Dr Tsz-Yan Milly Lo

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When Milly Lo was a young paediatric intensive care medicine (PICM) trainee, they were given a valuable piece of advice by their mentor about how to sustain a long career in what is naturally a high-stress specialty. Senior paediatric intensivist Dr Dave Simpson told Milly that it would be vital for them to balance out the intensity of their clinical workload with something different to relieve the pressure and prevent early burnout. It’s a testament to Milly’s commitment to their young patients’ care that they chose to find balance through a demanding innovation research career that is focused on improving the clinical treatments of critically ill children.

Edinburgh is home to Milly, so when it came to choosing a medical school, the University of Edinburgh’s reputation and its proximity to their parents made it an easy decision. Milly had always wanted to be a doctor, and their strong work ethic helped them to achieve this early ambition, but finding their niche in PICM would take some time. 

At medical school, Milly was drawn to the glamour and the glory of being a brain surgeon, but “I soon realised I didn’t have the correct personality for it”, they say with some relief. After working as a junior house officer in the Royal Infirmary of Edinburgh with only adult patients for one year, Milly realised how much they missed working with kids and decided to specialise in paediatrics. After successfully obtaining the Membership of the Royal College of Physicians, Milly became a junior registrar in the Paediatric Intensive Care Unit (PICU) at Edinburgh’s Sick Kids Hospital, and it was there that Milly found their true calling.

 Within a week of being in Edinburgh’s PICU, I felt like I had come home to the Mother Ship. I knew that this was the career for me.

Milly moved to the West Midlands, where they were completing the gruelling Specialist Registrar clinical training programme. Despite the long hours Milly was greatly enjoying the experience, but Dr Simpson’s advice about finding balance remained front of mind. Milly had always enjoyed research work, so they chose to pursue a career in academia alongside medicine. Milly decided it was the right time to interrupt their clinical training and dive into a clinical PhD research fellowship at the University of Edinburgh, under the supervision of Professor Robert Minns.

Milly’s choice of PhD topic had already presented itself to them, when three children of different ages, each of whom had sustained brain trauma in unrelated incidents, were admitted into the Edinburgh Sick Kids’ PICU on the same day. When Milly asked how each child should be treated given their varying ages, Dr Simpson told them to look up recent research on the subject.

Reading the literature I was shocked to realise just how little we knew of how to treat brain trauma kids of different ages.

In 2000, when Milly began their PhD study, ‘Big Data’ research was not a concept familiar to many, but Milly was determined to take a big data approach to improve childhood brain trauma treatments. Realising that the monitors at a child’s PICU bedside were generating a wealth of routinely collected data that was mostly going to waste, Milly learned to extract that data for secondary research analysis and, ultimately, to discover new ways to improve treatments. Today this information can be extracted through the central server in PICU with networked monitors, but during the early stages of Milly’s PhD, most PICU only had stand-alone, non-networked bedside monitors. This meant that Milly had to be available round the clock to connect those older monitors to an enormous computer, which needed to be wheeled on a trolley from bedside to bedside so it could drag precious data directly from the monitors before their data was deleted when a patient was discharged and the monitors were switched off. “That was an archaic experience!” they say. 

Professor Minns introduced Milly to a research active health care scientist, Dr Ian Piper, who leads BrainIT, a multicentre adult brain trauma research initiative.  BrainIT was leading data collection and analysis standards in adult brain trauma research.  The initiative also promoted the importance of sharing data for hypothesis testing and developing new treatment and analysis strategies, but it is limited to adult brain trauma. Milly was deeply inspired by Dr Piper’s open, collaborative approach, and with the support of Professor Minns they contributed their PhD data to the BrainIT databank as the paediatric pilot over three years. 

On completion of their PhD it was time for Milly to pause research training and resume clinical specialist training that had been on hold. Milly’s clinical training demanded all of their time, energy and focus, which meant the only way to juggle it with their research ambitions was by committing fully to clinical and research training in relay. 

Milly spent their final year of PICM training in the renowned PICU in Melbourne’s Royal Children’s Hospital in Australia. Upon completion, they immediately picked up the research training baton and became an Ontario Neurotrauma Foundation Post-Doctoral Research Fellow in Toronto; Milly was the first paediatric intensivist to be awarded this prestigious fellowship. Despite the long hours, Milly found time to enjoy some of Canada’s favourite winter sports, including ice skating by Lake Ontario and learning to snowboard. 

