research has been really varied. My day to day predominantly involves seeing new haematology patients with a view to recruit them into trials and reviewing those already enrolled in our trials. I’ve learnt how to follow protocols for trials carefully, the specific documentation required in trials patients and how to grade and monitor for adverse events and side effects and report these. I liaise with the energetic award winning Haematology trials team of nurses and administrators to ensure a smooth process for patients enrolled in the trials. In addition, my role has involved helping to organise and coordinate patient’s, sometimes extensive, investigations and admissions as required for eligibility assessment for some trials. For example we recruited the first patient in the country into the exciting BiTe antibody trial REGENERON and we now have our third patient successfully recruited. I also help to perform haematology procedures such as bone marrow biopsies, required for trials.

I have presented an interesting rare case of systemic mastocytosis who has been treated with a novel agent Avapritinib to our regional Blood Club in October; raising awareness of this rarer condition and the available treatment and trials open nationally in London that patients may access. I have also had a significant role in data collection for various studies including the ReMIND2 trial, VenAza trial at Guys and St Thomas’, and a trial looking at treatment of frail patients with mantle cell lymphoma based in Oxford. I am also collecting data on patient’s outcomes over the past 10 years treated with RCE chemotherapy, for publication as primary research here at RCHT. I have submitted a poster for a national medical dermatology conference in 2021, highlighting the role of dermatology and haematology in the treatment of some haematological skin conditions, such as mycosis fungoides, including novel therapies such as Brentuximab Vedotin. I have also submitted an interesting case to the British Journal of Haematology in which a patient with Monoclonal gammopathy of undetermined significance (MGUS) presented to RCHT with convincing lytic lesions on a CT scan suggestive of myeloma which has instead been demonstrated to be multiple haemangiomas of the skeleton on MRI and PET. This interesting and unusual case highlights why these imaging modalities are gold standard in myeloma..

Fighting COVID-19

With the advent of the COVID-19 Novovax vaccine trial I have helped to recruit and coordinate doctors to work in the trial to help with screening and eligibility assessment and getting their Good Clinical Practice training. Every Friday I have been working in the trial myself providing medical assessment and eligibility screening of participants in the trial. This trial has been extremely successful so far with excellent recruitment of large numbers in a short space of time and demonstrates RCHT’s ability to carry out research in a very organised and efficient way.

Most excitingly, in 2021 we will be setting up our own primary research trial at RCHT, the CRIMSON STRIPES Study, which will be looking at predicting who responds best to IV iron in pre-operative anaemia.

Continued professional development

I have taken an active role in teaching medical students on their Haematology attachment and the rest of our Haematology research team. The Haematology Department here has been acknowledged for its significant contribution to teaching by Exeter Medical School winning the ‘Staff Aureus Award’ and the ‘Excellence and Innovation in Clinical Teaching Team Award for Hospital Teams 2020’.

Dr Tucker and myself have built a free educational website providing learning and development for biomedical scientists, medical students and doctors. It has downloadable PDF notes on different haematological conditions, narrated presentations and demonstration videos to teach haematological procedures such as bone marrow aspiration/trephine and more recently skin punch biopsies as part of the national whole genome sequencing programme in acute leukaemia. These videos are going to be featured by the British Society of Haematology as useful educational resources nationally via their website and social media. Haematology Academy is also affiliated with HaemSTAR, an NIHR supported network designed to support research and audit into non-malignant haematology.

Finally, as well as teaching, I have also taken an active role in quality improvement within Haematology, with a registered quality improvement project into the communication between primary and secondary care for chronic Haematological conditions. This project is developing patient vaccination alert cards and is working with local GPs to develop useful Haematology information sheets for patient’s conditions and their management within the community.

As you can imagine it has been an exciting and busy start to the academic year with lots more exciting research and development going into 2021 for Haematology at RCHT. I’m very grateful for the opportunity to work alongside such a fantastic, enthusiastic and innovative team!

Follow the research pathway

Angharad is just one of many doctors using the research pathway as an opportunity to not only develop professionally but also offer the patients and colleagues new ways of working to improve services. As RCHT embrace a ‘culture of research’ the benefits to staff, patients and the organisation as a whole are clear to see.