What does it take to nurture the next generation of clinician-scientists?

In an era of rising healthcare demands and increasingly complex diseases, clinician-scientists have never been more vital. Straddling the clinic and the lab, they are uniquely positioned to respond to evolving challenges in healthcare with both breadth and depth—and to translate scientific breakthroughs into better patient care.

In this special feature, MEDICUS interviews two outstanding clinician-scientists who have not only advanced research in their own fields but also played key roles in mentoring the next generation and leading institutional change.

Taking the spotlight are Professor Darren Lim, medical oncologist and Interim Director for the Duke-NUS Centre for Clinician-Scientist+ Development, and Professor Paul Noble, former Chair of Medicine at Cedars-Sinai, Chief of Pulmonary, Allergy and Critical Care Medicine at Duke  and immediate past President of the Association of American Physicians.

Together, they share insights from their journeys, and how they’re helping build the next generation of clinician-scientists.

MEDICUS: Thank you for joining us. To begin, was there a turning point in your career that has shaped the direction of your research?

Darren Lim: As an oncologist, it’s always challenging because you are caring for patients with a terminal illness, often when there are few options left.

So we are always trying to find better options, better drugs, better solutions for some of the patients at risk. And that is probably a crucial reason why some of us go into research—to understand the whys and hows, and ultimately, to improve our patients’ lives.

So, there wasn’t a single turning point for me, but rather the clinical challenges and unmet needs inherent to the field that motivated me to go into research.

Paul Noble: When I started medical school, I thought I wanted to be a paediatrician. But caring for my first group of sick kids took such an emotional toll that I started to develop an interest in internal medicine.

The turning point for me really was during my third year of internal medicine residency at the University of California in San Francisco, when I was caring for patients who had undergone bone marrow transplants. I noticed over the course of my rotation that there seemed to be several patients dying of what looked like scarring of the lungs, or fibrosis—and it wasn’t due to any infectious agents.

When I reviewed the autopsy results for the patients who had passed away, I noticed that their lungs had extensive scar tissue. And I just became fascinated with why the lung formed such scar tissue—and that’s what I’ve been trying to understand for the past 30 years. 

MEDICUS: What question are you currently pursuing in the lab?

Darren Lim: I’ve specialised in treating lung, head and neck cancers, but my research focuses primarily on understanding the mechanisms underpinning the development of nasopharyngeal cancer.

Nasopharyngeal cancer is particularly prevalent in Asia, affecting men at a ratio of three to one. It is the third most common cancer for males between the age of 30 to 50 years old and while it is often curable, a relapse or a late-stage diagnosis makes treatment far more difficult—and can be particularly devastating.

As most of the research that’s been done focuses on populations outside of Asia, there are still many unanswered questions, which makes understanding the disease in our context even more critical. 

Paul Noble: My research has always focused on answering this question: why does the lung form such scar tissue? Specifically in idiopathic pulmonary fibrosis, the most severe form of fibrosis, which requires lung transplants the most often.

And I am very excited because we have identified some pathways from which some clinical trials have emerged. The current FDA-approved treatments slow the progression of the disease, but they don’t make people better. My hope is that one of these clinical trials will make people better and change the natural history of the disease.

MEDICUS: What’s the unique value of clinician-scientists in today’s health ecosystem?

Paul Noble: We identify research questions that’s truly matter to patients. And that comes from our experience caring for them, which enables us to see the issues they face up-close and to identify questions that help advance treatment or improve their quality of life.  

Darren Lim: And we approach problems systematically. After identifying the issue, clinician-scientists rally different people around them to solve the problem—whether it’s to develop better therapies or better ways of addressing the problem.

And this process of problem-solving is always driven by what they observe in the clinic and the unmet clinical needs of their patients.

MEDICUS: The demands of balancing clinic and lab are intense. How can we better support young clinician-scientists?

Paul Noble: That’s a really important point. And I think what has helped me over the years, was to focus my clinical work on the same subject matter that I do research on.

Oftentimes, young clinician-scientists find that a lot of their clinical work isn’t necessarily related to their research, but if they can combine their clinical interests with their research interests and focus on that particular area, then the synergy between patient care, the joy and passion of caring for patients, and pursuing research on the same disease they’re suffering from, will provide unbridled joy.

So it’s important to focus, focus, focus.

