Blood culture Myth busting!

Microbe Mail Ep 57 – Careers in Micro

Transcript

:: 00:00

So, what exactly does the microbiologist do? It's a common question asked of almost every microbiologist. Well, the answer really starts with the age-old cliche; “It depends”. It depends on what aspect of microbiology, whether it's human, animal, plant, environmental, food even. There are a ton of different microbiologists for the billions of microbes that are out there.

Second, it depends on the base degree with which you qualify.

So, on this episode of Microbe Mail, we're going to focus on three professions in medical microbiology to give students, the general public, and anyone wanting to know more about this field, an opportunity to get behind the scenes with us. This is Microbe Mail and I'm your host, Vindana Chibabhai.

:: 01:02

I'm so honored to be joined by three special guests today on this episode. Starting with the 1st guest and the one that's closest to me in proximity, Crystal Viljoen, who's a medical technologist in microbiology. Crystal, please go ahead and tell the listeners about yourself.

:: 01:18

Hi, I’m Crystal, I'm actually a lab manager at Charlotte Maxeke Infection Control Laboratory at NHLS and I've been a medical technologist for over 20 years.

:: 01:32

That's incredible, Crystal, and we're so looking forward to your insights and your experiences.

Next, let me introduce to the audience the guest who's actually furthest away from me in distance, Andrea Prinzi, who is a scientist in medical microbiology. Andrea, welcome to the show and please tell the listeners about yourself.

:: 01:51

Hi. Thanks so much for having me. I'm really happy to be here.

I am a clinical microbiologist by training. I was in the clinical lab for a very long time, about 13 years before I moved into the in vitro diagnostics industry, and so now I am a combination between sort of a medical microbiologist and clinical outcomes researcher and medical science liaison for the United States for an in-vitro diagnostics company.

:: 02:18

That's awesome. So, you're going to give us a very interesting perspective with all of your different experiences as well.

And lastly and certainly not least, Doctor Keeran Lutchminarain, a pathologist in medical microbiology and one of my very own classmates. Keeran, it's lovely to have you on. Please tell the listeners about yourself.

:: 02:36

Thank you so much Vin, it's such a pleasure to be on your show, especially that we go back such a long way. And it's also great to see how far we've come. But I am a medical microbiologist and I'm based at Albert Luthuli Hospital, which is a quaternary level hospital in Kwa-Zulu Natal.

And attached to that hospital is the reference TB laboratory, which I oversee and run on a day-to-day basis. So, I'm largely involved in diagnostics and treatment of TB and complicated drug resistant TB, but still at it with my clinical microbiology within the hospital as well.

:: 03:16

Yeah, that's going to give us a great perspective on things as well. So I'm really looking forward to hearing all of your insights in the field and all of your experiences. But before we head into our conversation, we've just got a couple of reminders for our listeners. Just a few things to remember.

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So ladies, if you are all ready, shall we get chatting about the fascinating aspects of a career in microbiology?

:: 04:10

Yes, let’s go.

:: 04:12

OK, Crystal, I'm going to start with you. If you can provide an overview of what medical microbiology is and why it is an important field of study.

:: 04:22

So, medical microbiology is a branch of medical science that focuses on the prevention, diagnosis and treatment of infectious diseases, whether it be bacteria, viruses, fungi or parasites. It studies the clinical applications of microbes to improve health.

So, a medical microbiologist usually identifies the best treatment for these infectious diseases and monitors patients treatment. They also identify organisms for diagnosing infectious diseases and assess how likely they are to respond to certain treatments.

:: 04:59

Great. Thanks Crystal. That's a nice intro. Andrea, Keeran, anything you want to add to that?

:: 05:05

I think that was really comprehensive. I would just add to you know, the medical microbiology laboratory and just the field as a whole is really responsible for contributing a lot of data that ultimately helps guide things like public health surveillance, antimicrobial resistance surveillance, and then also contributing data to things like, you know, projects or research studies that help us understand the impact of the microbiologic tests that we're doing on patient outcomes. And so, you know, in addition to real time patient care, it can also serve as a massive contributor to larger public health goals.

:: 05:42

Yeah, absolutely. Anything from your side, Keeran?

:: 05:46

No, I think Andrea and Crystal covered it quite nicely.

:: 05:50

OK, so I'm going to start with you then on the next one, Keeran. What are some of the educational paths one can take to enter the field of medical microbiology, from undergraduate degrees to the more advanced degrees and certifications?

:: 06:05

OK, so within the South African setting, there are three ways that you can enter that I'm aware of, and if anyone has others, they're welcome to join in. So, in our setting, we have, there's several degrees that we can get through.

