Role model: Andy Carr
Authors: Anne Gulland
Publication date: 28 Jul 2017
Anne Gulland speaks to Andy Carr, Nuffield professor of orthopaedic surgery at the University of Oxford.
One of the achievements Andy Carr is most proud of is the fact that the department he heads—the Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences—has 28 surgeons doing PhDs. When he first took on the role in 2001, just one surgeon was doing a research degree.
This is important to Carr because he has spent his career trying to assess whether the operations he carries out have worked—and he has encouraged other surgeons to do the same.
“One of the areas where surgery has lagged behind other medical disciplines is in evaluation. Surgery evolves iteratively. If you develop an operation or a technique it’s subject to continued adaptations and modifications. Although it’s not the same as discovering a drug, it’s still important to assess if the operation is working. One of the problems with surgery is that there hasn’t been a requirement or a culture of clinical trials. We often don’t have enough evidence for what we do,” he says.
Carr points to knee arthroscopy as a classic example. He doesn’t worry unduly about upsetting surgeons who are wedded to a technique that is shown to be ineffective. “My main mission is to try and improve the lot for our patients. We need to make sure that whatever we’re doing is properly evaluated so we can recommend it with confidence,” he says.
Carr was struck, in the early days of his career, by the fact that the person who decided whether an operation had been a success was the surgeon, rather than the patient. With other colleagues at Oxford he developed a series of patient reported outcome measures. Known as the Oxford scores, patients themselves assess the results of the surgery, and can help to identify any poorly performing operations. The scores have been translated into 20 languages and are used throughout the world.
Carr grew up in Bradford and attended the local grammar school where boys with an aptitude for science were encouraged to do medicine. After qualifying from Bristol University he began his surgical training in Sheffield. He then moved to Oxford where he was offered a research fellowship in molecular and cellular biology. “That changed my life more than anything else—I got the research bug. My role model was Peter Morris, professor of transplant surgery, who was a fantastic mix of a good surgeon and a good scientist,” he says.
Carr got his first taste of evaluating surgical outcomes as a member of the team that assessed the Oxford knee as a partial replacement joint. The knee was developed by John Goodfellow, whom Carr describes as his orthopaedic inspiration.
Carr is now at an age when many of the people he trained with have retired and he plans to do less frontline surgery, more teaching and research, and encourage more surgical trials. Currently his research focuses on tissue engineering and regenerative medicine and he has been awarded funding from the Wellcome Trust and the National Institute for Health Research to translate new nanofibre scaffolds for tissue repair developed in his laboratory into first in man clinical trials.
While he has had a busy and fulfilling career, Carr is keen to stress the importance of a life outside medicine. He and his wife, a paediatrician, have four children, the youngest of whom has just sat her A levels. He is a keen runner and rower and he encourages his team to balance their home and work lives.
He often takes his trainees on a team get away where he asks them to prepare two talks—one about something that interests them at work, and another about their hobby or passion.
“What’s really interesting is that often they find the talk on their hobby or passion the most challenging,” he says.
Nominated by Ben Dean
Andy is an excellent surgeon, has a sharp academic mind which is always open to new ideas. He is very astute strategically and above all he has an excellent work-life balance.
Ben Dean is an orthopaedic registrar in Oxford
- Carr A. Arthroscopic surgery for degenerative knee. BMJ 2015;350:h2983. [Link] .
Anne Gulland London