March 2020

I graduated in December 2019 with a PhD from the University of Nottingham that was funded by the British Skin Foundation. Whilst I have to admit that I feel like a bit of a “big-head” talking about my achievements, when the British Skin Foundation asked me to write a piece about my work for International Women’s Day (IWD) 2020, I knew that I had to give it a go. Before I tell you about my PhD though, I’d like to look at the issue of gender equality in the academic world, since it is IWD after all!

Women in research

When did women start getting PhDs? According to Wikipedia, Elena Cornaro Piscopia, of Venetian nobility, was the first woman ever to get a PhD in 1678, and the first British woman to be awarded a PhD was a psychologist called Beatrice Edgell in 1901. Whilst Wikipedia couldn’t tell me the exact date men started getting PhDs, a lot more of them have been doing it for a lot longer than women, basically since the medieval times (although the format of a PhD has evolved somewhat over time).

Whilst things feel much more equal in Britain today, I think it is fair to say that we still have some work to do. Luckily, there are schemes within universities now that encourage institutions to take gender equality seriously (for example, the School of Medicine, University of Nottingham where I did my PhD just got their Athena Swan Silver Award renewed last year, confirming their commitment to gender equality). However, I think most women and gender minorities who work in the academic world will be able to tell you some subtle (and sometimes not so subtle) ways they have felt they have felt disadvantaged or treated differently because of their gender. In the recent #immodestwomen campaign women academics took to twitter encouraging women to use their ‘Dr’ title to increase the visibility of their expertise, after women spoke out about feeling a pressure to belittle their achievements and hide their ambition.

Reflecting on all this, I can’t help wonder if my feeling like a “big-head” when I talk about my PhD might be partially due to some gendered conditioning that has taught me to be modest about my success, and so I am going to try and put that feeling aside for a moment and tell you about why I am proud of my PhD in eczema research, with no apologies...

Improving the questionnaires used in eczema research

Eczema is a long-term, itchy skin condition that usually begins in childhood. Systematic reviews are a way of collating and comparing different studies to produce clearer evidence. Systematic reviews are important in conditions like eczema, where there has been lots of studies done on the same topic that need comparing to understand the evidence for a treatment overall. However, a problem that systematic reviewers have is that researchers designing eczema studies all collect different information about how well the treatments worked (outcome measures), and so it is like trying to compare apples and pears. My PhD research was geared up to inform the Harmonising Outcome Measures in Eczema (HOME) initiative. HOME is an international collaboration working together to develop a ‘core outcome set’, which is aimed to make sure all clinical trials (studies that compare how well different treatments work) measure the same things so we can compare these studies. It also means we can make sure studies measure what is important to patients and healthcare professionals.

Presenting at the HOME V meeting, Nantes, France, 2017

How did my PhD contribute to this challenge? Firstly, by looking at one of the patient questionnaires the HOME initiative recommended to be included in all eczema clinical trials to understand how to use it in clinical trials better (this questionnaire is the Patient Oriented Eczema Measure, POEM, if you are interested). Secondly, by developing a new questionnaire called Recap of atopic eczema, RECAP, to measure patients experience of eczema control. This questionnaire is now also recommended for use in clinical trials by the HOME initiative.

I appreciate that for people with eczema who are looking for better eczema treatments and ways of stopping their eczema coming back, this probably doesn’t feel like a headline-making breakthrough. But science is a communal activity. Everyone involved in research is working on a project that builds into a larger puzzle. Every piece helps. My contribution to the development of the HOME core outcome set and improving the patient questionnaires used in eczema studies will hopefully ensure we can better interpret studies and collate different study findings together, to improve the treatment options for people with eczema. Always keeping this link in my mind, and understanding the larger goal, was what kept me going through the more challenging parts of my studies and makes me proud to be a part of an academic community putting our findings together, piece by piece, to help those with dermatological conditions.

So, what’s international women’s day got to do with dermatology research?

IWD is about celebrating women’s achievements, raising awareness against bias, and taking action for equality. I think it gives us an opportunity to reflect on the contribution women and people of gender minorities make to the field of dermatology and that it is not something we should take for granted. Everyone has a contribution to make  – so let’s create an environment where all can thrive and add their piece into this much needed area of research.

Thank you to the British Skin Foundation for funding dermatology research.

Dr Laura Howells, University of Nottingham

All views expressed are my own.

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