And the first one being if we go the scientific route, we go, you can do a Bachelor of Science, and you can do a major in medical microbiology. So that's something that's offered at universities.

The other course would be Biomedical Sciences, and you major again in medical microbiology.

These two Bachelor of Science and Biomedical Science, they take you more on the path of a medical microbiologist as a scientist.

However, if you want to join as a doctor, you've already, would have had to go through to medical school, get your MBCHB degree, and then you enter a registrar program, or in other countries it's called a residency in medical microbiology.

So, once you're done with your registrar program, you qualify as a medical microbiologist. And that career path would take you as a doctor in microbiology.

And then in all these, whether you're a scientist, whether you're a clinical doctor who has now become a microbiologist by specialization, you can still further your studies by doing research in any aspect of medical microbiology being it your Master's in medical microbiology and going and escalating up to a PhD as well in medical microbiology. So, that's some of the ways that I know that you can enter the discipline.

:: 08:02

Great, thanks Keeran. Crystal, Andrea, anything to add there?

:: 08:06

Just, so I'd like to add from a medical technologists point of view, there’s Laboratory Health Sciences, which is done through University of Technology or University of Johannesburg, where they are no longer doing like a medical technologist course, but Laboratory Health Science.

And this is a four-year degree and this is how a person can get into microbiology. Then after they qualify they do a board exam and just specialize in mono subjects such as microbiology.

:: 08:41

Right. Great. Thanks for adding that Crystal.

Andrea, I believe in the U.S. things are slightly different in that you don't usually have medical doctors specializing in microbiology. Is that right?

:: 08:53

Well, it does depend. There's actually a bunch of different pathways, and I'll keep it brief, but you can do medical laboratory science as a Bachelor's degree in your original four year university plan. Some people do that.

Some people get a Bachelor's degree in a medical science or biological science and then do additional like one to two years of training in medical laboratory science, if they want to become a, you know, certified, board certified, or what have you, medical laboratory scientist.

You could also do, you know, a Master’s degree in something and then seek certification through an organization after some hands on training after a year or two. Or you could do a PhD in a science of some sort, you know specifically, probably microbiology. But you can do a PhD in something related and then do a fellowship through one of the organizations here to get, it's called the CPAP Fellowship, to become a medical microbiologist.

Or in some cases, MD's, particularly infectious disease clinicians, can also pursue that fellowship route and also get an additional advanced certification in medical microbiology. So, there's kind of various routes there, and sometimes we do have MD's doing that. It's not as common as the other routes I mentioned, but it does, it does happen.

:: 10:11

OK, good. That's interesting to know of. So Andrea, I'm going to pose the next question to you then. What are some of the skills and qualities that are important for a successful career in microbiology? This is obviously for someone thinking of getting into it. What do they need to think about in terms of skills and qualities?

:: 10:29

Sure. I think I mean, obviously an interest and passion in science and medicine, I think microbiology most of all has so many complexities to it that you know I, when I used to train medical laboratory scientists that would come through the hospital, they either loved it or hated it because it would be really, really challenging. But that's what makes it so fun. So I think, you know, a great attention to detail, ability if you're in the clinical setting, an ability to multitask because it's pretty fast and furious sometimes. You know, these diagnostics can be pretty complex and need to be turned around fairly quickly, so that would be important.

But just also a love of things not always staying the same, right? So infectious diseases are always keeping us on our toes. And so an interest in being a lifelong learner, I think is really important if you want to do microbiology.

:: 11:22

Absolutely, yeah. Couldn't agree with you more.

Keeran, Crystal, anything to add to that?

:: 11:28

I think that apart from what Andrea mentioned, I think communication skills. I think you really need to have good communication skills, because a large part of our career is to effectively communicate laboratory results and give clear, concise advice to clinicians. And apart from that, if you go in the research way as well, you need to be effective in communicating the results of your research projects, both written and orally.

And, I think that microbiologists really have to be the type of person that pays attention to detail as well.

:: 12:10

Yeah, they're good points. Thanks. Crystal?

:: 12:13

They answered exactly how I had it as well, so nothing to add from my side.

:: 12:18

Okay, just something that I'd like to add and this is from experience of younger students coming into the lab and showing an interest. I think there’s this slight misconception that laboratory medicine is better for people who are introverts because you don't have to, you know, spend a lot of time communicating with people. To be honest, my feeling is that microbiology is, in fact the exception to that rule.

Because from all of the pathology disciplines, I feel that microbiologists spend far more time communicating with clinicians, attending ward rounds, being visible, and quite importantly so, as Andrea said, it's changing all the time. You really need to keep up with that. So that for me is an important quality to remember that it isn't necessarily something that is just for introverts or quiet people.

:: 13:07

I completely agree with that. A very important point.

