Tell us when you finished your studies at the Faculty, where you are now, and what you do there.
I finished my studies at FMHK in September 2021. I will be currently starting my Ph.D. studies at the APC Microbiome Ireland research institute, which is a part of University College Cork in Cork in the south of Ireland. I am a part of Prof. Subrata Ghosh’s research group there, we deal with the impact of microbiome in non-specific intestinal inflammation.
How did you get there?
Do you want a short or long answer? Unfortunately for the readers, I’ll write the long answer. I don’t want to reduce and simplify it and thus evoke an iceberg effect where only the successes are seen and a much larger portion of the failures stays unmentioned. Then it falsely looks too simple. In short, I’ll answer, the way I would like to hear it myself if I were to ask someone else this question. To see how his preferences changed over time and not just to get a generic answer from him that hard work and determination were necessary.
- 1. High School
At high school I inclined to mathematics, physics, chemistry and biology. I was one of the best students in my class, and I had a huge ego because of it. I decided to study at FMHK because of a biology seminar I had attended where we had listened to a presentation of an FMHK student who had gone to the Mayo Clinic for an internship, and I knew I had to go there too. Another contributing factor to my decisionmaking was that I considered the FMHK entrance exams the most difficult of all the Czech medical schools, which appealed to my bloomed ego so I wanted to show everyone who the boss was. My overconfidence got the needed smack, because my entrance exam test resulted 50th below the acceptance line, and I resigned and put up with studying pharmacy, where the entrance exams were much easier, and I got there without any special training study.
- 2. Beginnings at the FMHK
Eventually, the order of applicants changed so much that I was able to start studying medicine. However, the bad experience from the entrance exams motivated me enough not to underestimate my studies and take the most of this second chance. The first year of university studies was a shock to me, as it probably is to everyone. It hurt me even more because I had to exchange my logical thinking I had used at high school for the tough memorization of facts.
My plans to go to Mayo soon fell apart after failing „the flag test“ and getting a grade 3 for the Biophysics exam. It became clear that I was not as great a student as I had originally considered myself. This feel of being a below-average student was further reinforced by failing the Physiology early-term exam in my second year, and abandoned any ambition I originally had had.
I can call the exam period of the winter semester of my third year as the turning point. At that time, due to the stress of studying and affairs in my personal life, I fell into a reactive depression. In the acute phase, I was mentally really unwell, but I still managed to pass all the exams that I was facing at that moment and to this day I still don’t understand how I managed it those days. It took me another semester to stabilize mentally without professional help (looking backwards I know it was a mistake and I was just lucky that my situation improved).
The fundamental change in my personal adjustment was started by a grade 1 for my Pathology exam. This was my first grade one for a major exam and made me reflect myself. Over the holidays, I reevaluated my goals and remembered my dreams that I had approached FMHK with. Due to my renewed self-confidence, I set out to 1) really get the internship at Mayo, 2) perform my holiday practice in Germany, and 3) spend another year in an Erasmus internship in Germany.
I needed my GPA to be lower than 2 and preferably a SRA to get to Mayo. For the average, I figured that if I get just grades one during my fourth year, I could still fit into the required range. After intensive studying, I only failed the Neurology exam, which turned out to be graded 2, but it was still satisfactory for the average needed. I had a chance to work on my SRA at the Department of Pathology, where I used to go in my leisure time mainly to recognize slides, because at this department there is a rule that one must prove his qualities during the first year prior to getting the permit to do any scientific work the second year.
- 3. Erasmus Germany
To go to Germany I had to brush up on my German knowledge from high school and I took a course in medical German with a private tutor. This turned out to be a very good investment, because I managed to secure both a position for a holiday internship and an Erasmus study placement. I have to admit that I was terrible lucky with the Erasmus language exams because I was the only one examined that day, so I was both the best and worst student at the same time. I suppose this is why I only scarcely passed the exam (looking backwards I can reconsider my language performance as a tragedy at that time).
The year-long study stay in Germany took place during the fifth year, there is an exam in Surgery and Internal medicine that must be passed at the Czech faculty. So I went there knowing that I would have to split my fifth year. This was my blessing and curses at the same time. A curse due to the fact of spending an extra year at school. A blessing because during Erasmus stay one doesn’t have to stress about passing all the subjects of the year and has more time to learn about foreign cultures.
Even though I had a choice between Berlin, Tübingen and Saarland, I chose the least known Saarland faculty in Homburg. Homburg is not a large port city in the North of the country, but a smaller city in the West, nearby France and Luxembourg. It was this strategic location that was the main factor in my decision, as it allowed me to travel the most.
