Find your career: the ERS “My Career Path” series

Extract

Respiratory medicine is one of the most varied medical specialties, with several subspecialties [1]. Furthermore, respiratory research involves a plethora of preclinical, fundamental and translational science within individual specialities but also spanning across several specialities. For medical professionals, each subspecialty has its own benefits and challenges, and they can be very different from each other: the working life of a thoracic oncologist with a specialist interest in interventional pulmonology is likely to be very different from that of a COPD specialist who primarily works in the community. Similarly, life as a scientist working in cellular/molecular biology may differ in day-to-day tasks when compared with a scientist interested in systems biology or epidemiology.

Shareable abstract

The ERS “My Career Path” series provides an excellent insight into different subspecialties in respiratory medicine. All episodes can be found on the ERS Respiratory Channel. https://bit.ly/4sADqiS

Introduction

Respiratory medicine is one of the most varied medical specialties, with several subspecialties [1]. Furthermore, respiratory research involves a plethora of preclinical, fundamental and translational science within individual specialities but also spanning across several specialities. For medical professionals, each subspecialty has its own benefits and challenges, and they can be very different from each other: the working life of a thoracic oncologist with a specialist interest in interventional pulmonology is likely to be very different from that of a COPD specialist who primarily works in the community. Similarly, life as a scientist working in cellular/molecular biology may differ in day-to-day tasks when compared with a scientist interested in systems biology or epidemiology.

Ultimately, working in respiratory medicine often requires a number of different skillsets, and it can be difficult for early career members (ECMs) to decide which pathway they would like to choose and what skills are required to achieve success in their field of interest.

The European Respiratory Society (ERS) “My Career Path” series was launched in 2024 to give insight into the different career paths in respiratory medicine. Each online episode features an ECM interviewing two leading figures in a particular area of respiratory medicine. The episodes feature honest discussions about the often winding career paths that the speakers have led, an assessment of working in their chosen area, and general career advice for ECMs. The series is available for free on the ERS Respiratory Channel and episodes will continue to be released on a regular basis (https://channel.ersnet.org/channel-327-my-career-path). This article summarises the episodes that have been released at the time of writing.

Asthma

The speakers, F. Schleich and S. Saglani, gave insights into their careers in adult and paediatric asthma, respectively. Both speakers discussed the latest advances in personalised asthma management. S. Saglani highlighted that clinicians are increasingly able to phenotype paediatric asthma and then give targeted treatments, such as biologics. F. Schleich mentioned that biomarkers will be used to predict which patients may have worse disease progression, leading to earlier aggressive management to achieve “super-response” to treatments. This led to speculation that biologics would be used earlier in the disease process, for example as a disease-modifying therapy in preschool children to prevent the development of school-age asthma. S. Saglani emphasised that treatments are needed to target the structural changes in asthma, not just the inflammatory changes, in order to achieve the ultimate goal of remission and resolution.

The speakers also spoke frankly about obtaining funding in asthma research, which can be more challenging than for other areas of medicine [2]. There can be a misconception by some funders that asthma is not as exciting as other conditions, but the ongoing advances in asthma management will help to reduce this thinking. F. Schleich stated that strategies to attract funding could include addressing public health issues (such as the impact of rising obesity rates on asthma) or researching innovative techniques (such as the use of volatile organic compounds in asthma diagnosis). If ECMs get rejected from funders, S. Saglani advised to go through the funding panel's comments with a more senior mentor as there can be many reasons why your application was rejected, such as being too ambitious or not appropriate for that particular funder. Both speakers highlighted the opportunities that arise from undertaking an ERS Fellowship, which can give you the skills and connections to launch your research career [3].

Speakers: Sejal Saglani (London, UK) and Florence Schleich (Liège, Belgium)

Chair: Sachin Ananth (London, UK)

Take-home messages:

• Advances in asthma phenotyping are leading to personalised treatments

• Getting funding for asthma research can be challenging, which encourages innovative funding proposals

• ERS Fellowships are an excellent opportunity to enhance your research career

COPD

L. Uller highlighted the importance of travelling to different centres, including in different countries, to learn new skills. Early in her career, she travelled to Southampton (UK) as it is a centre of excellence for epithelial cell biology. The techniques she learnt there helped her find a niche in COPD epithelial research, which increased her prospects of securing funding and a research position. M.K. Han agreed that it is important for ECMs to find the next major advance in their field, as gaining skills in this area will help you stand out from other applicants. M.K. Han trained in advanced COPD imaging while working in the large COPDGene study, at a time when few researchers were doing this type of work. This novel experience was a factor in her securing a coveted research tenure at her university. Similarly, both speakers emphasised the importance of having mentors who work in clinical and scientific backgrounds, as you need networks in both areas to undertake translational research.