:: 13:11

OK. So next question, I think I'm gonna come back to you Keeran. What are some of the specializations within microbiology that one can pursue?

:: 13:22

So, this was a fairly loaded question, and you know you think microbiology is just looking under the microscope, but the actual reality of it is that it's subdivided into so many major infectious diseases.

So, there's so many different routes within microbiology. I mean, there's HIV, sexually transmitted infections, TB, looking at parasitology and neglected tropical diseases.

Enteric diseases, the whole issue of public health and microbiology in public health that Andrea brought up, looking at the laboratory in terms of quality assurance, quality control, there's the entire discipline of virology that falls within microbiology. That’s specialty on its own.

And going out of academics and out of the setting of micro itself with laboratory diagnostics, designing laboratory tests, as well as entering into pharmaceutics looking at vaccine development, development of new drugs, and then obviously all of that imports into changing diagnostic algorithms, and global guidelines on certain infectious diseases.

:: 14:43

So, basically what you're saying, Keeran, is that there's nothing ‘micro’ about this of microbiology in healthcare.

:: 14:51

Yes [Laughs] ‘Macro’-biology.

And I think once you start it, you realize how vast it is.

:: 15:00

Yes, absolutely.

Crystal, Andrea, anything further?

:: 15:06

No, that's great. I mean it's, that's what I love about it. You can go so many directions with this training. You know, there's so many amazing things you can do. I, everything that was already listed is absolutely feasible and realistic routes to go. I mean, you can also, obviously I'm in industry, there's a ton of work to be done in industry that's really meaningful and interesting.

There's, you could be in infection prevention and control at the hospital setting with the microbiology background. You know, like I said, you could go into public health. So, such a cool area to get training because they're really, there's so many amazing opportunities to expand and grow in other directions if you're interested in that.

:: 15:46

Absolutely. Anything more from your side, Crystal?

:: 15:49

I think Keeran and Andrea answered perfectly.

:: 15:53

Awesome. So, I'm going to take the next question directly to you then, Crystal. Can you share some examples of real-world applications of microbiology in healthcare just for somebody who's finding this conversation interesting but wants to have something a bit more meaty, maybe, or applicable.

:: 16:13

case that South Africa had in: 2017

And even just last year, the Cholera outbreak, which affected lives in two different provinces in Gauteng and the Free State here in South Africa.

And I just think just overall our normal, where somebody might have a case of pneumonia or a wound infection that isn't healing, or a person who's severely ill because of septicemia.

So, that would be my real-world application for microbiology in the healthcare sector.

:: 17:06

Absolutely. And I'm glad you brought up those massive outbreaks of public health concern because actually, that's when the general public hears about microbiology and medical microbiologists. Usually, you know, it's kind of something that's happening in the background, until there's a massive community based outbreak of some kind of infectious disease.

Andrea or Keeran, anything to add to that? Any experiences from your side?

:: 17:34

I mean, that's a great, that's the point I think I try to drive home a lot, what you just mentioned there. You know, with the science communication I do, is that there's the large outbreaks that you may see in the news and things. And then there's the day-to-day that people just don't, I think, don't even realize that behind every diagnosis that's made for an infectious disease in the hospital, there was a microbiologist behind it in some way or another.

Right. So, you know, I think when you go and get care at a facility and a clinician makes a diagnosis and they get some, you know, susceptibility test results back and starts an antibiotic. I mean there was a whole process behind that, right? That was done in the microbiology lab with a medical microbiologist who was trained to do that. And so I think just the importance of also emphasizing, you know, that essentially everything that happens in the process of you receiving care related to an infection certainly had something to do with a microbiologist.

:: 18:26

Yeah, absolutely.

Keeran, I think TB's quite an important point to bring home for that real-world application. Do you have anything to add from that perspective?

:: 18:35

Yes. So I mean, you know, in addition, TB is endemic in our country. We face, it's such an age old disease, but today we haven't, to date, we haven't really been able to get on top of the problem.

And I think in the real world, microbiology provides the base of diagnosis of TB. I mean, literally the diagnostics have evolved so much and advanced so much in the detection of TB, which is a fully preventable and treatable disease, and just using the microbiology lab in assisting the diagnosis, it helps in treating the patient themselves and improving mortality in the patient. And apart from that, it's so important to identify patients, treat them properly so they prevent the spread of TB in the community as well. So microbiology plays a huge role in TB.

And apart from the TB, like simple things like just having the flu and having a swab taken by the doctor, you know, results from that swab also informs vaccine development every year. You know, surveillance from all of that from all patients around South Africa. That's another very real-world example of how microbiology is used behind the scenes to develop these vaccines for people, the general public all over the world.

