Louise Breen is an Advanced Nurse Practitioner and Lead Nurse in Endocrinology at Guy’s and St Thomas’ NHS Foundation Trust. Here she tells us about her path to nursing and her involvement in the Society which culminated in her becoming the first Chair Elect of the Nurse Committee.
How did you get into endocrinology?
My interest in endocrinology was triggered in 1996 working as a staff nurse for pre-assessment and endocrine testing during a 3 month line of work at the Diabetes and Endocrine Department at St Thomas’. I returned the following year as a research nurse undertaking pharmaceutical company sponsored clinical trials in diabetes and endocrinology. It was the research in adult growth hormone deficiency that interested me most.
I was extremely fortunate to work with Professor Peter Sonksen who had a very progressive and supportive attitude to the advancement of endocrine nursing, he encouraged me to push myself in developing my knowledge and skills. I continue to be surrounded by an innovative, enthusiastic and supportive team.
“If you feel you don’t have time for a committee position, think about putting yourself forward to present at Society conferences, Chair a session or submit and present an abstract”
What do you enjoy most about your work?
Team work
Making a difference to patient care
Continued learning & development in my role, clinically and strategically
Mentoring staff
Can you tell us what you’re most proud of in your career, so far?
When I started out there was no designated endocrine specialist nurse, in 2003 we successfully proposed the first ESN role, I got the job and our ESN service has continued to grow. We now have a team of eight, and provide the following services: Nurse-Led Clinics, MDT support (Pituitary, Adrenal and NET), Endocrine Testing and Reporting, Patient Education, Education for other HCP and active input into research, audit, the development of guidelines/protocols and standard operating procedures.
My qualifications in Advanced Assessment and my registration as a Non-Medical Prescriber have allowed me more autonomy in practice and improved my knowledge and skills in endocrinology.
In 2011, I established the Nurse Led Virtual Thyroid Clinic which was well received by patients and has gone from strength to strength. Pre-COVID we undertook on average 30 virtual reviews per week, which put us in a good position during the pandemic.
How has the COVID-19 pandemic affected your work?
Fortunately we were well set up for virtual reviews and maintained a reasonable amount of scheduled activity, albeit with staff deployment. We are gradually getting through the backlog and returning our focus to ongoing service developments, research and audits. Remote meetings have been invaluable and in many cases a more productive and inclusive way to meet.
On reflection I have identified areas where we can be more efficient and recognised that we had little give in our service for ESN cover, as a result we proposed and created Band 6 and Registered Nursing Associate roles.
Why do you think it’s important to get involved with Society roles?
The Society are an excellent organisation to work with and the team supporting the Nurse Committee are very motivated, enthusiastic and supportive. I have served two four-year tenures and am now in my one year term as Chair Elect before I proceed to the role of Chair. My organisation views these roles as important for professional development, supporting me to attend relevant Society meetings.
Being at the hub of endocrine nursing in the UK has so many advantages in improving your knowledge and expertise in endocrinology and in my case has aided career progression.
The progression and advancement of endocrine nursing and my career have motivated me to continue my work with the Society. I have been extremely fortunate to work with exceptional people in this role and have made long lasting friendships.
What inspired you to apply to be Chair Elect of the Nurse Committee?
It is a pivotal time for the advancement of endocrine nursing and I wanted to be part of that ongoing process. The GIRFT report made it clear that we must focus on the retention and progression of nurses in endocrinology.
My experience and close working relationship with the Society and the Nurse Committee has readied me to take on this position. As Chair Elect it is a huge advantage to work alongside Anne Marland, our current Chair, to better understand the roles and responsibilities of the position and to continue to push the nursing agenda forward as I move into the role of Chair.
“The Society is an excellent organisation to work with and the team supporting the Nurse Committee are very motivated, enthusiastic and supportive”
What advice would you give to anyone considering being more active in Society activities?
Believe me when I say there is always something you can contribute. Many nurses hold back from applying for committee positions, thinking they don’t have enough experience, expertise or time. The committee is very welcoming and supportive.
Getting your employer on board to support time to attend meetings and undertake committee tasks is an important consideration, most employers will generally see the mutual benefit of this role. Travel expenses are covered and there are a number of virtual meetings to avoid too much time out of clinical roles.
If you feel you don’t have time for a committee position, think about putting yourself forward to present at Society conferences, Chair a session or submit and present an abstract. Get in touch with the Nurse Committee if you have any queries.
Society Endocrine Ambassadors Dr Gemma Gardner and Dr May Khine are both foundation year two clinicians in the Peninsular deanery (Torbay and Derriford Hospital) who intend to specialise in endocrinology and diabetes. In this short blog they share the endocrinology and diabetes teaching series they have developed.
We are both very excited to share our endocrinology and diabetes teaching series which took place between October and November 2021. When working as foundation year one trainees, we felt that dealing with diabetic and endocrinology related dilemmas on the ward was often daunting for junior members of the medical team. We decided to develop and organise a five-session teaching series aimed at junior doctors, physician associates and medical trainees with the aim of improving their confidence and knowledge for managing endocrine and diabetic issues on the ward and on call.
“It was a great opportunity for students to ask and discuss topics with experienced endocrinologists which ultimately gave medical trainees a confidence boost to manage endocrinology and diabetes ward/ on-call dilemmas.”
The teaching sessions were delivered online by endocrine and diabetes registrars and consultants, both at Torbay and Derriford Hospital, who kindly gave up their time to be involved in the teaching sessions. The sessions were highly informative and interactive with top tips shared around each topic. It was a great opportunity for students to ask and discuss topics with experienced endocrinologists which ultimately gave medical trainees a confidence boost to manage endocrinology and diabetes ward/ on-call dilemmas.
