Abstract
Introduction
In this issue of the Young GI Angle, we have the opportunity to share the personal experience of four experienced clinicians with a successful career in different fields of gastroenterology. Here, you will find some of their most important decisions that have been a crucial turning point in their life. Many young fellows will face similar situations. Therefore, the testimony of these authors may help those taking difficult decisions during their professional career.
Matthias Löhr
The two most important decisions in life are to find the right partner and the right job. I shall not dwell on the first, tempting as it is, but focus on the other. Notably, sometimes these are interlinked.
Most of us will be ignorant to many aspects of making a professional career and stumble into it at the beginning. Reading the biographies of great physicians, there is always an element of chance – turning into serendipity, if everything went well. It is sometimes amazing to see this evolution!
I am referring to decisions to be made once a certain path is started. For an academic career in medicine, the choice of your first supervisor, in my case for the MD thesis (Dr. med.), is pivotal because here the groundwork is laid for scientific conduct and research ethics. I was lucky, with both the discipline (pathology) and, above all, my supervisor (Prof. Dr. med. Günter Klöppel). During this early phase of my career, this was the best decision for my later path. However, this was not obvious at the time it happened! This decision triggered others, for example to do a postdoc as well as a PhD.
Studying abroad, pursuing my MD thesis work partly outside of Germany and doing a postdoc in the US made me open-minded for the other best career decision: running for the professorship at Karolinska Institutet and then moving here. Beside the outstanding academic environment, this position gave me the freedom to concentrate on the clinic (patients and ERCP) as well as research, education and teaching. This was an active, deliberate decision.
In the end, my best decision in life was to say yes to my wife of 30 years and the mother of our four children. Without her, whatever career decision I would have made would have been futile.
I met her on my first post.
Peter Malfertheiner
Career? It refers to a wide range of definitions and interpretations.
Concerning an academic career, I would opt for fulfilment in one’s professional life that includes advancing the field of specific interest and achieving results that ideally find recognition and appreciation. My ‘career’ in academic clinical medicine did not result from a strategic plan but was born from my general interest in understanding more profoundly the diseases that affect the patients under my care. There was not a single decision but a series of them which set the ground for my education and professional development. Two of them were determinant: the early decision as a student at the University in Bologna to choose gastroenterology as my future specialty and to proceed with my clinical formation at the University Hospital in Ulm. This allowed me to gain insight in two quite distinct educational systems in Italy and Germany. Both of them influenced me in the selection of my further career steps.
My best decision, if I had to choose only one, was driven by a once in a lifetime opportunity. I ‘met’ with a novel bacterium with unique characteristics that colonises and harms the human stomach. This happened at a time when I had already reached a scientific comfort zone focusing on pancreatic diseases. My working environment was perfectly set with regard to facilities, mentorship and teambuilding, ready for further career building. Then it happened: a senior colleague (he was not a gastroenterologist) referred me to the letter of Warren and Marshall about their discovery 1 and brought this new gastric bacterium, Campylobacter pylori (taxonomic classification as genus Helicobacter since 1989) to my attention. My first reaction was sceptical, but the new finding raised my curiosity. A series of fortunate coincidences, rich in anecdotal elements, allowed me to investigate the presence and role of this micro-organism. And the bug was there in the inflamed gastric mucosa of our patients with duodenal ulcer disease, exactly as it had originally been reported. Since then, nothing could stop me pursuing this new field. The topic was very controversial and poorly accepted. Many key opinion(-ated) leaders in the field rejected any pathogenic role of this gastric bacterium and warned it soon would be revealed as a fallacy. It demanded courage to face criticisms from established experts.
So, I witnessed the long-time dogma of a sterile stomach crashing. The chapter on peptic ulcer disease was rewritten, and new perspectives were opened in the field of malignant gastric pathologies. Importantly, the new discovery did not disregard fundamental previous basic scientific achievements but became integrated as a new element in the puzzle of traditional concepts in gastric physiology. I have learned many lessons through my decision to dedicate my ‘scientific career’ to Helicobacter pylori, but would like to share and emphasise that we should never become dogmatic, but rather we should remain open to revise traditional concepts and always courageously be prepared to embark on new avenues.
Laurent Peyrin-Biroulet
You may not believe me, but my best career decision was to leave my department! To be clear, in 2005, we already had everything at Nancy University Hospital (France): a cohort of 2000 inflammatory bowel disease (IBD) patients, fantastic health-care professionals, as well as excellent facilities for clinical, translational and basic research, but nothing in PubMed regarding IBD. However, the learning curve is very long to acquire the skills to develop a project and to make it successful. This is the reason why I decided to move away from my department for three years, with the full support of the Nancy group (Prof. Marc-Andre Bigard and Jean-Pierre Bronowicki). I first spent two years in Lille (2005–2007) working with Prof. Jean-Frederic Colombel, before taking a position as research fellow at the Mayo Clinic (Rochester, MN) under the supervision of Prof. William J. Sandborn and Edward V. Loftus (2008–2009). These three internationally renowned researchers in the field of IBD were my mentors, and without them, I would never have had the opportunity to be invited to write this article. More importantly, they became close friends, and I am always delighted to meet them during or outside an IBD meeting. After returning to France in 2009, my first major decision was then to start mentoring young IBD physicians, and I am happy to see them growing up so fast! I learned one important lesson from the three years outside my hospital. PubMed is sometimes perceived as a surrogate marker of success, but you should know that only your family and friends can help you to reach your goals (if any) and that is the most exciting part of life.
Yamile Zabana
Curiosity has helped me more than once both in my career and in my life. As a young clinical gastroenterologist, I received one interesting enterprise from one of my mentors: I had to be the link between basic and clinical research for my department. At the beginning, the task certainly felt overwhelming, but being curious, as I am, I decided to follow the path and give basic research a try. The work at the lab was something utterly different from anything else I have ever done. I was lucky enough to work with a great team at Fundació Germans Trias i Pujol, not only in my own department lab but everywhere else. I had to leave the clinic for three full years to embrace the lab as my main work. This felt like a leap into the void. The way of thinking was completely different (a biologist’s approach is wide and holistic), everything was new (real time quantitative polymerase chain reactions and R analyses – are you kidding me?), having only IBD as the link. Although I was done with my gastroenterology formation, I was the new kid on the block in the lab. This project demanded not only curiosity but humility, the capacity to begin (in a different way, with a different approach) again.
At the end of this endeavour, I learnt a lot of new tools to understand science (and life). I began to perceive IBD as something much more profound but again as something huge and fruitful. Not only did I serve as the bridge between basic and clinical research, but I had the opportunity to increase my knowledge and modulate my way of performing research in such a way that the working position I have now at Hospital Universitary Mútua de Terrassa owes a lot to this translational approach.
We are grateful for the kind collaboration of all the authors in this paper, in which they have shared many sincere and personal experiences during their lifetime. As you can see, there are many things in common such as mobility, an open-minded attitude and a continuous interest in research. These are some of the most important among many others, but we hope that they inspire you while achieving your goals in your professional career.