:: 20:12

Yeah, those are the very important points. You need the specimens, and you need the isolates to actually develop vaccines. So those are really great.

Keeran, I'm going to direct the next question at you, but Crystal, Andrea, please jump on and add your comments to this as well.

I think there's a lot of misconceptions that people have about careers in microbiology, so I'd like you to just to delve into a couple of things that maybe you have heard of or common misconceptions that you're aware of.

:: 20:45

You know, the greatest misconception is that it's boring. I've had when I was the registrar, one of my fellow registrars in another discipline is, like, ‘why did you ever choose that?’ So, I think you know, they think you sit in the lab and you may all just look under the microscope, but really it’s so much more than that.

It is, people think that there's no action in it, but it's a completely dynamic and ever changing discipline and you have to be on your toes all the time. So I think that's one of the greatest misconceptions.

The second is that often people say oh, but it's a dead end career, where do you go from there? Do you just work in a private lab or you just work for the state and you spend your life in a lab.

And I think that that is also really a huge misconception because as Andrea touched on and even Crystal, in terms of the technologist avenue, there's so much of variety that microbiology brings. And once you delve into it, you will identify the different aspects that you can move towards. So those are the two biggest points that I wanted to bring up.

:: 22:07

Yeah. And I think those are, those are the most common ones I hear about as well. Anybody want to add to those?

:: 22:13

First of all, I don't know if you've experienced this in your work, but I also find at least here that there's this huge misconception that medical technologists are, you know, we refer to them as medical laboratory scientists here, are not trained rigorously or haven't undergone extensive training.

I think the role of that profession gets really lost in the healthcare system here, and I think it, the assumption is always that you know, they may not have had to get any sort of additional certification or there's no like board exam or training like that, that people just kind of showed up in the lab and are just doing tests down there and that everything's run by machines. So I think that's a huge misconception here. It's getting better after COVID, I think awareness really improved, but that is a huge misconception I see here.

:: 23:00

Right. That's an important point.

:: 23:02

No, I agree. For a medical technologist, we often the force behind the result that gets for patient treatment, and we are often forgotten about or neglected. It's always the doctor gave me the AST result, or the doctor told me I’ve got this infection, but it's actually the laboratory who informed the doctor.

So yes, I think the medical technologists or the lab health scientists are actually just as you say, forgotten. They, we're behind the scenes and I think that is one of the things that I think that I've come to just, I'm OK being behind the scenes as long as somebody's health is OK, but yes, we are often forgotten about.

:: 23:45

So, I think that has something to do with the fact that during clinical training of doctors especially, and I'm not sure if it's the same in the U.S., Andrea, not a lot of time gets spent in the laboratory. So, they don't really have a background understanding of what the lab looks like, who works in the lab, does the analyzer do all of the work or does there need to be a human in place to actually do the checks and balances, the QC, the interpretation of the result, etc.

And I find that when we do invite students and young clinicians into the lab, it's kind of an ‘A-HA’ moment for them where they come in and they finally get a clear understanding of the role that we actually play and how vital that is.

:: 24:27

Absolutely. I used to run a little education program out of the medical laboratory for clinicians when they were on their rotations, they'd be rotating through either, you know, residency, fellowship, what have you. And we would, they would dedicate at least a couple of days to just being in the lab and getting some education from the laboratorians. And they, they loved it for one.

And two, they really like you said, they just didn't have any idea how the laboratory was functioning. And they really appreciated understanding it, right. Because knowing what's going on down there, I think helps a lot in your decision making and your relationship with the laboratory. And so yeah, that was something that was missing from their curriculum that they found to be really helpful when they could come down and see what was happening in the lab.

:: 25:09

Yeah, I think something we need to continuously build on; to find innovative ways to train undergraduates and young clinicians about the lab.

So, microbiology has undergone massive evolution in the last decade, maybe two decades or so, for over 100 years we were kind of using the same techniques. So, I wanted to ask you, Andrea, how has microbiology evolved in recent years, and what are the emerging trends or technologies that are shaping its future?

:: 25:39

I love this question. You know, I always think about I'm young right, I'm an early career scientist, I've only been in the field for, you know, maybe 15 to 20 years, I don't know, but that’s still pretty early.

But I laughed because when I started in the medical microbiology laboratory, it wasn't all that long ago, and we didn't have anything like we have now, I mean the length of time it's taken for things to explode has actually been quite short. I mean, you know, 13 ish years. And it changed completely.

So I think what we're seeing now is really this explosion of innovation and then rapid diagnostics, you know, really sensitive, accurate, fast tests that are turning things around very quickly, or things that are very comprehensive, so you've got, you know, you've got sequencing technologies, you've got AI, you've got polymerase chain reactions that are getting faster and you know also more comprehensive.