It was a valuable experience to host and lead this teaching series and we were very pleased to receive such positive feedback from participants which attended from across the Peninsular deanery. These are some typical examples of feedback we received:
Type 1 diabetes and types of insulins – “A really helpful lecture on a topic that I am often uncertain about managing on cover shifts. It was really useful to have stepwise advice as to what to do when called to see a hyperglycaemic patient on the ward and how to adjust their insulin in response”.
“Great practical advice pitched at a good level for junior doctors about common issues” .
Electrolyte abnormalities – “Picked out important points and gave clear algorithms, thank you for organising”.
Endocrine emergencies and disorders – “Information was concise and cleared up some misconceptions I had”.
We look forward to inspiring and promoting the Society for Endocrinology to the younger trainee population in future events. Look out for more events through our teaching platform “How2Doc” on Facebook or contact us through email gemma.gardner9@nhs.net or may.khine1@nhs.net.
If you want to find out more about our Endocrine Ambassadors or would like to apply to become one please visit our webpage.
Aldons Chua is a nurse manager of the endocrine investigation suite in Eastbourne. In our interview he tells us about how he came to this role and the research he is doing with his Endocrine Nurse Grant.
How did you get into endocrinology?
I began my career working as an endoscopy and liver transplant nurse in the Philippines. I set foot in England in 2016 and started as a staff nurse in an acute medical unit at Eastbourne DGH. Endocrinology nursing was unknown to me until a colleague and friend who is now my manager, Maria Ravelo, invited me to do some extra shifts in the endocrine suite. During my shifts, I met patients with rare endocrine conditions and hearing their stories made me fascinated with the specialty.
Can you tell us about your current position?
My main role at present is managing the endocrine investigation suite, covering two district general hospitals, which includes performing dynamic function tests and providing health education for patients with adrenal insufficiency. I also facilitate the commencement and monitoring of treatment for general endocrine disorders.
What do youmost enjoy about your work?
What I really enjoy is the autonomy as a nurse and collaboration with the multidisciplinary team. There is also so much support from colleagues even from different organisations and a variety of opportunities to grow personally and professionally. And, of course, seeing my patients have an improved quality of life through the care our team provided is the most rewarding part.
What are you most proud of in your career?
Becoming a nurse in the UK is what I consider as my proudest moment. As an overseas Filipino worker, it was a big leap of faith to move away from my family and homeland to work in another country with so much difference in language and culture. But it is such a blessing to have very supportive colleagues and managers who I have worked with since the very beginning, especially when it comes into my career aspirations.
How has your work been affected by the COVID-19 pandemic?
It has been very challenging. My associate practitioner and I were re-deployed to a COVID ward for 2 months during the first lockdown and our endocrine service was placed on a 10% service capacity. This caused a significant impact on the timings of our patient appointments, especially the investigations and teaching. However, it also made us resilient and innovative in our efforts to maintain the quality of care we provide while ensuring patient safety.
What do you think are the biggest challenges in your field?
We have a vision in our endocrine nursing service to provide excellent, safe and compassionate patient-centred nursing care. The biggest challenge is to keep the vision going, knowing that we only have very limited time and resources.
You have been awarded an Endocrine Nurse Grant, what was the application process and how did you find it?
Initially, I was reluctant to apply, as I had reservations about whether I qualified as I am still an early career nurse. I am very grateful to my mentor/research supervisor Dr Sofia Llahana who encouraged and guided me throughout the process. Also, the Society for Endocrinology set clear guidance on the website and the team were helpful in responding to my queries which made the process easier to follow.
What will the grant be used for?
The grant will be used to fund our research project which is investigating the barriers and enablers in the use of injection devices during adrenal crises for adrenal insufficiency (AI) patients. In the UK, most centres provide 3ml syringes and a needle or a safety syringe, depending on the centre, which are included in an emergency hydrocortisone injection pack. Although AI patients receive training on how to use these syringes there are still reports that they are unable to administer the hydrocortisone injection during an adrenal crisis due to the complexity of the device. First-hand reports of these problems from our own AI patients led to the research project. Adrenal crisis is a life-threatening event and the emergency injection of hydrocortisone can save a patient’s life. This grant will help us explore the experiences of AI patients on their use of the current hydrocortisone device during an adrenal crisis. The outcome will provide evidence of potentially modifiable barriers associated with the use of the current parenteral hydrocortisone in preventing adrenal crisis and will inform the development of future interventions.
What are your plans after completing this project?
I am looking forward to take on future projects looking at how we can further help and support our patients with adrenal insufficiency manage their condition even better. We are starting new nurse-led clinics soon and expanding the endocrine nursing service to help accommodate our increasing number of endocrine patients.
What advice would you give to anyone considering applying for the Endocrine Nurse Grant?
My first challenge was how to begin, so I connected with a mentor who works in the same area. Then, I familiarised myself with how to make a competitive research proposal as this is my first application. I believe that as nurses we have a huge desire to make a difference to the lives of our patients, and research is just one way. Take courage, and if you fail on the first attempt don’t lose heart, just keep on trying and improving.
Vaishali Limbachia is an intercalating medical student at Norwich Medical School, University of East Anglia (UEA). Vaishali has completed four years of the course enter their final year in September 2021. Last year, Vaishali became Secretary of UEA Endocrinology Society and in November 2020 became an Endocrine Ambassador for the Society for Endocrinology. In this guest blog, Vaishali shares what the UEA Endocrinology Society has been up to so far, and the importance of supporting and encouraging students in endocrinology.
*pictured Vice President, Vaishali Limbachia (left), and President of UEA Endocrinology Society, Milly Green (right).
