Found in Translation: The Benefits of Combining Research and Clinical Work

In this inspiring episode of WENT & Friends, host Alex Ashman speaks with Miss Elizabeth (Lizzie) Maughan, an NIHR Academic Clinical Lecturer in Paediatric ENT Surgery, about her unconventional journey into research and how she integrates clinical and academic work. Initially set against pursuing research, Lizzie shares how a series of serendipitous events. From switching degrees at Cambridge to a chance research project, she was led into a career blending surgery and science. The episode explores her pathway through academic clinical fellowships, a PhD, and her current role, as well as the challenges and strategies involved in balancing clinical training, research commitments, and family life.

Lizzie offers honest reflections on juggling multiple professional roles, the headspace required for research versus clinical work, and how a pragmatic mindset helped her carve out a unique niche. Her story emphasises the importance of strong mentorship, the transferable skills gained from academic work, and the broader value of research in enhancing patient care. This episode is rich in insight for trainees and consultants alike, especially those considering a portfolio career or taking a break from the programme for research.

WENTS & Friends is the official podcast for Women in ENT Surgery UK.
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Thank you to all of our guests for this season and to Karl Storz UK and the ENT UK Foundation for sponsoring season two of Went and Friends, the podcast of Women in ENT Surgery.

This season’s episodes are hosted by Alex Ashman. Produced and directed by Heather Pownall @heathershub of Heather's Media Hub Ltd. The podcast was created by Ekpemi Irune. The rest of the team includes Anna Slovick, Katherine Conroy, Marie Lyons, Tanya Ta, and Alex Ashman. 

Transcript

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Alex Ashman
This is WENTS and Friends, the podcast of Women in ENT Surgery UK. I'm your host, Alex Ashman. This season, we'll be looking at key career advice on return to training, working less than full time and applying for fellowships. And we'll be looking at factors that can make the working lives of women and minority individuals more challenging and what we can do about them. Today, we'll be talking to Ms. Lizzie Maughan NIHR Academic Clinical Lecturer in Pediatric ENT Surgery about her experiences with integrating clinical and research roles and taking time out of programme for research.

But first, a brief word about our sponsors. The WENTS and Friends podcast is sponsored by Karl Storz UK, who've kindly supported the podcast from the beginning and continue to do so for a second season. The podcast is also sponsored by the InterUK Foundation, who've supported the season with an educational grant. Thank you to Karl Storz UK and the InterUK Foundation for their support. Ms Lizzie Maughan is an NIHR academic clinical lecturer in pediatric ENT surgery. She currently works 50-50 clinical research, the latter being with the UCL Ear Institute and Greater Ormond Street.

She set up and runs the GOSH Advanced Pediatric Airway Surgery course now in its fifth year. So Lizzie, welcome and thank you for coming on the podcast.

Lizzie Maughan
Thank you very much for having me. It's an honor to be asked. Thank you.

Alex Ashman
You're very welcome. So first of want to talk about your sort of journey into research, which is sometimes a bit of a mystery for people starting out. Because I know you sort of, did an academic clinical fellowship and then you did more after that and you did a PhD and that's, tell us about your journey.