And so I think what we're seeing is, you know, when I was in the laboratory, there's a lot of discussion about these new technologies are going to take away a job from a medical microbiologist, but I would argue, and what I'm seeing a lot in my field now, is that that is, it couldn't be further from the truth.

As you get these advanced technologies, you actually really need more of a kind of an advisor role from the medical microbiologist, so there may be actual, you know, less hands on time for running a test or maybe less work going into the actual running of the test. But the interpretation has become increasingly complex.

And like you said, a lot of the training in medical training doesn't really involve a lot of this understanding around things like pretest probability and what a result means to you, and so you've got all these really great tests at your fingertips as a clinician. But figuring out what that really means in the context of everything else that's going on with these very, very excellent technologies is really challenging.

So, I'm starting to see a lot of advancement of microbiologists into things like diagnostic stewardship and antimicrobial stewardship, you know, training clinicians about understanding diagnostic technologies, things like that.

So, I think we might see a little bit of a shift from manual work on some of these tests, although that will always exist, we always need trained professionals to run these tests, but we're going to need more clinical microbiology expertise in the interpretation and utilization of the results from those tests.

:: 28:05

Absolutely. Yeah. That's a great way to put it.

Keeran, Crystal, anything to add to that?

:: 28:10

Just to some, I mean, Andrea put it beautifully. But with all these, the rapid automated tests, I think the point of it is to take the micro lab to the bedside. So, we want to take our test to the patient’s bedside to offer them ease, convenience, but obviously with the assistance of a microbiologist.

:: 28:34

Yeah, and the quality of the test that you would get in a lab, bring that to the bedside.

OK. Crystal?

:: 28:42

So, I agree with Andrea and Keeran about the development and the point of care technology that's coming out and also the molecular and the bioinformatics that will definitely make turn-around times a lot quicker, so the results don't have to rely on just culture of a specific organism, which may take 48 to 72 hours, but a molecular test which you can get within 24 hours, has definitely improved over time.

:: 29:14

Yeah, I mean, these days you could get a result in two hours, which is incredible compared to what we were used to.

So, the next question Crystal, are there any particular regions or industries with a high demand for microbiologists?

:: 29:30

I do think the pathology sector, definitely microbiology, microbiologists are definitely needed, but also in the food and environmental side of testing, so not just medical but our normal environmental health that we need to look at.

And then obviously with research microbiologists to take us into the future where we aren't reliant on old methodologies but faster turn-around times and more accurate, more reliable results. So, from there microbiologists are also needed.

:: 30:07

OK, great. Keeran?

:: 30:10

So, I think that you know, I did look this up because I wasn't too familiar. And what I did get from a variety of different sources is that some of the countries that have the highest demand for microbiologists is the UK, US, Germany, Japan and China.

And these countries were specifically picked because they have strong research institutions. They have well-funded microbiology programs, and therefore they have this driving force for the development of microbiologists, both technologists, scientists and clinical microbiologists.

:: 30:52

OK, that's interesting. I would assume that there would be a high demand in kind of low middle income countries, but it's likely a lack of resources.

It's not so much that there aren't jobs or that they're not in demand, but in fact that there isn't sufficient financial resources to have those posts available.

:: 31:13

We are struggling a bit here with there's a very high demand, but we are noticing kind of a, they're considering it a crisis if you will, with medical laboratory scientists. There's an intent, you know, an incredible need for them. But there again isn't a lot of awareness about the profession.

And so, we've seen a drop in individuals going into those programs and then coming into medical microbiology in the laboratory, and so there's a lot of advocacy work around that here now because, you know, it's obviously a wonderful career and I think there's just not a lot of awareness.

And then some of our training programs are having a hard time sustaining, you know, if they're not getting enrollment and things. So there is a big demand, but also we're finding some challenges with staffing right now in a lot of our clinical laboratories.

:: 31:59

Right. So, it's in fact it's a global problem then not really necessarily based on the income of the country. That's interesting.

So, Keeran, what would you say is the role of research and publication in a microbiology career?

:: 32:18

Look, I think if you start out not having any research background, I think you, microbiology will automatically push you towards research. And the important aspect being is what you see in the laboratory, it's very important to communicate what you're seeing in microbiology, to inform the rest of your country and the rest of your world, more especially looking at the perspective of WHO.

So, and research can span over several fields. It could be just writing up case reports. Very importantly, and I'll touch on TB is looking at surveillance data, research in terms of surveillance data.