First, I would like to introduce our society. We are a society run by medical students, for medical students. The committee consists of 4th year, intercalating, and 5th year medical students. Guided by the President, we organise revision sessions for medical students currently learning diabetes and endocrinology, in addition to other events that aim to raise interest in endocrinology. We also run social media pages, keeping our members informed of our society news and events, as well as Society for Endocrinology activities. To further engage with our members, weekly diabetes and endocrinology exam-style, multiple-choice questions are created by the committee members and posted on our social media pages.
Each academic term we have organised and delivered a teaching session on diabetes and on endocrinology. The aim of these sessions is to revise content from the medical school curriculum, which at Norwich Medical School, is taught in year 3. The presentation slides used for lectures are constructed by committee members. It can be challenging to cover a module worth of content in a couple of hours. The sessions are taught by medical students who have undergone diabetes and endocrinology teaching, placements and exams, so are able to provide useful tips.
On top of the teaching sessions, we organise and run mock objective structured clinical examinations (OSCEs), aiming to give medical students a practice run. We design 6 stations, for example a diabetic foot examination and communication skills station, to give members a realistic experience of the summative OSCE. Each committee member runs one station to keep that station consistently delivered. At the end of each station, we feedback verbally to students. In addition, we provide a marking scheme, which we constructed for written feedback, so students can see where marks were given. This allows students to gauge their learning needs in preparation for their summative OSCE. These mock exams are highly subscribed and the feedback is very positive.
This year I organised our first Diabetes and Endocrinology Careers Event, targeted at medical students. Three consultants kindly volunteered their time to speak at the event. Each spoke about their motivating force that led them to choose this specialism, their professional journey, what their day-to-day life is like and shared top tips for medical students. This was followed by an opportunity to ask questions. Speakers shared highly interesting patient cases, showing how the specialism involves detective work and how endocrinology impacts multiple systems. Each speaker’s professional journey was very different, emphasising how there is more than one path to follow. Many useful tips were shared, for example getting involved in research, and opportunities at the Society for Endocrinology. It was a highly inspiring and informative event, that I personally enjoyed, and the feedback was positive, with the only suggestions for improvement being they wished it was longer! I found the event reinforced my passion for specialising in diabetes and endocrinology in the future.
I have had a fantastic year working with great colleagues, who share an interest in diabetes and endocrinology, in organising events and sharing our interests with other students. Next academic year, I will fortunately continue being a part of this brilliant society and assume the role of Vice President of UEA Endocrinology Society. I look forward to working with the new committee members, putting on more events and continuing to share Society for Endocrinology activities and opportunities to members.
Helen Loo, Endocrine Specialist Nurse at Oxford University Hospitals, is one of our first students to successfully complete the Oxford Brookes Masters-level Module in Endocrine Nursing. This module provides nurses with an opportunity to develop their careers and improve standards of patient care in line with the Competency Framework for Adult Endocrine Nursing. The Society collaborates with Oxford Brookes to deliver this 40-credit module, enabling nurses to get academic recognition for all their hard work. All credits can be directly counted towards the Oxford Brookes University MSc in Health Sciences or transferred to Masters-level qualifications at other institutions.
Read our interview with Helen to get valuable insights in to the module and find out about her career as an endocrine nurse.
What inspired you to choose endocrinology as a career?
Before I started working in endocrinology I was living abroad. When my family and I decided to move to the UK, I saw a position advertised to work in endocrinology. After I started researching the area, I was inspired to apply. Endocrinology appealed to me as the discipline is so vast and mixes both acute medicine and chronic disease management.
Tell us a little about your current position and what you enjoy most about your work
I work in a large endocrine team at a busy tertiary referral centre at Oxford University Hospitals, and see patients with many diverse endocrine disorders. Endocrinology is a rewarding area to work and study within as the discipline is constantly changing. There are many opportunities to learn and to apply your learning in practice. I particularly enjoy developing innovative solutions to improve quality of care and nursing practice. As an endocrine nurse, I also feel very privileged to be able to support our patients holistically through the various stages of their diagnosis and treatment.
Tell us about your main research interest
I take a special interest in the areas of male fertility, adrenal insufficiency, gender dysphoria and support the treatment and diagnosis of patients with Cushing’s syndrome. During my Masters-level Module in Endocrine Nursing, I specifically looked at the management of adrenal insufficiency, prevention strategies, and innovation in endocrine nursing care. I was interested in this area of endocrinology because I was inspired by a complex patient who came to us with a medical alert dog, who alerts the patient when their cortisol levels drop. In 2019, I presented a poster at the Society’s Annual BES Conference on this subject and was privileged to be the recipient of the Annette Louis Award. You can read more about this in The Endocrinologist.
Why did you decide to apply for the Oxford Brookes module?
I applied for the Oxford Brookes module as I wanted to build on my experience, knowledge, and skills in endocrine nursing, while advancing my understanding of the health needs that directly relate to our patients. I hoped that it would develop my confidence in undertaking research, enhance my critical enquiry skills and improve my evidence-based practice. All these expectations were met and more!
What is your advice for anyone considering doing the Oxford Brookes module?
This is an excellent course and will really help to give you more expertise in your chosen area and develop your profession. I would advise those considering the module to plan well and to take a responsible approach to their own learning.
What were the challenges of the module and how were you supported?
My biggest challenges were that it had been quite a few years since I had done academic work and I also had two primary aged children. The university provided me with support to get back into writing academically and I reduced my hours to enable me to have a better work life balance. My mentor was also amazing. She supported and encouraged me to manage my own learning to develop my skills and maximise my potential.
What are the biggest challenges in your field?
I think some of the biggest challenges are working within the constraints of the NHS, as well as the effects of the pandemic on health care. Challenges always provide opportunity however, and it is with this mind set I move forward.
