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Home institution and country: University of Nottingham, Nottingham, United Kingdom
Host institution and country: Children’s National Medical Centre, Washington DC, USA
Dates of visit: 23 February 2018 – 20 May 2018
Children with optic pathway glioma often experience vision problems, before and after the treatment. My research aims to understand how cognitive development is affected in these patients. I want to know how children with optic glioma use the residual sight to think and learn, and if they compensate for visual difficulties by relying more on the auditory channel. To do this, I assess various abilities (e.g. attention, memory, and English comprehension) using analogous tests that rely on sight or hearing. I hope to identify patterns of strengths and difficulties in these children that will help to support their school progression.
Why did you choose the host lab?
I first met Dr Walsh in 2016 in Liverpool at the International Symposium on Pediatric Neuro-Oncology. She gave a talk about long-term neuropsychological outcomes in children with cerebellar mutism syndrome, and I was really impressed by her presentation. She depicted a clear profile of these children by linking the abstract figures of the results to the real patients behind the study, addressed clinical factors with a sophisticated fine-grained approach and critically reflected upon the real-life implications of her findings. I realised I could have learnt a lot from Dr Walsh because of her unique combination of clinical and research expertise in the neuropsychology of paediatric brain cancer (my clinical supervisors are not neuropsychologists, and my psychologist supervisor is not an oncology clinician). My supervisors reacted with enthusiasm to my suggestion of visiting her lab. They saw not only the possibility for me to have specific additional training, but also the opportunity to develop a long-term partnership with the Children’s National. With this broader vision in mind, we invited Dr Walsh to collaborate on my research, providing additional patients from her institution, and she responded with interest to the offer.
Do you have any interesting souvenirs from the host lab?
On my last day at the host institution, I receive a farewell present from my mentor Dr Walsh. It was the book “Healing children” written by Dr Kurt Newman, President and CEO of the Children’s National. He was a paediatric surgeon at the hospital and wrote a collection of stories that inspired and shaped his approach to child medicine. I had no expectations for this book, but it turned out a great revelation! Dr Newman was very different from a stereotypical surgeon with “snob” attitude (as he himself refers to the category) within medicine’s hierarchies. He had a broad view of children’s health and well-being and highly valued the contribution of not only doctors, but also nurses, social workers, psychologists, and parents to provide adequate care to children. I believe this is particularly true for children with brain cancer, since the tumour affects the centre of every mental and physical functions of a developing system. However, research priority is still given to wet lab research (e.g. genetics, biology). This book has helped me to build a stronger argument for the need of more research on neuropsychological outcomes and quality of life in children with brain cancer. It was truly inspirational!
They saw not only the possibility for me to have specific additional training, but also the opportunity to develop a long-term partnership with the Children’s National.
How has the trip inspired you in your research?
Being immersed in a clinical and research environment fully tailored for children was highly inspirational to me. I realised this during the Research and Education Week, an event to showcase the variety of research projects conducted at the Children’s National. First, I appreciated the involvement of young patients and families at every step of the research process. For example, some of the research questions addressed arose from parents’ concerns and focus groups were organised to plan new studies or feed-back the results. In
addition, I was surprised to see that researchers in a specific condition benefitted from close relationships with experts in a different area in terms of sharing knowledge, expertise, tools and data. This might be particularly important for brain tumour patients as a multidisciplinary approach is also necessary in research in order to address the complexity of their mental and physical difficulties (e.g. co-occurrence of cognitive dysfunction and visual impairment). A children’s hospital is the kind of institution I see myself in for a postdoc fellowship.
My lab envisages to integrate the UK in multicentred studies in neuropsychology across North America, and Nottingham would be the central hub for the UK institutions within this network of English-speaking countries.
Did you have a personal mentor or anyone who particularly helped you?
Dr Walsh was my personal mentor, and her clinical research coordinator, Tess Kennedy, was particularly helpful too. We worked closely together before my arrival, to complete ethical approval, registration, etc., and she was my point of reference for practicalities at the Children’s National. Her help was crucial to start my work smoothly and she also thought about my social life. For example, she gave advice about life and housing in DC and organised a happy hour evening during my first week so that I could get to know some of her young colleagues. When she left her job, Dr Walsh suggested that I move to Tess’s desk to be closer to the other researchers who would have been able to assist me in the last month. I was afraid I would have been lost without Tess; instead, the whole team (and in particular Anthony Gioia) took very good care of me, inside and outside of the office! Also, as they were all Americans coming from different states and institutions within the US, speaking to them was extremely helpful while considering a postdoc career in the US.
Does your lab plan to collaborate further with the host lab?
Despite our careful preparation to maximise children’s enrolment during my visit in Washington, it was not possible to achieve the target number of participants. However, Dr Walsh has decided to continue to work on this collaborative project until we reach 20 patients as planned. We are all determined to gather the sample needed for a strong publication! This means that I am still in contact with the Washington team for regular updates, to coordinate the data sharing and to plan the preparation of the manuscript. In addition, my supervisors are working to extend this partnership to other research centres, like the Sick Kids Hospital in Toronto. My lab envisages to integrate the UK in multicentred studies in neuropsychology across North America and Nottingham would be the central hub for the UK institutions within this network of English-speaking countries.
How has this visit been beneficial to your research and your career?
Halfway through the visit, Dr Walsh and I arranged a meeting with the Neuropsychology department as we wanted the whole team to know more about myself and our collaborative research project. The idea of presenting my theory-driven work to a clinical audience for the first time was a bit daunting. However, I was pleasantly surprise by their appreciation of my theoretical framework, which is often undervalued in clinical research. I benefited from their clinical input to envisage how to move the research area forward. This talk also gave me the opportunity to know Dr Berl Madison, Director of the research fellowship program at the National Institute of Health. She gave me precious advice about postdoc opportunities at the NIH and offered to connect me with research groups that fit my research interests. Finally, the relationship consolidated with Dr Walsh during the visit was advantageous at the International Symposium on Pediatric Neuro-oncology (ISPNO; 1-3 July) in Denver CO, USA. Since Dr Walsh is a well-known neuropsychologist in the field and has many collaborators across North America, her reputation and help made it somehow easier to know new colleagues and showcase our collaborative research.