James Fullerton

Dr James Fullerton, specialty registrar in clinical pharmacology and National Institute for Health Research clinical lecturer, University College London and University College Hospital

What do you do? and what is a typical week for you?

I am lucky enough to have a variety of roles! Whilst I would predominantly describe myself as a Clinical Pharmacology and Therapeutics (CPT) Specialty Registrar, I am also a student, lecturer, researcher, teacher, supervisor, mentor and manager.

Currently, most of my time is spent looking after patients either under the guise of the Clinical Pharmacology firm (normally 10-20 inpatients with general medical problems) or the Acute Medicine team, where I am in charge of overseeing all the medical patients coming into University College London Hospital (UCLH). I additionally undertake outpatient clinics for both these services, seeing largely unselected medical patients with a focus on those with cardiovascular risk factors and/or disease. It is (hopefully) needless to say that repetition is rare and both the variety and complexity of the people and problems we are asked to tackle is vast! On-call commitments are always tiring but do not dominate my life. Indeed, the experience and team-bonding you gain from these shifts are some of the best bits about being a medical doctor.

As an NIHR Clinical Lecturer 50% of my training time is protected for research. This will hopefully enable me to build on work undertaken during my PhD, apply for and win further funding to develop my ideas, and answer clinically orientated questions for patient benefit. My time in this environment is spent formulating experimental plans, undertaking them and drafting academic manuscripts (book chapters, papers etc.).

Away from research I am a clinical teacher and lecturer of medical students and post-graduates, and act as a personal mentor for the MBBS students. I hold positions on both local (UCLH) and national committees (the Society and Resuscitation Council UK), act as the regional representative for CPT and General Internal Medicine (GIM) and run the North East and Central London GIM Training Program.

What qualifications and experience do you have?

Before undertaking my medical degree, I undertook a degree in Experimental Psychology at New College, Oxford. I have subsequently gained both clinical (membership of the Royal College of Physicians) and research qualifications (PhD at University College London). The latter was a basic science project with translational relevance. Clinically, I have worked solely in tertiary teaching hospitals with rotations though the general medical specialties and intensive care. I have also spent a year in Sydney, Australia gaining further experience of intensive care and in both designing and operationalising large phase 3 trials through working at The George Institute.

What’s the most interesting aspect of your job?

The variety! Hopefully from the ‘job description’ you get the idea that I have multiple roles and commitments and as such no two weeks are the same. One week you may be doing night shifts leading a cardiac arrest team, another will be spent in a Clinical Research Facility undertaking in vivo human research, and the next I will be sat at a regional or national formulary/guideline committee helping determine what treatments should be made available and when. As my career continues I suspect the variety will only increase further.

The other aspect I relish is the people I work with; both the dedicated doctors and basic scientists who – each in their own ways – are helping advance patient care. As a rule, all are motivated, intelligent people who are passionate about what they do and who push you to both develop personally and succeed.

What are your research interests?

Throughout my career the common theme to my research has been the ‘acutely unwell patient’. I have worked on the detection of critical illness in the community, the optimal management of cardiac arrest and, for the majority of the time, sepsis, - its diagnosis, pathophysiology and treatment. I am lucky enough to have undertaken a diverse range of epidemiological, basic laboratory science and clinical trial research, spanning the translational spectrum. Moving forwards I will likely focus on developing and utilising human models of inflammation and critical illness in order to answer focused clinical questions. I will also look to develop an interest in peri-operative medicine, practical aspects of Clinical Pharmacology (for instance compliance, prescribing errors, individualised therapeutics) and toxicology.

What one piece of advice would you give to someone seeking a career in clinical pharmacology?

Embrace the unknown. Clinical Pharmacology is all too often seen as ‘under the radar’ or ‘off limits’ to many medical students and even Foundation Year and Core Medical Trainees, being deemed either too esoteric (what do you actually do?) or aloof (I never thought I would get a place, aren’t you all boffins?). This is a great shame.

CPT training (at its best) should be flexible, varied and thorough, producing doctors who can tackle complex medical patients, think independently and will lead interesting careers spanning clinical work, medical education, management, academia and industry. Most importantly, they will be cognizant of the science that underpins clinical practice, be prepared to challenge dogma and have the skills required to drive improvement in patient care.



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