Finding inspiration during his student years at Flinders University provided Professor Tom Snelling (BMBS ’98) with the impetus to not only excel in medical practice and research – but also to appreciate the people who need better medical outcomes.

As Professor of Infectious Diseases at the Children’s Hospital at Westmead, and Professor in the School of Public Health at the University of Sydney where he leads the Health and Clinical Analytics team, Professor Snelling says his work, especially with children, has been humbling.

“Medicine has given me a good appreciation of the extreme hardships encountered by many families, and a deep respect for those who work to help alleviate suffering,” he says. “I regret that society doesn’t always value this work as highly as it should.”

Career Trajectory

Professor Snelling describes his career trajectory as being more circular than linear, and influenced more by chance than by design.

“I think I always wanted to do something valuable, but in my last year of school I was leaning more toward engineering, and even enrolled in a civil engineering degree. I switched to medicine when the opportunity arose at the eleventh hour, after I had finished school in 1992. I received a call from the Flinders University admissions office to let me know someone had withdrawn, and that I was invited to interview to replace them. It was my grandmother who convinced me to take the opportunity.”

At Flinders, he gravitated toward teachers who were not only impressive and motivating, but who also took an interest in his personal development – especially Professor Jack Alpers and Professor Gary Kneebone, who inspired his interest in internal medicine and paediatrics.

He also remembers a few lighter moments as a medical student that tickled him. “My friend Frank Mwaungulu was part of a contingent of students who joined us from Malawi. I remember Frank was once asked to assess an elderly patient who was concussed after a fall. He pulled the curtains around him, roused the patient, and asked ‘Mr Smith, can you tell me where you are?’. The patient looked back at Frank confused before responding, ‘Africa?’.

Before graduating from Flinders in 1998, Professor Snelling spent a term at Alice Springs Hospital, returned during his basic paediatric training and also did a year in Darwin for advanced training in infectious diseases, as well as at the Women’s and Children’s Hospital, at Flinders Medical Centre and at the Childrens Hospital at Westmead. He returned to Darwin to do a PhD under the supervision of Ross Andrews and Jonathan Carapetis, in which he evaluated the new rotavirus vaccination program and its impact on severe gastroenteritis among remote children, finding high rates of persisting disease among young Aboriginal children.

Eventually he moved with his young family to Perth to take up a combined clinical and postdoctoral research position at the Perth Children’s Hospital and the Telethon Kids Institute, shifting from observational studies to clinical trials of paediatric infectious diseases and vaccination. “A driving goal was to design studies that were highly efficient, and also directly relevant to policy and clinical practice. The design expertise we developed has become sought after and has led to a number of collaborations across a broad range of disease areas.”

After seven years in Perth, Professor Snelling moved to Sydney to set up a new research team in the Sydney School of Public Health and a learning health initiative at the Sydney Children’s Health Network. “Our driving philosophy is that every patient encounter is an opportunity to learn about what works, what doesn’t and in whom.”

On Reflection

Reflecting on the genesis of his medical career, Professor Snelling says that if he had his time again, he would approach medical studies in a different way.

“I’m pleased that I studied medicine, but I regret that I entered straight from school,” he says. “I wish I’d studied a more general degree first, although that wasn’t the usual pathway back in the 1990s. Now, most medical students have completed other degrees first, and I think that’s leading to a more academically diverse workforce, although there is still far to go toward a workforce that is also more diverse in life experience.

“The amount of information that junior doctors are expected to know is growing quickly. Flinders was an early adopter of problem-based learning, recognising that it was not possible to teach students everything they would ever need to know, so we should instead teach students how to teach themselves by finding and synthesising relevant information. The digital era has greatly expanded the quantity and quality of accessible information, so these skills are now more important than ever.

“Young people who have asked me about careers in medicine usually say they want to be of service to the community. I think it’s important that they know that there are a whole range of careers where people provide service, and medicine is by no means the only way to do this. But I feel the main advantage of a career in medicine is that it leads to a vast range of possible futures and a highly varied working life.

“If I thought my younger self would listen, I’d tell him to stay as general as possible for as long as possible, hold off specialising – and to take more leave.”

Kick-Start

In 2002, Professor Snelling received the first Frank Fenner Early Career Research Fellowship from the NHMRC, which kickstarted his postdoctoral research career. “It had great meaning to me because the late Professor Fenner was heavily involved in the elimination of smallpox and was a hero of mine.”

Professor Snelling’s focus has been to improve how clinical studies are designed, and how evidence is generated and used to guide decision-making. “I worry that too much research is designed following a one-size-fits-all approach, with insufficient thought about the needs of decision-makers as the end-users of that research,” he explains.

“I’m trying to understand how studies can be designed bespoke to the specific needs of consumers, clinicians and policymakers. Unlike many researchers who focus on a particular disease or a particular aspect of a disease, I take more of a meta-research perspective, to think about the process of doing research itself.

“Essentially, I enjoy the intellectual challenges in medicine. I’ve always had difficulty doing as I’m told, so I’ve been very lucky to be able to choose my own adventure. So, to paraphrase Frank Sinatra, I’m proud that, for the most part, I’ve done it my way. I’ve taken many risks with my research and I’ve had my share of failures but\ I hope that I’ve forced people to think more about the purpose of research, and how studies should be designed and implemented. At the very least, I hope people will learn from my mistakes.”