What do you think will be the next major breakthrough in your field?
Endocrine nursing is a continually evolving specialty and is now becoming academically accredited. The competency framework benchmarks endocrine nursing with continual scope for development and innovation. I am really excited for the future and the part I will play.
Dr Julia Prague is a clinical consultant and clinical academic at the Royal Devon and Exeter NHS Trust and University of Exeter. In our interview, she tells us about her clinical practice and research projects, as well as how she thinks endocrine practice will evolve after the COVID-19 pandemic.
Tell us a bit about your current positionand what you enjoy most
As a clinical consultant and clinical academic I split my time almost 50/50 through the week. At the moment, my clinical commitments include outpatient endocrinology, and inpatient endocrinology, diabetes and general medicine. I moved from London to Exeter last year, and one of the big reasons to move was that near 50/50 split between clinical commitments and research. It’s a great balance that gives me time and space, not only to be with the patients, but also to investigate and take forward some of the issues that they bring up in clinic. Forming new collaborations and being in a new unit with new colleagues is pretty exciting too.
Don’t let yourself be put off by the general medicine component or thinking that it’s all diabetic feet!
Research wise, I’m particularly interested in the menopause through a number of different collaborations. I’m working with the respiratory department on a project looking at lung conditions and sex hormones. Investigating the impact of the menopause in diabetes. I’m also still involved in establishing the role of neurokinin 3 receptor (NK3R) antagonists to treat hot flushes and improve sleep during the menopause.
What got you interested in research on menopause?
Spending hours with the women in our research study of a new treatment for menopausal flushes, and from receiving hundreds of emails from menopausal women wanting to take part. My admiration for them was huge, not least because they so often described themselves as struggling to cope, yet they were the complete opposite of that, meeting endless challenges with amazing fortitude and whilst mostly suffering in silence. To then see them leave misery and suffering behind and find themselves feeling vibrant and human again was rewarding beyond measure.
Furthermore, the majority of women will have menopausal symptoms that impact on all aspects of their daily life, but many will also have co-existing medical conditions before their menopause and these can also be impacted too. Many medical conditions are influenced by the menstrual cycle and that’s an aspect that is under-investigated and I think is really interesting. Inflammatory bowel disease, for example, can fluctuate during the menstrual cycle and Crohn’s disease typically gets better in pregnancy.
Diabetes is also impacted by the menstrual cycle, and it’s the same hormones that are changing during the menopause but this hasn’t been investigated, which is why I’m now interested in this, as this is something patients often report as being a problem for them. I think it’s important to listen to what patients are telling you and then try and investigate why that is, to hopefully find an improved solution for them.
There will be far fewer centres doing more complex endocrinology, and the development of this could be guided by some of what we have learnt regarding remote consultations and remote networking during the pandemic.
How was your work affected by the COVID-19 pandemic?
I was a Senior Registrar at King’s College Hospital at the height of the first wave, so I became involved in a lot of the management and service re-design work within the diabetes and endocrinology department, including rota management to facilitate re-deployment to general medicine but whilst maintaining a core specialist service and whilst supporting our junior trainees and particularly our international medical graduates who were isolated from their families, and ensuring our patients were supported and aware of sick day rules and had all the medications they needed. Our department was also therefore part of the frontline team. I was the medical registrar on call for the first peak weekend of King’s admissions. Then I got COVID-19 and could not get out of bed/off the sofa for 4 weeks.
I moved to Exeter towards the end of summer 2020 to take up my Consultant job. Since then I have continued to do quite a lot of frontline COVID inpatient medicine. Now we’re involved in recovery and trying to catch up. Many patients couldn’t be seen through the pandemic because resources had to be syphoned off elsewhere.
The Society has become much more inclusive, and far more diverse, with a much broader mix of people, and I think that should really be celebrated and welcomed.
I never imagined I would interview for my consultant job on Zoom! Moving to a new city, a new department, a new consultant role and a new research role during the pandemic was definitely an interesting twist at such a significant stage of my life and career.
What are you proudest of in your career so far?
My work on menopause and NK3R antagonists – being published in The Lancet was a huge honour, and the potential that this work has to relieve suffering of women is incredible. As a doctor, all you want is to relieve suffering in your patients and this has that opportunity. It’s also given me a platform to continue working in that field and to be invited to speak at international conferences, as well as develop new collaborations.
This drug class are now in phase three studies and it looks like they’re probably going to be marketed from around 2023/2024. This research is still advancing within the pharmaceutical field, butte top-line results coming out continue to show great promise for the therapy. Seeing the NK3R antagonists come to market will be amazing. For me, to have played some part in that will be awesome and to see patients being able to go to clinicians and get that medication prescribed will be great.
There will be far fewer centres doing more complex endocrinology, and the development of this could be guided by some of what we have learnt regarding remote consultations and remote networking during the pandemic.
What do you think are the biggest challenges in endocrinology?
We have to mention COVID recovery, in what was an already overstretched system. However, somewhat linked to that, is the pull of general medicine on our time as endocrinologists. The pandemic has further highlighted this to be an important issue. Hospital inpatient medicine is busy and can’t be cancelled. However, it is essential for recruitment, training, and retention that our specialist time is more protected. The new internal medicine training (IMT) programme will change the number of specialty training years to shorten it, which could have some quite big consequences for the endocrine discipline.
COVID-19 has brought some positives though; it’s highlighted that we can achieve quite a lot remotely with patients using virtual appointments, and some patients prefer fitting their appointments in to their life rather than having to attend the hospital. How this translates going forward though could involve big changes for the specialty.
The Society has become much more inclusive, and far more diverse, with a much broader mix of people, and I think that should really be celebrated and welcomed.
