Lawen Karim is a specialist registrar trainee in vascular surgery based in London andHe is due to start a Clinical Training Fellowship at our BRC in October 2020. Lawen told us about how he has adapted in his research and clinical work during the COVID-19 pandemic.

2020 Clinical Training Fellow Lawen Karim

I decided to take time out of clinical training to undertake a PhD to develop and enhance my expertise in research with the ultimate aim of becoming an academic surgeon. Upon completion of my research and having successfully secured my PhD and high impact outputs from it, I intend to return to vascular surgical training. I am currently enrolled for my PhD and was awarded an NIHR Guy’s and St Thomas’ BRC Clinical Research Training Fellowship which is due to commence in October 2020.

I elected to conduct my research at the Academic Department of Vascular Surgery at St Thomas’ Hospital because of their international reputation in vascular research and track record in supporting junior researchers with their studies. My research will investigate patients with critical limb ischaemia, the most severe manifestation of peripheral vascular disease. My PhD relates to developing a tissue perfusion scan (BOLD MRI) for the muscles of the calf/foot and exploring the value of the scan in predicting successful limb revascularisation. The study relies on recruiting patients for MRI scanning prior to and shortly after surgery.

The COVID-19 pandemic has led to an unprecedented situation and many challenges for the medical community. As a consequence, much of the research activity that is not relevant to COVID-19 has paused. I have returned to clinical work to support the NHS and currently work three days a week in different south London hospitals. My current NHS duties involve assessing and managing patients with a range of surgical problems and determining whether they require emergency operations to preserve life and limb.

In preparation for my Clinical Training Fellowship I have been, on average, dedicating two days a week for research. The current restrictions placed on non-COVID-19 related research means that I am unable to scan any new patients with critical limb ischaemia. I do, however, benefit from BOLD MRI scans accrued in 13 patients prior to the COVID-19 pandemic and have spent my time perfecting the analysis of these scans. Interpretation of scan sequences is a laborious process at present taking several hours.

I intend to take up my Fellowship in October 2020. The situation with regard to recruiting and scanning new patients for my study remains uncertain, however, I am confident that I will be able to progress my project by using the time and the scan data already accrued to refine MRI sequences and scan analysis. This includes automation of image analysis using machine learning, a collaborative effort with colleagues at Imperial College London, which can be done using scan data I currently have.

As part of my research, I will also be assessing the collateral circulation in patients with critical limb ischaemia. Currently at St Thomas’ Hospital, patients with severe limb ischaemia are still undergoing surgical intervention to improve blood flow for limb salvage. I hope to start this aspect of my PhD very soon as the scans can all be downloaded and analysed remotely.

Once all these data are analysed, I plan to pre-emptively commence writing the various chapters of my thesis. It’s really important to me that I can still progress my research as much as possible given the current situation, and that I have a sustainable plan for the next year, ensuring that my PhD time will not be interrupted.

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