Lizzie Maughan
So I started university actually reading biology at Cambridge and, natural sciences. And very quickly in my first few weeks, I had a bit of a crisis of, I don't think this is for me. don't think, ironically, I don't think I like research. I think I don't like lab stuff. I don't think I'm accurate enough to care about pipetting time amounts. I just don't enjoy this. I wanted something more person-facing, but my school had, although they hugely encouraged me and championed me, they had kind of, when I'd said, oh, I might be a scientist, they'd taken that and run with it. I hadn't really ever looked around at other things I could do. And I had this very stereotypical view that, well, if I have a science career, I'll either be a teacher, a scientist, or go into the city, none of which really appealed. I didn't come from a family of medics. It had never crossed my radar. And then a family that I babysat for said, oh, well, my husband's an obstetrician, do you want to do some work experience with him? So I did and then left the first day being like kicking myself thinking, well, I found it now that I should be doing medicine. so Cambridge was very flexible eventually after some cajoling and let me change subjects after one year of natural sciences to medicine. And so I went into it thinking, I don't want research at all. I want to be totally clinical. I was offered the opportunity to do the MB PhD kind of program. Didn't want to. I thought about academic F2, didn't want to do that either. And I found ENT in my fourth year at medical school. So I transferred from Cambridge to UCL and was given my ENT placement at the Royal National Throat, Nose and Ear hospital. And again, it felt like a very light bulb moment of I found within medicine, I found my tribe, I found what I want to do. And then at that point, it was just anything I can do to make myself as compassionate as possible for ST3, even from year four of medical school, I kind of thought, where's the holdup? Where's the bottleneck? And at that time it was always very difficult to get into for registrar training. I already got the person's back out, went through it all and started working towards it. And I got to the point halfway through F2, I'd done my MRCS, I'd done everything that I needed to do to tick boxes. The only thing that was going to start getting me real points extra over anyone else was the slightly higher hanging fruit, i.e. the research degrees. And so I chose do a masters alongside my CT1 year. So I my F1, F2 and CT1 in the Oxford Deanery because they had an F2 job in it that had ENT, A &E and pediatrics. All the London rotations for ENT seemed to include care of the elderly, which meant for me that's GP. That's streaming people to become GP is that's not streaming people to be surgeons. So I trained transfer Deanery to take up, to do that role. And then they treated their core trainees really nicely. So I stayed on.
 
I got an ENT-themed core training in Oxford, which was six months of neurosurgery to be followed by 18 months of ENT. I started doing this master's in surgical science alongside my neurosurgery first six months purely because it was going to get me maximum points on the ST3 form. I was very much get in, get out in terms of mindset. But then in it, I was then given a project and I became really passionate about the project, which is a long story anyway because the project was in the tracheal tissue engineering sphere, which then subsequently became really controversial. But at the time, the star was in its ascendancy and they'd just done the first tracheal tissue engineered transplant at Gosh, who was doing really well. My supervisor to be was being interviewed in the media all the time and everyone thought this was wonderful. And so I was joining thinking, my God, how lucky am I to be part of this, to get this for my master's project. And then concurrently with that, an academic clinical fellowship position was announced in London, themed in Airway, linked to this whole thing. So I didn't, at that point, I had not really been ever been in contact with Martin Burchill and his team. I knew of them, but I was in a different part of the wider superstructure lab. But I kind of thought, well, if I get that, that's a run through number. And that was my entire thought process was I will take, if I, if I'm competitive now, I will take that because it's a run through number. And I applied and I got it. And then whilst I was doing it, then did finish the master's project alongside restarting CT one year as ST one in London, because they weren't going to count that towards my training. I started to really appreciate the flexibility, the fact that the research and clinical were breaks from the other, because I think especially as a core trainee, but even still as a registrar, you can quite often feel like a foot soldier that's just head down in the trenches. And then you come out and then on the other side, well, you might actually be the most knowledgeable person in the room about your project. And people do ask your opinion and put you forward. And actually Prof. Birchall was really wonderful for that and as a mentor and as a champion. So I liked the fact that this was, I'm sort of 26, 27, 28 years old and my voice was being heard. I didn't really ever feel at that stage in my surgical career that anyone's voice was being heard. It wasn't just me or because I was a girl. I didn't perceive anyway. So that was quite nice. And then I kind of went into my ST1 still thinking I'll just take the three years of research time. I probably won't do the PhD, but then I'll just go straight through in my run through number. then at that, alongside my ST1 to three years, the whole tissue engineering world was exploding because of all the controversies around Paola Maccherini. And it was just a fascinating thing to watch and a terrifying thing to watch, to be honest. But my research had then been kind of pushed into like a side, at a side angle off into the cell biology.
 