What do you think will be the major changes in the future of endocrinology?
I think there will continue to be a drive for a smaller number of national centres of excellence in endocrinology. There will be far fewer centres doing more complex endocrinology, and the development of this could be guided by some of what we have learnt regarding remote consultations and remote networking during the pandemic. That will be good for patients overall but the downside could be that there will be a smaller number of centres with specialist services, which means that staff may have less involvement in specialist endocrinology. A lot of these changes will be driven by the GIRFT recommendations, which will affect how all services are delivered going forward.
What challenges do you see for your research?
Availability of funding will be critical. COVID has had an impact on available funding but so has Brexit, there’s now a lot of European grants that UK researchers will not be eligible for. Universities have less money because they’ve had fewer students and international students may think differently about studying in the UK post-Brexit and post-pandemic. Charities that fund research have also been hit as many of their fundraising activities were suspended during the COVID restrictions. The Government has a significant financial deficit to address. Availability of research funding was already challenging but it’s going to be even more difficult in the years to come. It’s usually funding that restricts research activity rather than a lack of ideas or collaborations.
How would you like to see the Society develop?
My overwhelming memory of attending my first Society meetings in 2006/2007 is of a lot of senior white men wearing tweed jackets! Now every time I come to Society meetings it’s such a stark change from that. Everything that the Society has done, and is doing, to make itself more reflective of everyone within it is really important. Recruiting the next generation is also a huge part of that, and it is great to also see more focus on this now than then too. The Society has become much more inclusive, and far more diverse, with a much broader mix of people, and I think that should really be celebrated and welcomed.
That level of change takes time and effort and over the years I’ve tried to play some part in helping to make the Society a more different place to the one that I initially knew.
As a Leadership and Development Awardee I was really looking forward to SfE BES 2020 as we were going to be paired with award lecturers, and it is also always a great opportunity to catch up with friends, previous colleagues, and previous as well as potential new collaborators. But of course, that didn’t happen. I’ve just been finding my feet as a new consultant and researcher in a new city but being an Awardee has opened up other opportunities. I’ve been involved in discussions with an external organisation exploring new collaborations and identifying our shared goals and objectives that we could achieve together. I’m sure that being an Awardee has helped me be offered these opportunities.
Who have you been most inspired by?
Prof John Wass, obviously, but I have also been very lucky to have amazing clinical and research mentors. From the literal beginning to the end of my clinical training and beyond (now over 15 years!) with Dr Simon Aylwin at King’s and Dr Roderick Clifton-Bligh in Sydney. I also learnt a lot from Prof Waljit Dhillo whilst doing my PhD at Imperial.
Why do you love endocrinology?
The balance of the acute and long-term follow up of patients, and the importance of making the right diagnosis for patients based on their history, examination and targeted investigation. Many patients with endocrine conditions go undiagnosed or misdiagnosed for a long time, so when you make the right diagnosis and instigate the right treatment, they feel and do so much better and you often see it unfold in front of you. As endocrinologists we are also part of a much wider multidisciplinary team, which is great.
Any words of wisdom for aspiring endocrinologists?
I’ve always tried to be involved with the Society in recruiting the next generation. It’s important that they get to see the ‘real’ endocrinology and diabetes because often, those rotation attachments are mostly inpatient general medicine.
My advice would be to try to get to clinic as much as possible because a lot of our patients are outpatients, and also to go and review specialty patients on the wards when they are admitted. Remember also that there’s lots of different sub-specialties within endocrinology (and diabetes) so there is a place for everyone and an opportunity to be involved in the areas that you find most interesting/rewarding.
Don’t let yourself be put off by the general medicine component or thinking that it’s all diabetic feet! I also always recommend going to SfE BES, it’s a really good platform for meeting other clinicians and scientists involved in the field, and hearing about the patients that we look after. Get involved, come along and see what the specialty really has to offer.
The Society for Endocrinology is 75 years old in 2021. As part of our celebrations, we are collecting members’ opinions, with a focus towards the future – after a particularly hard year for us all!
We are keen to reflect the diversity and breadth of our discipline by hearing from members across all backgrounds, career stages, career types and geographical locations, to get a true flavour of the range of views, needs and challenges faced by our Society members.
Read this interview with our new Early Career Member of the Society Nurse Committee and Endocrine Clinical Nurse Specialist at Maidstone Hospital, Emily Falconer, to find out more about her career what she enjoys most about endocrine nursing.
Tell us a little about your current position
I’ve been working in my role at Maidstone Hospital and Tunbridge Wells Trust for just over a year. My role varies from day to day – each day usually consists of dynamic function tests, running nurse-led thyroid clinics, presenting at multidisciplinary team meetings, patient steroid education clinics and chasing and interpreting results. Aside from this, I have recently joined as the Early Career Nurse Representative for the Society for Endocrinology Nurse Committee.
What inspired you to choose endocrinology as a career?
Before my current role, I was working on a busy acute medical ward specialising in gastroenterology, cardiology and endocrinology. It was here that I developed an interest in endocrinology and its vast array of conditions. I was then fortunate to take over the role of Endocrine Clinical Nurse Specialist when the position became available within my Trust.
What do you enjoy most about your work?
I love the patient interaction and enjoy being a person of contact for them if they are in need of help or reassurance with their condition. I find it very rewarding when you can see the difference in patients’ wellbeing and empowering them to manage their condition.
Can you tell us about your career path and what you are most proud of?
I suppose I am proud of what I am doing today! I qualified in 2016 and then worked on the wards and as a Junior Sister. I am extremely excited to work as a Specialist Nurse in a field that I have great interest in and that has many potential areas to get involved in.
Do you have research interests?
