Dr Karishma Sethi-Arora is a Post-CCT Research Fellow in Inflammatory Bowel Disorders (IBD). She’s blogged about her career and how research has been an intrinsic part of it since her undergraduate training.
My career in gastroenterology and, indeed, first experiences of research, started during my undergraduate training at Imperial College London. As part of a BSc in Gastroenterology, I undertook a laboratory-based research project, investigating the pathological diagnosis of the pre-invasive stages of gallbladder cancer. I showed that the use of Ki-67 proliferation marker increased reliability of diagnosis. I was awarded a first-class honours for my work in this area. Reflecting on this, I would say, being able to partake in a clinically orientated BSc was crucial in shaping my future career decisions.
I went on to embark on specialist gastroenterology training in 2015. As expected, it was a steep, but thoroughly enjoyable learning curve. I rotated through gastroenterology departments in busy central-London teaching hospitals and inner-city district general hospitals, training in general and in-patient gastroenterology, endoscopy, and even spent six months working in tertiary level transplant hepatology.
But it was my clinical experience while working within a central-London tertiary IBD unit that really ignited my passion for a career in IBD. I enjoyed managing patients with chronic diseases, working with, and learning from a wide multi-disciplinary team, and was fascinated by the immunobiology of the inflammatory bowel disorders and the ever-evolving IBD therapeutic landscape.
Leadership
During my post-graduate training, I undertook a fellowship in Leadership and Quality Improvement and achieved a post-graduate certificate in Healthcare Leadership. I studied quantitative and qualitative research methods, approaches and philosophies in great depth and developed a practical understanding of evidence-based practice, undertaking an assignment involving the formulation of a research question in ‘PICO’ format, to reflect a common clinical question, and conducting a literature review with critical analysis of studies to try to answer the research question.
Throughout my post-graduate years, I was a passionate clinical educator, interested particularly in simulation-training and developing other innovative methods to deliver training in gastroenterology. While working in a simulation centre in inner-city London, I developed an online e-learning archive which was used to deliver human-factors training to doctors and nurses nationally and went on to win the BSG Alistair McIntyre prize for improving training in gastroenterology in 2022.
I decided to undertake a dedicated research fellowship relatively late in my training, but at a time that came at exactly the right time for me, both personally and professionally.
Collaboration
I am very much a reflective clinician, and while transitioning through the traditional “Novice to Expert” training journey, I began to focus my learning not simply on the patient alone, but also on the healthcare environment within which the patient sits. I started to appreciate the various organisational factors that affect patient outcomes and see the direct benefits to patients of organisations that embody values of innovation and promote patient-centred research.
Following a move to Manchester, I undertook the final year of my speciality training within the tertiary IBD unit at Northern Care Alliance’s Bury Care Organisation, a post that was monumental in furthering my insight into the clinical-research interface and prompting my application for a research fellowship in clinical and academic IBD.
I would say certain intrinsic personality traits attracted me to pursue research. I am inquisitive by nature, but also known for being meticulous and organised. On a personal level, I am very much a “people person”, which throughout my training years, led me to take up extra-curricular activities such as performing arts and even working in hospitality! I trained in classical dance and taught and choreographed dance. In retrospect, the collaborative skills required in working towards a common performance goal (either in the performing arts or the silver service waitressing world) were almost identical to the skills required to promote high-quality patient care and skills I would find crucial in the field of clinical research.
The NCA IBD fellowship has given me the unique opportunity to enhance my clinical skills in advanced IBD, but also develop myself academically.
I have worked as a sub-investigator on a number of commercial and observational studies, responsible for the identification, enrolment, consent, and clinical assessment of patients throughout studies. This has been absolutely crucial in developing my understanding of the operational aspects of clinical trials.
I have developed skills in academic writing and presentation and had opportunities to travel nationally and internationally to present collaborative work.
Working with Professor Jimmy Limdi (pictured above with the gastroenterology research delivery team) has been a true honour and a career-shaping experience; his effervescent passion for IBD is infectious to all around him and drives forward his vision to deliver excellence in IBD care. I am particularly proud that, in the first year of my fellowship, our team successfully recruited five UK-1st patients to phase III and IV clinical trials. We have also recently recruited the first patient in the UK to a clinical trial assessing a recently licensed IBD therapy, Mirikizumab, and its effect specifically on bowel urgency in UC, which we know is a particularly distressing symptom for IBD patients.
Award
In October 2023, the NCA-IBD research team were awarded the “Putting Participants First” award at the Greater Manchester Health and Care Research Awards, a feat not achievable without visionary leadership and water-tight teamwork! The opportunities presented, and skills developed, through this BSG-endorsed fellowship, really are second to none, and I would recommend such a fellowship to any senior trainee interested in pursuing IBD as a future career sub-speciality.
As my training journey comes to an end, and as I embark on a career as a Consultant Gastroenterologist, I feel uniquely positioned to be able to take such a wide breadth of experience forward, offering expertise in clinical research and education to the teams that I lead, but most crucially, offering considered, holistic advice, incorporating the available best evidence, to patients suffering with inflammatory bowel disorders.