Although we needed to know about how we were going to put epithelium on the grafts and part of tissue engineering was all about that, how you can make graft better, how you can integrate it better. The field was just completely unfundable. No one wanted to touch it. Regenerative medicine and tissue engineering were a dirty word. And so I picked a bit of it that I had really actually started to enjoy, which is a more cell biology angle and went that way for my PhD. And the thing that kept me hooked through that time, even though it seemed shocking to watch, was the fact that I might project and what I was doing on a day to day was actually extremely surgical. So it was doing animal modeling and I was doing tracheal surgery on rabbits. in a time when clinically, I was barely being allowed to do a tonsil, my hands and my technical skills were progressing in my research practice because I was doing these tracheal essentially resections and anastomosis single-handedly and developing the confidence that comes from knowing that your patients, your animals are doing absolutely fine and well. I found that my clinical skills or my research skills and my clinical confidence was actually being improved by my research rather than the other way around, which is quite, I think, rare for a surgical project, for a surgeon in research. And then, so after all that, a PhD, which was funded in my first year by the Royal College of Surgeons and then the next two years by the Wellcome Trust and then came back into training again, expecting to not do any more research. That was that me done. But then realizing that it's like the matrix which is a kind of analogy I use quite a lot, which is that I've taken the blue pill now. I've had my eyes open to people actually giving what I say credence and questioning why I'm doing everything. And you start seeing the cobwebs and the shadows of, but we don't know why we do that. It's fine to not know, but to pretend that we do is also disingenuous. There's room for improvement there or there's room for improvement there. And I had a very close mentorship from Colin Butler, who's now one of the consultants at Great Ormond Street in the ENT department. he basically taught me how to do these tracheal transplants on rabbits. It was very see one, do one, teach one. But he was only an ST4 himself at the time. But through the association with him, because he was already set on a career at GOSH I ended up coming to Great Ormond Street as this tag along, essentially. I hadn't really thought about PEDs. And he was like, you'll do PEDs. You'll see. You'll see. You will, I'm sure, end up in pediatric ENT. Come and meet my work friends at GOSH And then was standing in the corner of one of the theater. And again, another one of my mentors there. Richard Hewitt had a very difficult case on the table and he made some offhand comment over his shoulder, essentially being like, this is eight month old, needs a laryngotrichia reconstruction, but they're too small. We probably shouldn't do it till two years because we don't have any stents of the right size. But that means that they're probably going to stay in hospital for two years because of the country they come from doesn't really have much home tracheostomy care. And the family lives miles away from the hospital and this is the sixth kid out of. However, you know, they're just this kid, poor kid, I wish we could just do this now. And I said, well, if the center is the problem, I can make you a stent. Like I know how to do that now. And I, and he'll go then. So I did. And I kind of got the MHRA to approve this compassionate use of this 3D printed stent that I had friends in material sciences who made help me make it. And we did this and we put it in. And at the end, I think I then saw the power of this. ⁓ this is a tool like any other tool. I have the connections. I can make this really valuable and useful and it doesn't just have to stay removed. Translational can really mean translational. I realized that I needed to keep doing it. So I then tried to start doing it again in the evenings and weekends that I had as an ST3, realizing that that was not going to happen much, especially then when I had my two children. And it just felt like there is no way that this is not the ball that gets dropped. have your main ball then becomes shifts inside my family and my children that cannot be dropped. So wherever I juggle, however many balls I drop, I can't drop that one. Clinical ball, again, I can't drop. So the one that's going to get put down quite often is going to be research. by this point, because I'd done that case at GOSH I carried on doing research projects and helped enabling people in the wider department. Colin and I were becoming this sort of twin tag team of the research in the department and it felt very much like this was becoming my USP as to why I would be hired. So then it felt like, I can't drop that ball either because that's my USP. I then at that point came to the conclusion that I needed to be an academic clinical lecturer, even though I had massive reservations about how it was going to drop my clinical training percentage. But I felt like I didn't really have a choice and that I really felt passionate this needed to carry on and I couldn't see how I was going to do that without bringing it into my daytime timetable. 

Alex Ashman 

So, I mean, you mentioned that lovely analogy about juggling all the balls and not dropping the glass balls, obviously, and only dropping the plastic ones, the ones that will bounce and not break. How do you integrate the clinical work, the research work and all your other commitments? How do you make it work? Do you focus on one thing at a time? Do you do something else? 