Currently I feel I am still on a steep learning curve so I am focussing on progressing and developing within my current role. However, research is definitely something I would like to explore in the future and having been involved with the Society, I have now realised the extensive opportunities and prospects within endocrine research.
How has the COVID-19 pandemic affected your work?
I have been fortunate enough to be able to continue our endocrine service throughout the COVID-19 pandemic. However my unit where I perform my dynamic function tests has been moved a total of five times during the pandemic, which has kept me on my toes! It has also meant that unfortunately I have had to temporarily postpone my learning and training at alternative Trusts.
What do you think are the biggest challenges in your field?
Aside from COVID-19, the large amount of patients we are treating with lasting endocrine effects from the immunotherapy agents used in cancer therapy.
What do you think will be the next major breakthrough in your field?
I am excited by the new prospects in the medical management of Cushing’s, such as the development of medications including Osilodrostat and Melanocortin-2 receptor antagonists.
Any advice for anyone interested in endocrine nursing?
If you would like a role which treats a magnitude of fascinating conditions and allows you to keep patient contact while making a difference to quality of life, then this a great opportunity to do all of that! I would advise to gain basic knowledge within an endocrine setting if possible. Working on an endocrine ward really helps as an introduction to the field.
Our 2020 Society for Endocrinology Dale Medal winner, Frances Ashcroft, is Professor of Physiology at the University of Oxford and a Fellow of Trinity College Oxford. She will be talking about her fascinating research on ion channels and their role in insulin secretion during SfE BES 2020 Online. Find out more about her career and research and get some invaluable words of advice in this interview article.
Tell us a little about your current research
My research interests are ion channels and the metabolic regulation of insulin secretion. These two fields come together in our studies of the role of ATP-sensitive potassium channels in insulin release. I am excited to understand how the metabolism of beta cells works, and how high blood glucose levels in diabetic patients change these beta cells, so that they don’t secrete insulin anymore.
Can you tell us about your career path and what you are most proud of?
I did my undergraduate and graduate studies at the University of Cambridge in zoology. I then did post-docs in Leicester with Peter Stanfield and Los Angeles with Susumu Hagiwara, where I worked on calcium and potassium currents in muscle. After this I set up my own lab in Oxford and chose to study beta cells. I used a technology called patch clamping to look for ion channels closed by glucose. I was a total novice at patch clamping and I was fortunate that others helped me get started and that I got a grant to do it. I have always been led by the science and followed what I am interested in, which in my case is ion channels. I have written a popular book on this subject called the Spark of Life.
I’m most proud of the success of all the brilliant students and post-docs who have worked in my lab. It’s also been wonderful to meet some of the neonatal diabetes patients who have been helped by our work. Andrew Hattersley and his team found that 50% of neonatal diabetes cases are due to mutations on the ion channel I had been working on for 20 years, and we were able to show that these mutations impaired the ability of ATP to close the channels and thus prevented insulin secretion. However they could still be closed by sulphonylurea drugs. This was very exciting because it enabled the patients to transfer from insulin injections to oral tablets.
What inspired you to choose endocrinology as a career?
When I was an undergraduate it was thought that electrical activity was mainly confined to muscle and nerve cells, so I remember being fascinated at finding that it also occurred in endocrine cells, like pancreatic beta-cells. When I took up an independent position at the University of Oxford, I decided to work in a field that was different from my previous one and where there were people at Oxford with whom I could collaborate. I picked beta-cells because of their interesting electrical activity and because I met Stephen Ashcroft, who was working on the biochemistry of insulin secretion. It was the start of a long and happy collaboration.
What do you enjoy most about your work?
There are three main things I enjoy most about my work. Firstly, making discoveries – there is nothing quite like the exhilaration of finding out something new. Secondly, seeing the people who have worked in my lab flourish is a constant joy. And finally, the wonderful long-term collaborations I have had with some outstanding scientists, such as Steve Ashcroft, Patrik Rorsman, and Andrew Hattersley.
How has the COVID-19 pandemic affected your research?
Lockdown was a twofold problem because it prevented us from working in the labs. It was also impossible to keep all of our animal colonies going because of reduced staff in the animal house. We are back in the labs now, but social distancing means that we cannot work at the same intensity as normal. There’s also a constant low level of anxiety about the virus that affects everyone.
What will you be presenting during your lecture at SfE BES online 2020?
I’ll be talking about our work on the role of the ATP-sensitive potassium (KATP) channel in glucose-stimulated insulin secretion. Glucose has to be metabolised by the beta-cells for it to stimulate insulin release. This is because metabolically generated ATP closes the KATP channel, thereby triggering electrical activity, calcium influx and insulin exocytosis. I’m going to show how mutations in the KATP channel that impair ATP inhibition cause neonatal diabetes and increase the risk of type 2 diabetes. I’ll also talk about how chronic hyperglycaemia impairs the metabolic generation of ATP, reducing insulin secretion and speeding the progression of impaired glucose tolerance to full-blown diabetes, and what this means for diabetes therapy.
What do you think about the move to virtual meetings?
The biggest benefit is that you don’t have to travel – which is both good for the planet and saves a great deal of time. Another benefit is that if the talks are posted online, you can listen to bits you’re particularly interested in again at your own convenience. This means you don’t run the risk of missing a talk because another you want to hear is scheduled at the same time. The drawback is that you don’t get to meet your colleagues in person and you miss out on those unexpected and stimulating conversations that lead to new collaborations.
What do you think will be the next major breakthrough in your field?
I think this year has taught us that making any predictions about the future is very unwise, because we never know what’s going to come around the corner!
Any words of advice for aspiring endocrinologists?