The episode also included advice on having a family life alongside a research career. While it was acknowledged that there is never a perfect time to start a family, sometimes waiting may be advantageous as you can mature as a person and a scientist. You can then use the skills gained as a scientist in parenthood, and vice versa – for example, it may make you more efficient in your research as you have stricter timings to complete work-related tasks as you also have parental responsibilities. Also, having a partner with a more flexible work schedule can be very important in managing family time.

Speakers: MeiLan K. Han (Ann Arbor, MI, USA) and Lena Uller (Lund, Sweden)

Chair: Augusta Beech (Manchester, UK)

Take-home messages:

• Working in different centres is an important way to develop new skills

• Gaining expertise in the next major advance in your field will increase your employability and chances of successful funding applications

• Various factors are important in your decision about when to start a family

Thoracic oncology

Both speakers, J. Aerts and G. Hardavella, recognised the many advances in thoracic oncology during their own careers. Prognoses continue to improve, even for patients with advanced disease. For example, J. Aerts reminisced that when he started working as a clinician, endobronchial ultrasound was not part of routine clinical care, and now there are a multitude of interventional pulmonology techniques in thoracic oncology, such as navigational and robotic bronchoscopy. The speakers acknowledged that it can be challenging to keep up to date with all the advances in thoracic oncology, and that timely access to diagnostics and treatments is still an issue in some places in Europe.

The emotional toll of working in this field was also explored, with G. Hardavella remarking that a lung cancer clinic can feel like a rollercoaster, with patients from different backgrounds at different stages of their disease. J. Aerts said that the emotional rigours of thoracic oncology prove that empathy is a prerequisite personal characteristic if you want to specialise in this field: it could be your fifth time breaking bad news that morning, but for the patient it will be the first time, so you need to approach every patient sensitively. G. Hardavella emphasised the importance of building defence mechanisms to withstand the emotional rigours of the work, such as discussing challenging cases with colleagues and consistently doing your hobbies outside of work.

There are many support networks for ECMs interested in thoracic oncology, such as the International Mentorship Programme at the International Association for the Study of Lung Cancer (IASLC) [4]. G. Hardavella, who is currently the Secretary of the Thoracic Oncology Assembly of the ERS (Assembly 11), mentioned that Assembly 11 will soon introduce a support network for ECMs, which will help with various aspects of their careers, including submission of abstracts to the ERS Congress.

Speakers: Joachim Aerts (Rotterdam, the Netherlands) and Georgia Hardavella (Athens, Greece)

Chair: Sachin Ananth (London, UK)

Take-home messages:

• Thoracic oncology has seen many practice-changing advances recently

• The specialty can be emotionally demanding, and so an empathetic character and stress relief strategies are vital

• Many international societies have support networks for ECMs interested in thoracic oncology

Bronchiectasis

The speakers, S.H. Chotirmall and A. Shoemark, described how both scientists and clinicians can forge careers in respiratory medicine. Bronchiectasis is a fast-growing subspecialty and has undergone a revolution over the past decade, with detailed work on the pathophysiology and international collaboration leading to the first licensed therapies [5]. A. Shoemark worked as a scientist in a hospital lab diagnosing primary ciliary dyskinesia (PCD) and conducted research in her spare time. This led to a successful national funding application for some dedicated research time in her job plan, which allowed her to launch her career in PCD and bronchiectasis. By comparison, S.H. Chotirmall undertook his clinical respiratory training in Ireland, which has the highest incidence and carrier rate of cystic fibrosis (CF) internationally. He completed a PhD on the role of oestrogen in CF. Upon moving to Singapore, he switched his focus to bronchiectasis as it is an underrecognised and underdiagnosed condition across Asia, and studying Asian populations is important as the current bronchiectasis literature and subsequent guidelines are based on research conducted in predominantly non-Asian patients. S.H. Chotirmall and A. Shoemark both run laboratories with close links to clinical settings, maximising the opportunity for truly translational research.

Both speakers stressed the importance of following your passions in your career. S.H. Chotirmall mentioned that when he had the opportunity to do a PhD in the middle of his clinical training, some of his colleagues tried to dissuade him as they perceived that it would affect his training. However, because of his passion to pursue research, S.H. Chotirmall forged ahead with the PhD and now feels that it was the best decision he ever made in his career. The importance of mentors was also discussed. A. Shoemark mentioned that she has mentors for different areas of her professional and personal life, including mentors working in a completely different field who can provide a unique perspective, as well as strong female mentors. Both speakers remarked that it is easier than ever now to find suitable mentors, as networks exist through international societies and clinical research collaborations, such as the European Multicentre Bronchiectasis Audit and Research Collaboration (EMBARC; www.bronchiectasis.net) and Better Experimental Approaches to Treat PCD (BEAT-PCD; https://beat-pcd.squarespace.com). EMBARC and BEAT-PCD have opportunities for ECMs, such as the BEAT-PCD early career research training programme and the EMBARC “FUTURE” programme [6, 7].