The description of all the experiences from this study stay would be enough for a book of short stories, so I’ll summarize it briefly here. Apart from the classical things like learning a foreign language or meeting new people from different cultures, I also performed in the student theatre, learned the piano and explored the city on foot or by bike. In addition to other major German cities, I visited seven other European countries. To name a few, I visited an exhibition of Leonardo da Vinci’s drawings in London for the 500th anniversary of his death, a large exhibition of Rembrandt’s work in Amsterdam for the 300th anniversary of his death, and first two stages of the Tour de France in Brussels.
In addition to traveling and fulfilling my study obligations, I have also pursued scholarly activity. I managed to get into the Institute of Virology, where I was to participate in HPV research. Unfortunately, the professor was permanently out of the department and the Ph.D. student who was put in charge of me then had no more time because new students came into the laboratory and he had to primarily focus on them. However, this is the reality of such laboratories.
For me personally, the biggest benefit of this placement was that I gained confidence in my own abilities. The ability to live in a foreign country, to study in a language that I don’t speak so well, and to proactively deal with new obstacles without help I was used to from back home. To put it simply, I realized that further career abroad was another option.
- 4. Biochemical aspects of nutrition
I think this is a good place to mention my participation in teaching of the elective course Biochemical Aspects of Nutrition, as this is also associated with my stay in Germany.
When I approached the medical school, informal lectures on nutrition by Soukup, M.D. and Tomšík, M.D. were very popular among students. I was already becoming interested in nutrition myself at that time, so I was enthusiastic about attending these lectures and soaking new information. To my delight, the popularity of these informal lectures crystallized into an official elective course, Biochemical Aspects of Nutrition. Soukup, M.D. presented mainly clinical experience proven in his private practice, and Tomšík, M.D. on the other hand, enriched the audience with theoretical background of why it is good to do certain things. Thus, students used to leave the lectures with information on how and why they should take care of their food. I myself took this course in my fourth year, but at that time this information itself was not enough for me and I started reading studies on the subject myself. That’s when I first recognised the importance of microbiome and its role in health and nutrition (I missed this in the curriculum of the subject a little bit).
During my stay in Homburg, however, I heard through whispers that Tomšík, M.D. had quit the faculty. On one side, I was sorry, because the students would lose a slightly different perspective on nutrition, but on the other one, I felt an opportunity. I knew Tomšík, M.D. personally and I also knew well the material he lectured on. I did not hesitate and wrote an e-mail to Soukup, M.D. that I was interested in taking Tomšík’s place in the course. When no reply had come for a long time, I continued spamming and sent the same email, from different email addresses (at that time I was struggling with the fact that Gmail did not always deliver my mail). After more weeks of „radio silence“ I instructed my Mother to ask Soukup, M.D. after his public lecture if he had received any email from me. Sustain cheekiness beared its fruit, and I was allowed to help teach the course the following academic year.
- 5. Mayo and Covid
After returning from Germany, I more or less only had to take an exam in Internal medicine and Surgery. So I had plenty of time for other activities. I wanted to continue my SRA in pathology, but unfortunately my position had got filled during my absence. So, instead, I focused on the earlier mentioned Biochemical Aspects of Nutrition.
I also had time to plan how to arrange further tours abroad a as part of my studies. The gameplane was to fulfill my resolution and try to go to Mayo and then subsequently to take some pre-state-examination internships in Germany.
Despite the lack of a completed SRA, I managed to get nominated for the Mayo internship. Together with passing the Intern exam, I spent very relaxing Christmas in 2019. I was aware of some virus spreading in China, but probably like everyone else I didn’t pay that much attention to it at that time. After all, the Chinese were used to dealing with similar respiratory infections effectively since the SARS epidemic.
In February, I had an interview with Professor Temesgen, which I passed successfully, and I was to spend three months in summer in the microbiome laboratory. You can probably imagine my excitement at having my dream come true. I chose the microbiome laboratory because I was quite interested in the subject. It’s a very complex subject that is hard to understand when you are only marginally involved in it. So this internship was to show me if doing science and studying the microbiome was something for me, and if I were willing to focus on it after school.