My best advice is to ‘find a friend’ – a good person to collaborate with who you not only admire scientifically, but whose company you enjoy. My collaborators have supported me through the inevitable difficulties a scientific life throws at us, have celebrated with me when things went well, and are endlessly and wonderfully stimulating to interact with.
I also think it is important to do what makes you excited and follow what you are interested in. As science is a hard field, unless you love what you are doing, it is perhaps not the best career for you. I’d also recommend you remember Churchill’s advice – never, ever, give in. Perseverance gets you a long way in science.
You can hear Prof Frances Ashcroft’s medal lecture “Metabolic regulation of insulin secretion in health and disease” during SfE BES 2020 Online on Wednesday, 18 November, at 13:05-13:35 GMT. If you haven’t already, register for SfE BES Online now!
David Mangelsdorf is Professor and Chair of the Department of Pharmacology at UT Southwestern and an Investigator of the Howard Hughes Medical Institute. His research focuses on nuclear receptor regulation of metabolism. Dr Mangelsdorf will present his Medal Lecture at SfE BES Online 2020, on Monday 16 November. Learn more about his research, upcoming presentation and career in our interview.
Tell us a little about your career
I became Chair of Pharmacology in 2006, which I inherited from Alfred Gilman, who discovered G proteins and won the Nobel Prize for it. At first I was reluctant to become Chair but then I realised that the role isn’t just about holding together a department but also mentorship and recruiting great, young talent. Here the Chair is given quite a bit of latitude, you keep the Chair as long as you want it and are doing a good job – really you are a benevolent dictator, where you make the rules but they are for the benefit of everyone.
I wanted to be able to juggle three balls, the department, my research lab and my family. Our department has a great administrative team to support me in managing the department and I run a joint lab with Steve Kliewer. We did our PhDs together and have now been working together since 2002.
What inspired you in to endocrinology?
As a graduate student I was in Mark Haussler’s lab, which discovered the hormonal form of vitamin D and its receptor. Mark Haussler was a great scientist and mentor who supported and inspired my work. I then went on to investigate orphan nuclear receptors.
What are you most proud of in your career so far?
The accomplishment of understanding the role of orphan nuclear receptors. I was involved in deorphanising several nuclear receptors.
I am most proud of the discovery of the farnesoid X receptor (FXR), as it has become an important therapeutic target for biliary cholangitis and more recently nonalcoholic steatohepatitis, a type of fatty liver disease. Our work showed how FXR affected liver and lipid biology and to see it now being developed into a therapeutic target is one of my most significant accomplishments.
Steve Kliewer and I are a team, we worked on FGF hormones together, to establish what they do. We worked out the FGF signaling pathway and showed the important role of FGF19 and FGF21 in liver function and metabolism.
Please tell us a little more about what you will be presenting during your Medal Lecture at SfE BES online 2020?
I will be focusing on how FGF21 signals from the liver to the brain to regulate metabolism and nutrient stress, which has implications for obesity, diabetes and the response to alcohol. You can think of FGF21 as a stress hormone, it responds to nutrient stress and two of its most common inducers in people are sweets and alcohol. FGF21 signals to the brain to trigger an anhedonic response – intended to tell you to stop consuming it.
If you give animals a choice between water and water with something sweet or alcoholic added, they will choose the sweet or alcohol up to a point but when FGF21 is administered they stop and return to only drink the water. However, if you knock out the FGF21 signal entirely, they not only keep drinking the sweet or alcoholic water but they drink it even more. FGF21 also encourages more water drinking, presumably to encourage hydration when consuming sugar or alcohol.
Why do you think people eat and drink to excess then?
This is more of an addictive or conditioned behavior but there is no evidence, yet, that FGF21 can affect this in people. We know FGF21 is active in the human brain and perhaps even in areas that control addictive behavior. It is possible that the human FGF21 pathway evolved to compensate for the intake of very sweet or alcoholic foods. We know that people who enjoy drinking, and who drink more, have more of a certain genetic marker in their β-klotho gene than teetotalers. β-klotho is a co-receptor for FGF21. This may have evolutionary significance as alcohol is a natural preservative and there was an evolutionary advantage to having a little alcohol in things like water, to prevent disease. When you start drinking, you might like a sip of beer or wine but would hate stronger alcohol like vodka. People condition themselves to drink more as they get a buzz from it.
Could the FGF21 pathway have therapeutic applications for obesity and alcoholism?
There are very few things known to limit the intake of sugar and alcohol in humans, so there is potential therapeutic value in FGF21 but this needs much more investigation. However, human genetics do point towards a role for FGF21 in overdoing alcohol and sugar consumption.
How has the COVID-19 pandemic affected your research?
Significantly, I think like everyone else it has set us back. We thought it would be just 2 weeks lockdown back in March but even now we are not back to full working capacity. We do a lot of animal work, so we couldn’t do anything. Our long-term studies using animal models had to be stopped and that meant we had to cull colonies. So when we came back we needed to restart everything – in some studies it has set us back as much as 6 months to a year.
The other problem is the inability to interact directly with other people, either in a laboratory or at conferences.
What do you think about the move to virtual meetings?
Doing virtual talks is a terrible experience in my view, it is so artificial and the technology isn’t quite up to par yet. You really miss the human interaction.
The only benefit is saving money on travel and being able to be present at meetings you might not have been able to attend. I’ve enjoyed being at home with my family but do miss interacting with colleagues directly.
What do you enjoy most about your work?
Well, before COVID-19, I enjoyed interacting with the lab – I have an open door policy. I enjoy the element of discovery, I like to be inspired, to take bold steps, not to be afraid to ask a big question, and to go in new directions. I love learning about new areas, we have just started working in neurobiology.
What do you think are the biggest challenges in your field?
