Dr Toby Jeffcote, ICU Consultant at Alfred Health and Senior Research Fellow at ANZIC-RC, Monash University
Research focus: To undertake health services research to improve outcomes for patients with moderate to severe traumatic brain injury.
Dr Toby Jeffcote is a recipient of a Monash Partners Strategic Translation and Research (STAR) Clinician Fellowship. The program invests in emerging and mid-career clinical academics to support their career pathway development and train the next generation of researchers. Monash Partners spoke to Toby upon accepting this Fellowship.
What is your career background and research history?
I currently work as an intensive care physician at the Alfred Hospital in Melbourne, but I have a long-term interest in Neuroscience and completed a master’s degree in psychology prior to my medical training. My clinical training included time spent working in both neurosurgery and neurology before deciding on a clinical career in intensive care medicine. My clinical training also included time out to complete a PhD in Bioengineering at Imperial College London focused on novel neuromonitoring techniques for patients with acute brain injuries in the ICU. Completion of my intensive care training has allowed me to refocus on my research career by working part-time as a senior research fellow for the acute brain injury research group at the ANZIC-RC in Melbourne.
How did you find yourself focusing on severe traumatic brain injuries in Australia within your research?
During my first few years as a doctor, I cared for patients with traumatic brain injuries (TBI). I had the opportunity to gain experience in surgical and intensive care management and the early rehabilitation of these patients on the neurosurgical ward. I was struck by the terrible impact that these injuries had on our patients and their loved ones. Lives were often devastated by the severe disability that resulted from these brain injuries. I was also surprised to learn that brain injuries are managed in the ICU with very limited access to data about the physiological status of the injured brain. The profound impact of the patients’ stories and the realisation of how little we know about acute brain injuries in the ICU made me determined to work in this area to try and to improve outcomes for these vulnerable patients.
What is the prevalence of severe traumatic brain injuries in Australia and current issues that patients face?
Globally, TBI is the most common neurological disease with over 27 million cases per year. Although the management of critically ill TBI patients has improved over time, mortality remains unacceptably high at 30 to 50%. In Australia alone moderate to severe traumatic brain injury (msTBI) costs up to $A2 billion a year. Outcomes from msTBI can be improved. Patients suffer from an initial primary injury but then suffer secondary injuries in the days and weeks following their injury. Reducing this secondary brain injury is the goal of clinical management but it is made much more difficult by the complexity of both the disease process and the care pathway of msTBI. This complexity is a barrier to effective research and improved clinical care for msTBI.
Tell us about your research study PRECISION-TBI.
PRECISION-TBI aims to take a novel combined approach to msTBI with four components.
1. A data collection infrastructure that helps us understand which patients are suffering from msTBI, how they are being cared for and what outcomes are associated with different approaches to care.
2. A mechanism for improving the quality of care provided by giving feedback to participating sites.
3. The performance of small-scale prospective research studies within the data collection infrastructure to test the feasibility of interventions before carrying out larger trials.
4. Improving our ability to predict outcomes from msTBI by using data specific to the Australian healthcare environment.
What are you hoping to achieve with your research?
With these four pillars we are hoping to collect valuable data about how msTBI is managed in Australia and which treatment approaches are most successful at improving outcomes. We are aiming to directly improve the quality of care provided to patients with feedback about logistic and clinical performance e.g. time to initial CT scan at each site. We also want to identify feasible candidate interventions that can be scaled up for testing in larger clinical trials. Finally, we want to improve the ability of clinicians and researchers to more accurately predict outcomes from msTBI in order to guide clinical decision making and improve research efficiency.
Why did you apply for a Monash Partners STAR Clinician Fellowship?
The STAR clinician fellowship is a valuable opportunity for financial support, recognition of achievement and most importantly access to advice and mentorship from more senior clinician researchers who have successfully navigated a career path that combines these two demanding disciplines. All of these factors motivated me to apply for the fellowship.
Why is support for emerging and mid-career clinical academics crucial?
As an early to mid career clinical academic there are limited opportunities for funding and recognition of innovative and effective research work outside of the NHMRC grant opportunities. The STAR clinician fellowship offers salary support and invaluable mentorship opportunities from experienced clinical academics who can offer advice and help to navigate how to effectively combine clinical and research work.
What is the significance of receiving the STAR Clinician Fellowship for your career and research?
Combining research with a clinical career is not straightforward. Completing my PhD at the beginning of my clinical training has meant that I have been unable to prioritise research in recent years due to a need to focus on clinical exams and other training requirements. This interruption to my research career is not recognised by the NHMRC and precludes me from applying for certain types of investigator grants. The STAR clinician fellowship is an important recognition of research achievement that can help to demonstrate progress in a research career that does not follow the typical pathway. I want to express my gratitude to Monash Partners for the opportunity and recognition that this fellowship represents, although research is intrinsically rewarding, external support and recognition is hugely valuable for early to mid-career researchers.
What are your future aspirations for your research/career?
My main goal has not changed since the start of my research career – it remains to improve outcomes for patients with msTBI. With the financial support from the STAR fellowship and other competitive grant applications we can complete the analysis of the PRECISION-TBI dataset and expand the neurocritical care network that we have established to encompass all of the neurotrauma centres in Australia. This network will allow us to continue improving the care provided for patients with msTBI in Australia, take part in large scale international trials of novel interventions in msTBI and to progress investigations into the agents that we have identified in our feasibility studies.