Darren Lim: There’s been a significant paradigm shift in our ecosystem. Along with that, the infrastructure has improved a lot in terms of the training that’s available and the funding support to run these training programmes.

At Duke-NUS, we have formal pathways like the Clinical and Translational Sciences PhD programme, the Master of Clinical Investigation programme and the PhD IBM programmes. So there are many more clinicians now who are embarking on obtaining these accreditations, which is significantly different from when I was still starting out.

At the Duke-NUS Centre for Clinician-Scientist+ Development, besides having a supportive infrastructure in the form of programmes including the ACE-in-grants, the Individual Development Plan and the Khoo Scholars Programme, we have also roped in a team of clinician-scientist mentors who are stepping up to guide and nurture the next generation of aspiring clinician-scientists. We have built a whole ecosystem around mentorship.

MEDICUS: Speaking on mentorship–how critical is it to this journey?

Darren Lim: It’s essential. Having mentors who have walked the same path, who are able to empathise with their journey is critical because they can help aspiring clinician-scientists navigate the challenges and issues they encounter on their journey.

For instance, they can provide constructive criticism on research and serve as a sounding board, they can advise on different success strategies or help open certain doors.

Paul Noble: It’s impossible to express how important mentors are. And for a clinician-scientist, you really need both clinical mentors and scientific mentors.

There can sometimes be pressure to do a lot of research during your residency training, and that may be fine for some people. But if you want to combine a clinical career with a research career, you really need to embrace those clinical years and learn as much as you can.

What benefitted me over the years was having tremendous clinical mentors who taught me the skills of diagnosis and patient management. But equally important was having research mentors who taught me the approaches to research and the key techniques that would enable me to be able to address questions in the lab derived from taking care of patients.

MEDICUS: Communication seems key to this hybrid identity. Why is it so important?

Paul Noble: Communicating your work, particularly as it relates to patients, is probably one of the most important aspects of being a successful physician and clinician-scientist. How do you present your research? And how do you couch it in a way that makes it clear that it is focused on patients?

I think that is a unique talent of a clinician-scientist and one that needs to be nurtured and fostered early in one’s career. Learning from your mentors can be crucial in this process.

Darren Lim: And you probably need to take a more holistic approach too. Communication doesn’t need to just involve the scientist or the clinician-scientist. It is also important to involve even patients as advocates—patients who perhaps have benefited from some of the science. They can be a powerful voice.

With that, you can advocate for policymakers to drive meaningful change, to eventually change policies or implement changes in the healthcare system that will benefit everyone.

MEDICUS: What advice would you give a medical student or junior doctor considering this path?

Darren Lim: Be very clear about your motivation. Do you want to excel in the clinic? Or do you want to tackle this clinical problem that motivates you to hit the lab every morning?

It’s not an easy path, but it can be a very fulfilling journey.

Once you’ve decided to pursue this path, speak to as many people as possible who have either taken the journey or in the midst of doing so. And I always say that you need to have this big, hairy, audacious goal, or BHAG.

Paul Noble: I think the most important thing is to find that passion, find that disease that really gets you out of bed in the morning, makes you want to read more, and then engage with experienced, successful researchers who can help you to learn the key techniques and approaches to do science the right way.

If you can combine that question you have about a particular disease with a great research mentor, it is impossible to describe just how wonderful that career can be.

MEDICUS: With such intense schedules, how do you unwind and recharge?

Darren Lim: I stay balanced by focusing on a few key areas—I make sure to learn something new to keep my mind sharp, and I also prioritise my health by exercising regularly, eating well and getting enough rest.

Paul Noble: I think exercise is really important. I enjoy running. I have run a couple of marathons before, but my body won’t keep up with that anymore! But I still like to run, particularly where I live in Los Angeles, not far from some of the canyons. The Runyon Canyon in the Hollywood Hills is a special place where I find great solace in running.

MEDICUS: Finally, what’s your long-term vision for your research?

Darren Lim: That we can translate some of our discoveries into something tangible that benefits the patient in the clinic.

Paul Noble: My hope is that I can identify new treatments that change the natural history of progressive pulmonary fibrosis before I am finished, so patients don’t have to undergo a lung transplant. We are all eventually going to die of something. And my goal is for my patients not to die from pulmonary fibrosis.

MEDICUS: Thank you for sharing your insights and personal experience with us.