Lizzie Maughan 

Exactly that. Yeah. It's really good question. And I don't know if I've figured out the balance yet, but I've generally always been quite goal-orientated as a person. So to start with, was, all of this is an aid of getting a, you can go back to the start, all of this is an aid of getting a consultant job in ENT. then it's, oh, and yeah, I want that to be in London. And yeah, I want that to be in pediatric ENT. And oh, well, yeah, I quite like that to be at Central Teaching Hospital with research and the integration of those things, the eventual job that I want to look like does involve a research commitment. And therefore, I want eventually to be able to balance my week with commitments integrated throughout the week. So I went into this four-year academic clinical lectures thinking, right, well, I need to start modeling that and walking that now because in four, four plus fellowship years time, I'm going to need to be able to do that. And I'm going to need to do it on day one, hitting the ground running so that people don't point fingers at me as being an inferior surgeon for having been an academic. So I tried for the first 18 months to do it as a split week straight away and I found it incredibly hard. And I've actually kind of caved to myself and then I'm now doing a whole of ST7 as a research year and then I will do the whole of ST8 as a clinical year. And the clinical side is not the problem. The clinical side is almost never the problem. I find that they're very different head spaces and that head space shift is quite jarring and quite difficult to manage. And you need to, I find I need to put quite a lot of energy from myself into changing my headspace from clinical to research. I need almost no effort to go back the other way because I find that clinical work just comes at you. It wants something from you. There's a problem. They tells you what the problem, you fix the problem. So it's quite passive. You know, you sit in clinic, there's 12 people to see. They just keep coming. They tell you what the problem is. You fix the problem. You don't have to turn up that day and then write out de novo a thing for each patient. Do you know what mean? The headspace that you need is quite passive. Whereas the research headspace comes from you and it's generative and you have to really bring yourself to the table because there's no one else to bring it. And so I found that I just could not get my research head off the ground on my project and get going and get up onto that steady state with the research, doing it as a split week. hope now that I've had this year to get up there and I like this project and I want to run with this project long-term that now I'm up there. I can keep going when I come back into clinical practice and then aim for a more balanced split week going forward. But at the moment, I've had to kind of accept that I need to have a dedicated time to essentially be a year one registrar in academia equivalent rather than going part-time straight away. 

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Lizzie Maughan 

so the concept of harmony rather than balance, I think, is trying to work out, okay, well, what needs to happen to get an overall view where it all looks harmonious and balanced, even if that means that for now something's got to come up in the fourth floor. It's not dropping other balls, but it's something has got to take precedence. The dominant note in the chord has got to come out and be different at this point versus that point versus that point. 

Alex Ashman 

Sounds like you're talking about sort of sequential multitasking, trying to do one thing whilst time rather than trying to do it all simultaneously. That makes a lot of sense, to be honest. 

Lizzie Maughan 

I think some people may do quite well at doing multiple things at once, but I'm maybe not that person. I concentrate so heavily on whatever it is I'm doing. I my husband thinks it's hilarious that I profess to be this surgeon with an academic career and yet I'm like not listening half the time and he's like, what are we doing again this weekend? I did tell you like three times what you do, but I'm just, I was focused on something else. Whether it was the child was about to kamikaze off something or whatever it is, can't, I can't do the two things at once. 

Alex Ashman 

To be honest, I think that most of us probably aren't good at doing two things simultaneously. We're good at having a lot of plates spinning, but we can't keep them all spinning at the same moment. Yeah. I think that's entirely fair. Yeah. I was going to say, in terms of your clinical training, I know you said that clinical work is just, you know, it will find you. It doesn't require necessarily any sort of generative work to make it happen. But what's your experience been of clinical training in the context of having to divide it 50-50 with the research? 

Lizzie Maughan 

I have had a really positive experience from it. I have had uniformly supportive trainers and TPDs who've gone out of their way to make it work for me. And I think that's why it's been, it's been fine. Like my log book has kept up apart from this year, you know, with trainees that are doing it a hundred percent and that can't happen without a huge amount of buy-in and goodwill from the department that you're in. The timetables that I've been given at every trust, we've worked out a system where I've only lost one list. So three lists have been preserved out of a 50 % timetable. And I think that that only works because it's people and they're people that have seen me as an SHO where I did it as blocks. So I was always in their mind, purely clinical training when I was there and they all... I get the impression that they want me to succeed and that I've chosen to do this and they have all been really helpful. And that's not even just tertiary big teaching hospitals, that's DGHs. And part of it is me also being on a bit of a PR crusade about people in research because I perceive it having a negative connotation about competence surgically and or that you've got your head in the clouds or that how can you possibly be have as good hands if you've spent half the time doing it. You either can't be as good as us or you're really good and that makes us all look bad. Why should we not be better with twice what you've had? know, going around and, know, but going back to units who have trained me before as an SHO or trained me when I was fully clinical and going, you know me, you know what I'm trying to achieve here. I'm not trying to get out of doing work. This is my service provision, but it's in a different context has really helped. And being willing to be on the 100 % on the on-call rotor, even though that's technically not what I need to do, but going above and beyond to offer and give first and to go back to these departments before they set the timetables and go, you know, hi, can I buy you a coffee? It's lovely to see you again. I'm really looking forward to coming back to work with you. You know, doing it face to face and so that I found it, I generally prefer face to face stuff anyway. when I have to have any sort of difficult conversations with anyone, I'd much rather do it face to face than virtually or on a phone call. But, it kind of, I've, I think that because I've gone out of my way as have my supervisors on a charm offensive, then I've found everyone really very helpful and therefore it has worked. And that's the benefit, I guess, of doing it in the deanery, then which you trained before as a clinical training. They know you, then you're not put on them by a power that be. And you know the internal dynamics and the powered plays and the people who need their backs massaged versus people who need their backs scratched. You've already made those connections and that network around. And I think that that is where the emotional intelligence side of it makes it successful. 