Speakers: Sanjay H. Chotirmall (Singapore) and Amelia Shoemark (Dundee, UK)

Chair: Augusta Beech (Manchester, UK)

Take-home messages:

• There are excellent opportunities to undertake translational research in bronchiectasis and PCD, especially in populations that are less well studied

• Being passionate about your work is essential in order to overcome any challenges

• Seek out mentors for different aspects of your professional lives, including via international societies

Interstitial lung disease

The many reasons for specialising in interstitial lung disease (ILD) were discussed. P.L. Molyneaux stated that he enjoys working in a specialty where there is not always a clear right or wrong answer to clinical dilemmas, but you still have to make a decision for your patient. M. Molina-Molina also credited her mentors for her route into a career in ILD, including her work with Antoni Xaubet in analysing fibroblasts and macrophages in the bronchoalveolar lavage of patients with ILD. The ERS ILD Mentorship Programme gives an opportunity for ECMs to connect with mentors in this field [8]. P.L. Molyneaux agreed that mentors are important, but having a peer support group can be just as important for emotional support, and advised to contribute to each other's projects and build networks this way.

The speakers also gave advice on balancing clinical and academic responsibilities. P.L. Molyneaux has been able to organise his schedule such that his clinical and academic work are in separate halves of the week, although the lines can blur and he often has to do clinical work during his academic days, and vice versa. M. Molina-Molina thanked her team of clinicians and doctoral fellows for undertaking their growing research work together, highlighting the importance of involving your team in your projects. Likewise, surrounding yourself with people in your personal life who understand your career choices is essential, in order to have a clinical academic career as well as a family life.

Speakers: Maria Molina-Molina (Barcelona, Spain) and Philip L. Molyneaux (London, UK)

Chair: Catharina C. Moor (Rotterdam, the Netherlands)

Take-home messages:

• ILD is a complex sub-specialty, which can be both rewarding and challenging

• Developing strong networks with your peers is just as important as having good mentors

• Balancing a clinical and academic career can be difficult, but can be achieved through teamwork and having supportive friends and family

Chronic cough

Chronic cough being a disease was a central issue argued by both speakers in this episode. Both speakers emphasised the importance of educating the wider medical community about this condition, especially since it can ruin patients' lives with debilitating symptoms and social isolation. Thus, A. Morice stated that clinicians should use the experiences of patients with chronic cough when educating others about it.

The latest advances in chronic cough management were also discussed. A. Morice spoke about gefapixant, a P2X3 antagonist that blocks the neurons that cause coughing, and how it helps approximately two thirds of patients with cough [9]. There are several ongoing trials of other agents: some that block the irritation caused by epithelial damage, and others that block the neurons involved in the cough reflex. E. Millqvist also mentioned that more research needs to be done on the role of the vagus nerve in respiratory medicine, including its role in driving cough and breathlessness. Therefore, both speakers argued that there are sufficient research opportunities to become a leading member of the chronic cough community. E. Millqvist acknowledged that it can be difficult to secure funding for research projects in chronic cough, but this should improve as recognition of the condition improves, and A. Morice suggested that collaborating with industry is a good way to fund your work.

Both speakers concluded by encouraging ECMs to join the Chronic Cough sub-assembly of Assembly 5. The ERS Congress used to receive no abstracts on chronic cough, whereas it received over 40 in 2024, confirming that chronic cough is a rising subspecialty.

Speakers: Alyn Morice (Hull, UK) and Eva Millqvist (Gothenburg, Sweden)

Chair: Sachin Ananth (London, UK)

Take-home messages:

• Chronic cough is a rapidly growing subspecialty with excellent opportunities for research

• New treatment advances are improving patient outcomes, but more recognition of this condition is needed

• Collaborating with industry is important for conditions that typically attract less research funding

Conclusions

The ERS “My Career Path” series has provided excellent insight into different subspecialties in respiratory medicine. A common theme was the importance of having mentors to support you in the challenging moments of your career. The ERS is a leading source of professional mentors for ECMs, through its assemblies, clinical research collaborations and other opportunities (such as participation in task forces).

While this article summarises the main areas of discussion from each episode, watching each episode in full is recommended to gain deeper insight into the nuances of each subspecialty. Future episodes will cover paediatric lung conditions, exercise medicine and many more areas, as respiratory medicine continues to evolve.