Looking at what your country is doing with the organism, how the organism is becoming resistant to antibiotics, and what type of resistance is it? What mutations are causing the resistance? So, when you have all that kind of information, you're able to put it together, package it in terms of research, and present it to bigger bodies like the CDC, the WHO, who can use this information to then, in plan, design laboratory diagnostics, design pharmaceuticals to keep up with the changing dynamic of any infectious disease that we see and any microorganism that's causing a problem worldwide.

So, in terms of the role of research, I think it's an integral part of microbiology and you will learn to love it because you will want to communicate what you see in your little lab. You could be anywhere.

For example, I did a little project, you know, we implemented the GeneXpert Ultra, which was a wonderful, it is a wonderful tool to be used. But in South Africa, and we were the first to implement it, according to The WHO recommendation. And it was implemented.

So sorry, not the GeneXpert Ultra, the line probe essays, the second-line line probe essays. So we implemented the second-line line probe essays. It was recommended by the WHO that it can be done on patients who are smear negative or smear positive TB. But we took this wonderful platform and we put it in our lab, and it just did not work well at all for our smear negative patients.

And so, I had then designed a research protocol to look at how did this actually, was it ever feasible for us to use it in our setting when we have a high burden of smear negative TB in South Africa. And it didn't work well, so we could inform the WHO, yes, we used your recommendation, but it wouldn’t work in South Africa, in a South African setting.

And then the algorithm had changed as a result of it. So, I think you know those, that is how research plays into microbiology, the work that you do and communicating the work that you do.

:: 35:40

Yeah, I love that example, Keeran, because it actually shows that research is not just about publications and saying that you've got so many research projects behind you or a PhD or whatever it might be, but that it's actually informing real world policies that are going to affect patients in the future. So that was a great example.

Anything to add Crystal, Andrea?

:: 36:00

No, that was a really great answer. I completely agree with everything that Keeran said. I would just add too, if you do go into the industry sector, you know there's entire research and development, you know portions. So, if that's something you're interested in, that's great.

But I would also say if you end up in more of like a field position, which is where I am, you're really involved in like you're saying, real time, real world evidence generation with these diagnostics and I, you know I have sub specialty training in implementation science, which is so relevant for microbiology, for exactly the reasons that were just brought up, is that not everything works in the same setting.

Everything's really context dependent, and the laboratory voice and medical microbiology voice is very often missing from a lot of these clinical outcome studies. And so, I always really encourage individuals that are working in medical microbiology, to you know, try to participate in these research teams, if possible, or make sure that you know, voice of the microbiologist is at the table because it really is so important to understand how things should be implemented, used, or how they're going to impact patient care in the long run.

:: 37:09

Right, and I'm glad you brought up the implementation and translational science because it's becoming, it's coming to the fore very much so in microbiology and infectious diseases and so very important, so that research projects don't end at that point, where OK, it's a research project that's been completed, now what? That there must be some kind of translation of that.

:: 37:31

Absolutely.

:: 37:32

Crystal, anything from your side?

:: 37:34

No, I have nothing to add there. I think it’s great what was answered.

:: 37:38

OK, great. Crystal, can you share any personal anecdotes or stories from your own microbiology career that might highlight how exciting and rewarding it is as a field?

:: 37:51

So, so I'm going to just put out when I was a student still studying to become a medical technologist, I was working in the routine microbiology lab and I was on the stool bench and I saw this worm in this, in under the microscope, and it was actually a Strongyloides stercoralis, which is not actually very common found in South Africa. So, seeing it under the microscope was actually really, really fascinating for me, and it was just something that I was like wow!

If I've seen this, maybe you know who knows what else I will find out during my career and it just gave me the sense of excitement and something different from the routine stuff.

And I just love that with the work that I do is that I actually make a difference in someone's life, even though I'm behind the scenes. But it really gives me a sense of accomplishment there.

:: 38:54

That's a great story. Thanks, Crystal. Andrea?

:: 38:57

Yeah, I love that. I have so many moments like that in the clinical laboratory that were so special and I think that's probably the point is that every day was different and I loved that, you know, and I just kind of the more, I guess you could say ‘mundane activities’ were still always very interesting and then you know, when I got trained in the Biosafety Level 3 plus lab or you know up and coming pathogens of concern that was exciting and scary and interesting and you know and then when I moved to industry, I love, again, what microbiology offers it's, you know, nothing is the same any one day. Sometimes I'm teaching, sometimes I'm giving talks about microbiology concepts. Sometimes I'm involved in clinical outcomes research related to diagnostics.

Like just lots of variation in activity for me I think keeps it really exciting. And like I said, things are always changing so having to be this lifelong learner, you know, always keeping up with what's going on, I think is what makes microbiology just really fun.

:: 39:57

Yeah, absolutely. Any stories from your side, Keeran?