Specifically in my work it is the complexity of the central nervous system. It takes a long time to do thorough and careful investigation in the brain.
More generally, the lack of funding makes it difficult to take risks and move the field forward. Investigating new areas, defining new pathways and developing new models needs a lot of funding and a lot of time.
What do you think will be the next major breakthrough in your field?
To demonstrate whether FGF21 and FGF19 are viable therapeutic targets. When looking at treatments that are given long-term, there will always be problems. All drugs have side effects but the longer you are exposed to them the more likely adverse effects may occur. We need to establish if these targets are good for designing new treatments. Deciphering the neuroendocrine circuits of metabolism and behaviour is ongoing and will be key to establishing new therapeutic targets.
Any words of advice for aspiring endocrinologists?
You have to ask a big question to answer a big question. Don’t be afraid, if you want to make a difference, you have to take risks. As long as you are asking an important question, you are going to learn something – you shouldn’t spend time trying to put a round peg in a square hole, whilst losing sight of what the science is telling you.
For example, we were trying to find the ligand for a different nuclear receptor when we discovered the one for LXR. The graduate student had used a negative control that came up positive in her experiment. She was distressed that her experiment had failed but in fact she had inadvertently found the LXR ligand.
In the spirit of the times, my advice is that you should practice safely masking your face, but not your science!
You can hear David Mangelsdorf‘s Medal Lecture “FGF21 and Nutrient Stress: Eat and Drink, But Don’t Get Too Merry” on Monday 16 November at 13:40 GMT. If you haven’t already, register for SfE BES Online now!
Dr Steve Millership, Research Fellow at Imperial College London, is one of our 2020 Early Career Prize Lecture winners. His research focusses on the beta cell epigenome and the impact of diet on beta cells and he will be giving his lecture “Tracking of imprinted gene hypervariability and diet-induced deregulation in pancreatic beta cells” at SfE BES 2020 Online on Tuesday, 17 November. Read this interview to find out more about his talk and get some expert advice on how to become a successful scientist.
Can you tell us a little about your career, research and an achievement you are proud of?
I started my career in metabolic energy homeostasis and cell biology and have always been fascinated with it. I did my PhD in Cardiff University and moved to the London Institute of Medical Sciences to complete a post-doc on imprinted genes and modelling diabetes in mice. In the last year or two I have been writing grants and fellowships, as well as doing a short term fellowship with the Welcome Trust at Imperial College London to continue exploring the modulation of the beta cell epigenome and the effect of diet on beta cells in diabetes. I had been in this position for about 2 months and in the transition phase of getting set up on my own, before the pandemic started.
A proud moment for me was winning the Early Career Prize Lecture – very exciting and unexpected! I would have originally said my proudest moment was when my first paper was accepted, but that has now been overshadowed by winning this award.
Can you tell us a little more about what you will be presenting at SfE BES Online 2020?
There are two main angles to my talk. The first is that beta cells are not all equal and a small percentage are doing different jobs to the rest. This is important to help understand how they secrete insulin as a whole islet. The model I created has the ability to image imprinted gene expression longitudinally and you can look at individual cells and analyse them. The second part to my talk is about how the diet can deregulate and alter expression of beta cell genes, which could explain why diet is so essential to beta cell function.
How has the COVID-19 pandemic affected your research?
I didn’t go in to the lab for six weeks and have mostly been grant and application writing at home, so it has been good to have the opportunity to do that and make lockdown feel more productive. In our lab we have had restricted occupancy so there is only ever 5 people in the lab at a time. This means you don’t get the same lab environment, as everyone just gets on with their own thing and as everyone is so spread out, there is little socialising. However one benefit I have noticed is that my efficiency and organisation levels gone through the roof, as you have to make the most of limited time in the lab. I’m not usually an organised person so that is one thing that has changed for the better!
What do you enjoy most about your work?
I’ve always really enjoyed having hypothesis driven conversations and not knowing what is to come is exciting. I find it really interesting solving mysteries and working on something that has a high impact on human health.
What do you think about the move to virtual conferences?
I went to two conferences in the last month and I found having everything laid out in front of you provides an opportunity to focus on certain bits that are beneficial to you in more detail, and you can go to more talks than in person. Another benefit is having access to conferences you wouldn’t usually go to as there is no need to travel, which can be expensive. However a major drawback of online meetings is not having as much opportunity to network with other attendees. Sometimes talking with other people you can find out valuable bits of information or find better opportunities to collaborate.
What do you think are the biggest challenges in your field?
One of the biggest challenges in beta cell biology is determining what the best method to treat diabetes is – there is always the divide between advancing beta cell function, or reducing insulin resistance. We always had the belief that efficiently functioning pancreatic beta cells is better for diabetic patients and saving beta cell function is a better option, but it is hard to decide which pathway is most effective as there are still things we don’t fully understand.
What advice would you give to aspiring endocrinologists?
One piece of advice I would suggest is, when you are writing grant or fellowship applications, give yourself time and let your ideas develop. You ideally need to give yourself between 6-12 months and write them as you go along, getting feedback from talks and people from the field.
My PhD mentor gave me a couple great pieces of advice which I didn’t expect to be so helpful. She said to make sure you have got at least one main paper coming out of your post-doc which you can call your own, and also to get on with people! It’s difficult to achieve anything if you aren’t collaborative and you don’t get anywhere by keeping your experiments to yourself and not getting help or feedback. You need to be open to ideas and having your work critiqued and then take that feedback on board.
You can hear Dr Steve Millership’s lecture “Tracking of imprinted gene hypervariability and diet-induced deregulation in pancreatic beta cells” on Tuesday, 17 November at 15:55 GMT. If you haven’t already, register for SfE BES Online now!
The Endocrine Post 