Alex Ashman 

So there is a fair amount of being proactive and sort of, I don't know, having good communication skills and people managing it a bit to make sure that everyone's on board. And you're saying it actually sounds like the skills required to get your, presumably your grants, your funding and research and the skills required to get your, you know, the equivalent of a less than full-time clinical post source out are probably roughly the same skill set. There's some transferable skills in there. 

Lizzie Maughan 

I say, I think more in the research context I think that's, so I feel, I do feel now having settled into this is what I should be doing in my life, I can see a point to it, that I now feel like as often happens when some people have epiphanies, I now feel quite evangelical about a period of doing something that is not medicine or surgery is really good for you. So your communication skills and your ability to get your point across and bring people along with you such that they will collaborate with you and not see you as a threat, but they'll see you as an ally. I have seen as being an, I'm kind of an insider in both worlds, but also an outsider in both worlds. And so you see for with a clinical hat, when I look at my research colleagues and go, I don't envy you having to constantly make sure that your point is absolutely right. Whereas on the other side of it, you can just go, well, it's the right thing to do. 

Alex Ashman 

That's almost sort of teaching you those, I don't know, what do call them leadership skills, then you have to be able to convince people maybe by being the one who is expert in the field or maybe by having the right connections or maybe just by, I don't know, convincing them some other way that you want the thing to happen. And it's probably useful to come back to being a consultant one day with those skills because I've noticed in management as well. 

Lizzie Maughan 

Yeah. And it's the kind of what's your motive? What's their motivation? What's my motivation? Why is this person getting their way over what I think needs to be done? In medicine, a lot of it is still very hierarchical. This person in the chain of command in the hospital, whether it's the anesthetist or another specialty or someone who's just more senior to you time served, well then that opinion, unless there's a really good reason, can carry more, usually carries more weight. And that's not to say that isn't sometimes absolutely correct because they may well have seen it before or if they haven't, they have much more experience to be able to draw on. It's just empirical research. ⁓ it's not that that isn't valuable or right, but you don't get that automatic, well, I must listen to this person just by your rank or your job description in research. So you do have to kind of work out a bit more about what somebody's motivation and what can I give them before I ask for something for myself. 

Alex Ashman 

Yes. I mean, overall, it sounds like whilst people might say, oh, yes, you want to be 100 % clinical, not have any portfolio or research or any other interests, but it sounds like actually a lot of these non-clinical areas provide a lot of transferable skills, of life learning that's required to actually do the job outside of, because most people say when you're a consultant, most of the job is not clinical, the clinical bit's the easy bit. Perhaps it's not a bad thing to have some of those skills. 

Lizzie Maughan 

Yeah, to succeed in any part of medicine going forward, as you say, at the higher levels, it's much more people management. And I think medical school prepares us in sense that gives us the knowledge, but it stops there. And then there is, it's there, but for the grace of God, go you. What joint, what jobs, what mentors, what trainers do you get that are helping to develop the rest of your clinical persona? What do you see modeled? What cultures have you been exposed to within your hospital trusts? And then, in a very hierarchical context. And then you come out the top end and they go, yeah, cool. Go on then. It's a very player-manager dynamic of you might be the best striker ever, but where was any of your managerial training? Where was your financial training? How to manage your own money? Where was your mentorship training? Where was your teaching training? And yet now, you know, as an F2, ⁓ well, cool. You go teach the F1s. There's, you know, I think there's a lot about being a doctor now as well that maybe in previous generations wasn't quite as heavily pushed for everyone to be competent at. But now there's this perception that we can all do those things equally without realising the value added of a dedicated time out to learn how to do some of these things properly. 