:: 40:02

I have lots of stories Vin. [LAUGHS}

:: 40:07

We’d be here for the day. The next 24 hours [LAUGHS].

:: 40:11

But just, you know, touching on Crystal and Andrea, you know, in the last six years microbiology has evolved so much and there's been so many exciting changes that we sometimes wanted to rip our hair out, you know, because you just can't cope. But I think just being a part of the change is so exciting and rewarding in itself and looking at how the change is impacting patients.

And to me, as much as because I have the medical background and being a doctor, every specimen that passes through the laboratory, I see that as a patient and not as a specimen. And that's how I teach registrars.

So, when you are with that specimen, you're doing the best that you can for that patient. Because that person is now in your hands, and I think that is in itself is the most rewarding thing for me and has pushed me forward to sort of drive differences in the laboratory, make positive changes and just sort of contribute to patient care and, you know, global knowledge, local knowledge, global knowledge. I think that in itself is just the most rewarding thing.

:: 41:26

Yeah. Yeah, that's a very important perspective as well. And if I can add to that, you know, just with about 13 years of experience in microbiology, the number of new pathogens and new resistance mechanisms that have come about in my very short career span is pretty incredible.

And I think that speaks to the evolution of infectious diseases, which is quite different from any other discipline, if you think about it, you know, hypertension is hypertension, its always been there, and same with many other diseases. It's not often you find a career that evolves so quickly, when new things come about as often as they do, so that for me is a highlight.

Andrea, I want to ask about other the fields of microbiology. So here we've really been focusing on human medical microbiology, but we did give some indication that there are different fields of microbiology. And are you able to give us a brief summary of those?

:: 42:25

Yeah, there's a lot that can be done and I'll just, I'll just touch on a few very briefly. I have, you know, I've spent my whole career in human medicine, but I've done a lot of work with like American Society for Microbiology, for example, and they have a very big group of individuals, of microbiologists that work in, like environmental microbiology or agriculture, you know, food production, things like that.

And so, yeah, that's I love that you asked this because there's again a million routes you could take in microbiology. You know, for food production, there's a whole microbial sciences sector from, you know, fermentation processes, you know, to like alternative food products for example.

I wrote an article a few years ago about how sometimes they use fungus to make vegan meat substitutes. You know, there's a whole fascinating sector there.

And then also just microbiology related to testing of, you know, food safety or other products that are used. There's all sorts of microbiology related to designing things that may help the environments, that may break down toxic waste or chemicals or things like that, so you know, all sorts of areas that need microbiologists and certainly aren't just related to human health. And we are seeing this One Health approach to things now, right where we're trying to bring all these groups together.

So, I think if you are a young microbiologist, becoming aware of these sectors is really important because they think we're headed towards the future where all of these work really interchangeably, which will be important.

:: 43:58

Absolutely. Yeah. That's a great point bringing up One Health there.

Crystal, Keeran, anything to add?

:: 44:04

I think Andrea summed it up for me.

:: 44:07

I also had One Health on my list, but yeah, it's also sum up for me.

:: 44:12

Yeah, so, so interesting fact I was reading, I think it came up on my Google feed in fact, because I like reading about space and you know what's happening in outer space, etc. And on my Google feed over the weekend there was an article about a study that was done on the International Space Station, and one study actually cataloged the entire list of bacteria and fungi that were isolated on the International Space Station. But the newest article was actually talking about a species of drug resistant bacteria that was isolated on the ISS and there was a whole discussion around it and how it actually got there and you know, it got me thinking that we talk about, we've been talking about human health for hundreds of years, and now more recently we're talking about One Health and the idea of global health and planetary health has become important over the last few years. And in my mind, I just thought, Oh my goodness is the next thing going to be solar system health?

We're gonna talk about what's happening in space? Where is this going to end? No but really, it is a reality. It is a reality though.

:: 45:27

OK. So, we're on the penultimate question. Crystal, what advice would you give someone who is considering a career in microbiology?

:: 45:37

There's so much to choose from, but it is really a rewarding career and you must be ready for changes, must be ready for rapid work like n ioutbreaks. You never know what's going to happen, so it will be something that will keep you on your toes.

:: 45:55

Absolutely. No space for boredom.

:: 45:58

None at all.

:: 45:59

I think just in the beginning it may feel a bit daunting. It did to me. But just because of the magnitude of the work that you need to get through, but I think keep an open mind and simplify things for yourself because at the end of the day it can be, it is very rewarding.

So, just that little bit of piece of advice when you're starting out, just keep a broad mind, you know, look at it in its perspective, yeah, and just work hard as with anything, you know, work smart, work hard.

:: 46:34

Yeah, and try and keep up and get it done.

Andrea?