In 2010, Milly returned to Edinburgh to take up their post as a consultant paediatric intensivist and research lead in PICM. Milly had loved living abroad as a trainee, but when it came to establishing themself in a hospital, a university, and a city for the long term, Edinburgh was the clear favourite. Family connections played a big part, but the support that University and hospital colleagues had shown Milly was instrumental in their decision too.

They gave me the flexibility to build my research team and work, which was highly unusual for a NHS consultant post. With their support, I was the first paediatric intensivist to successfully secure the prestigious NHS Research Scotland (NRS) Career Research Fellowship to further ring-fence time for my research work.

With NRS-protected research time, Milly wasted no time in getting started. Their conviction that big data could improve care and outcomes for young patients had only strengthened, but they were frustrated that there was still a lack of big data PICM research worldwide.

Paediatric intensive care clinical research has always trailed behind the adult equivalent, so it seemed crazy to me that we had this vast amount of routinely collected clinical data that we were chucking down the drain, instead of making better use of it to close the data loop and improve patient care.

Milly went back to BrainIT and spoke with Dr Piper about joining forces to start a paediatric equivalent. Dr Piper also felt that there was an urgent unmet need for data-driven research in childhood brain trauma, and he was happy for Milly to direct what quickly became KidsBrainIT. 

Milly contacted the UK-based paediatric intensivists friends and previous mentors they had worked with in the UK, Melbourne, and Toronto.  They were unanimously keen to be part of an exciting partnership with an open collaborative infrastructure for developing and sharing research to improve care for children with life-threatening brain trauma. KidsBrainIT was launched officially in 2015 in Barcelona during the annual BrainIT meeting, which attracted European clinical and research partners. The problem was securing funding to conduct its first research project, as there were very few paediatric-specific funding opportunities and competition for medical research funding was fierce. Three UK funding bodies turned them down, but Milly refused to give up. When a larger European grant came up in 2016 they applied without hesitation.

I was a fairly unknown researcher at the time, but I thought, ‘I've got nothing to lose in trying’. Luckily the funders bet on me, and that's how we got our first big funding for KidsBrainIT.

Milly was the first paediatric intensivist to be awarded such a prestigious EU grant, and with that KidsBrainIT gained momentum to rapidly expand beyond the initial plan.

By 2020, 17 PICU across the UK and Europe had joined KidsBrainIT, and there is significant interest from countries outside of the EU. Most excitingly, with Milly’s leadership, KidsBrainIT was awarded the MRC Proximity to Discovery seed funding to build a new clinical-academic-industry collaboration with Dr. Vera Nenadovic of BrainsView Inc to revolutionise brain injury care by developing and implementing innovative brainwave data-driven analytical solutions. 

Balancing a clinical and translational research workload takes forward planning, meticulous organisation, and the cooperation of colleagues in both camps, as well as the support of Edinburgh Innovations. Milly says that they are lucky to be surrounded by colleagues who support their ideas and innovations, and understand the time demands on both their clinical and academic work. This allows Milly to strike a balance that’s vital to delivering a highly demanding clinical workload and academic output.  Not content with making this happen in their own work life, Milly has supported and mentored several nursing and allied health professional colleagues to incorporate research into their clinical roles. Improve Patient Care Through research and Appreciating Clinical Excellence (IMPACT-ACE), the boundary-breaking research group Milly has pioneered, provides frontline clinical staff with formal academic support and training. This enhances multidisciplinary engagement and empowers clinical staff to deliver and maintain clinical excellence through a translational and evidence-based approach. At Edinburgh Sick Kids’ PICU, critical care improvement research and innovation is a team passion, and Milly’s model ensures that Edinburgh PICU truly delivers an open collaborative approach to interdisciplinary research and innovation.

As if an intensive clinical workload, IMPACT-ACE, and KidsBrainIT were not enough to keep them busy, Milly is also hard at work leading the development of a novel data-driven seizure detection tool via an MRC-funded clinical-academic-industry  partnership, called Window in the Brain. Far from needing a rest, Milly’s energy and enthusiasm appear boundless. What’s their secret?

I’m a big kid myself, so paediatric intensive care is definitely the right place for me!