Alex Ashman 

Yeah, absolutely. Thanks so much for talking us through all that. It sounds like you've had, don't know, quite a sort of serendipitous journey into research in the first place, having started off saying you're just going to do it for a year and then, I don't know, it's turned out, I don't know how many years later, you're sort of absolutely fully into it in a role that is very specifically what you wanted to do. I mean, there's a sort of, there's a sign that people really got to just keep on doing what they want to do. And I don't know, be a bit bloody minded about it maybe. 

Lizzie Maughan 

I'm maybe like most surgeons, I am quite pragmatic and therefore if I'm doing it, it's got to be serving a purpose. I think I find sometimes with my internal medicine colleagues who are the other ACLs, I'm one of only two or three other surgical ACLs within UCL, which is one of the largest ACL cohorts there is and is dominated by the medical specialties. They have an opposite way around about how they perceive academia and the value of academia. I mean, ask an oncologist about what the value of research is. They will all look at you as if you're an absolute child. like, well, this is the reason why we're moving. Surgery has this, there's this weird feeling that research doesn't apply to us or that it shouldn't apply to us or it's a disconnect. And I felt very much affected by that earlier in my training, and that both internalising that and saying, I mean, I'm doing this because it gives me points, but that's pretty much the only reason for doing any. And then realising that if I'm not doing it, who is going to do it? Some of the diseases that we're looking at, there aren't really any other centers out there looking at those same cohorts of patients. And we have the numbers more than anywhere else. So if we're not doing it, who is doing it? I think also observing the kind of the tertiary and quaternary referrals that comes through, gosh, is definitely quite moving and affecting, and maybe more so as a parent now. But well, these people have come here because they can't be treated somewhere else. So if we say we can't, that means it can't be done. And that feels very shocking to have to say to someone when I feel like, it feels like that could be done. what would need to happen for that to be done? Well, I'll go and explore that and see what could be done. Yeah, it's, I see the value of it now hugely as a tool. And being pragmatic, that is how I now see it. And it's whatever tool you're going to bring to a department or bring to the surgical community, it feels like as long as you do something else outside of surgery, you're bringing something else that's going to enrich what we know as a specialty. 

Alex Ashman 

and probably give you more skills coming into the job than you would otherwise have as well, as you've said. Thanks so much for taking time out to speak to us. Is there anything you wanted to say otherwise before we finish? 

Lizzie Maughan 

Just that if anyone is interested or wants to sound things off, you know, I've always loved to to mull things over with people and try not to put my own spin or angle on on what other people feel like they want to do. But yeah, I think that there has been to me no downside to doing research whatsoever, apart from the fact that it's lengthened my training considerably. But actually, you know, when I talk to my mentors, they're like, but the job that you want wouldn't have existed if you hadn't done those things. So you've created your own lane and then run on it. And there are lots of other ways people can do that, but if you don't look up, then you don't really do anything to differentiate yourself. 

Alex Ashman 

Thank you for joining us for another episode of WENTS and Friends, the podcast of women in ENT surgery. If you've enjoyed this episode, please make sure you subscribe on your podcast app of choice, leave us a review and share it on social media. Don't forget that we have a back catalog of episodes on a range of subjects from mat-leaving menopause to surgical training and culture change. We're on Twitter, Threads, Instagram and LinkedIn, so make sure you follow us for details of upcoming episodes and events. And if you're an ENT UK member, you can join WENTS UK if you haven't already via your online membership page. Thanks again to all of our guests for this season and to Karl Storz UK and the ENT UK Foundation for sponsoring season two of WENTS and Friends, the podcast of women in ENT surgery. WENTS and Friends is produced and directed by Heather Pownall of Heather's Media Hub. The podcast was created by Ekpemi Iruni The rest of the team includes Anna Slovick, Katherine Conroy, Marie Lyons, Tanya Tar and me, Alex Ashman. Next week we'll be discussing imposter syndrome, confidence and psychological safety with Ms. Sadie Khwaja. Until then, take care and thanks for listening.