:: 46:48

I think this is in line with that open mindedness. That's really the comment that I had pop into my head first and foremost.

I think in addition to everything else that was said, which is all I think completely accurate, I agree with all of that. I think keep in mind how broad the field is like we've been saying this entire episode, but also consider all the ways microbiology can influence health, the environment and otherwise.

Because again, these things are going to start mixing a lot more and so don't go in and think there's just one pathway to influencing health or other areas of science with microbiology, there's really a ton of areas. So I encourage, you know, talking to as many people as you can from different career paths to really understand all the different opportunities out there related to microbiology.

:: 47:29

Right. Those are really, really important points. Just one last thing for me, is that you need to be adaptable. So, the idea of machine learning, artificial intelligence, these newer technologies, you know, microbiology is not void of these. In fact, there's a lot of AI and a lot of talk of machine learning and bioinformatics.

And so really it is quite important to remain adaptable as these technologies change, advance, and move the field in directions we never thought about before. And so that would be my advice.

:: 48:04

And you know, to add to that, I love that point because I think stressing the importance of understanding that you might have to get training in disciplines that don't seem directly related to microbiology, you know you might have to learn, in bioinformatic, you know, you know epidemiologic, statistical methods or coding or understanding data, or you know what I mean? Like, I think I love that you bring that point up because I think, you might have to acquire training and things outside of what seems like an obvious microbiology force or training program in order to continue to do microbiology in the future.

:: 48:40

Yeah, absolutely.

And then my final question really is to all three of you, and any one of you can volunteer to go first. What resources, organizations or networking opportunities would you recommend for individuals interested in pursuing a career in microbiology?

:: 48:58

I can jump in first here. I would just strongly recommend getting involved with the American Society for Microbiology. Even though they're called the American Society, they are a global organization and do a lot of work around the globe. I'm really involved with them on, you know, I’m on various committees and part of the government and stuff and they do a lot of really wonderful things related to training, networking.

They offer lots of free resources, all sorts of things that help young career scientists, microbiologists, and again they cover all areas of microbiology, not just human health. So, if you are interested in those other areas I you know they're very supportive in that way. So I highly recommend getting involved with them.

:: 49:43

Yeah, that's a great suggestion.

Keeran?

:: 49:46

From a medical microbiology from a doctor's perspective, I think looking at the Colleges of Medicine, South Africa, just having a look at their website. And then if you're looking to specialize and do your fellowship in another country, I think a good place to start would be the UK, because they also run a very good microbiology program. So that would be the fellowship of the Royal College of Pathologists, a lot of information is on their website.

And for the other bachelor degrees, I think all the universities across South Africa or, they do have various Bachelor of Science degrees in microbiology or related. So, I think just looking at the prospectus of the individual universities could be help as well.

:: 50:38

Thanks, Keeran. So before I ask you, Crystal, so we also have listeners from other low and middle income countries. If you are not sure, I think just reach out to the universities in your country to find out what degrees are on offer for medical science, medical microbiology as a science, as a pathology discipline, or as a technologist, and see what the routes might be where you are.

Crystal, do you have anything else to add in terms of those resources?

:: 51:06

So, just in terms of a resource from a medical technologist point of view, the South African Society for Medical Laboratory Technologists. They definitely assist in terms of CPD information, so talks and lectures about new technologies and things that are affecting the direct laboratory work and diagnostic work. So there is a lot of information that comes from there.

:: 51:35

That's a great one as well.

And then last but not least, South Africa has the Federation of Infectious Diseases Societies of South Africa, which includes the daughter society, the South African Society for Clinical Microbiologists, which is also a good place to look.

:: 51:53

Thank you all so very much for joining me and for your insights and experiences, for the laughs and the fun we've just had in the last hour. So, next time anyone comes up to you and asks you, what do you do, you can direct them straight to this podcast episode.

And I hope you'll all consider joining me again sometime in the future for another episode of Microbe Mail.

:: 52:15

That's great. Thank you so much.

:: 52:17

It was great to have you, Andrea. I know we got you up really early this morning, but thanks for joining us. It was great to have you here.

:: 52:23

No, it's my pleasure. It's my pleasure. Thank you.

:: 52:26

Thanks Keeran.

:: 52:28

Thanks Vin. Thank you so much for inviting us. I really appreciate it.

:: 52:32

Thanks, Crystal.

:: 52:34

Thank you so much for having me on.

:: 52:37

So, one last reminder to send us feedback on this episode on social media, on Spotify Q&A or even by e-mail. Also remember to follow, like, and share Microbe Mail wherever you might be listening from. So, until next time that's it from me your Microbe Messenger, and all of the Microbe Messengers in the Microbe Mail team. We'll see you again soon with more contagious mail.