The head of this laboratory was Purna C. Kashyap. When I looked him up online, I found on Twitter that he had attended the Gut Microbiota for Health conference. There, he took pictures with other researchers in the field and I subsequently checked out where and what they were doing for inspiration. One of these people was John. F. Cryan. After some more googling, I found that he is the father of the so-called „gut microbiome-brain axis“ and that he works at the APC Microbiome Ireland institution. When I had read their motto „Interfacing food and medicine“ I lamented that this was the place for me, but that I had no real chance to go there.
But then March came, everything was getting cancelled, lockdowns began, and the world was plunged into the first wave of Covid. Even though the Czech Republic handled it brilliantly, it was already clear that there would be no Mayo that year and the stay would be postponed to the following year. So I looked for information so that I could go in the sixth study year. I learned from people who had done it this way that in order to go, I still had to be an FMHK student. Once the last state exam is completed, you automatically lose the student status. Since this is a summer internship and the state exams also end in summer, one must then postpone the last state exam until the fall term. In order to do this, you must complete some of the pre-state internships during summer and thus be in the proper state exam course.
Of course, I was in the wrong state exam course, and noone in my class was very enthusiastic about switching places with me (except for one pregnant classmate who only needed a date for one exam and planned to spend the rest of the time with her baby). The Study department´s dealing with the pregnant classmate was not developing well enough, but eventually, after persistent spamming, I managed to squeeze into the correct state exam course.
My plans regarding the state exam internships abroad also had to be reduced and transformed as a result of the pandemic. In the end, I decided to perform my internship in Görlitz in autumn of 2020. Those who still remember how various waves of covid swept through the world immediately realised that after a relaxing summer, European hospitals were immersed into capacity pandemonium in autumn.
The week before I was set to leave for Germany (the same week in which I was sitting for my Gynaecology state exam), the Saxon government decided to change the rules for foreign travellers coming into the country and I was not allowed to start my internship. Fortunately, I had thought of this eventuality and had already informed the Department of Internal Medicine at the UHHK of this possibility in advance, where I was promised a position in the worst case scenario, which I (unfortunately) had to take up.
After successful passing the state exam in Internal Medicine, I started looking into what had changed in regards to the postponed internship at Mayo. I was truly disappointed that not much had changed and it looked like the internship was cancelled for that year as well. So I waited a few more weeks, but Mayo pretended to be the British Kingsguard and gave no indication of any change. This worried me, and I began to look for a replacement to obtain scientific experience that was so important to me.
Thanks to not having participated in an Erasmus traineeship, I had 12 months to use. There is an Erasmus graduate scheme, where you get a placement somewhere while you are still studying and then continue with Erasmus-funded traineeship after you graduate.
So I thought I would take advantage of this opportunity and sent about 12 emails to various German microbiome workplaces. I got replies from three of them, and with considerable delay, one of which was explicitly negative. The communication with those positive responses was tedious and did not raise any optimism in me.
It was sometime around this time that I lamented that I probably wasn’t going anywhere and decided to take a desperate action. I remembered APC Microbiome Ireland and John Cryan, so I also emailed him at 11:30 PM asking for an Erasmus placement. Half an hour later I got a reply saying that it was no problem and that we would discuss the details at the Zoom Call in three weeks.
I had to pinch myself and clean my glasses a few times as I read this, because I needed to make sure I wasn’t dreaming and that I was reading it correctly.
Looking backwards I can review that this success was purely accidental in that I chose the right time to send the email. In addition to managing a laboratory of fifty scientists, John was also the university’s President for Research. He used to be receiving over a hundred emails a day, and ignored most of them after reading the headline. I happened to reach him when he was probably at home at that time, and could thus pay more attention to the email.
At the interview it was clear to me that I was going to Ireland because John radiated a friendly atmosphere and I also impressed him with my enthusiasm for the cause.
To make matters even more confusing, shortly after the interview I learned that Mayo had finally impulsed the deal and that it was possible to do the internship, but I would have to extend my studies into the next semester to make the time. After a few days of Sophie’s Choice, I decided to trust my instincts and chose Cork over Mayo.
- 6. Erasmus graduate Cork
After completing a bunch of paperwork, so typical for Erasmus, all I had to do was pass the last state exam in Paediatrics and I could fly to Ireland in the summer of 2021. Unfortunately, I fell ill two weeks before my deadline and couldn’t study properly, so I failed the exam. I was supposed to fly out in mid-August, but there were no alternative dates available until the beginning of September. Fortunately, it was possible to arrange with both Erasmus and the laboratory to postpone the beginning of the internship by a month.
This did not make my troubles go away though. I would describe this period as the most stressful period during my medical studies. At least if you measure it by the amount of hair that I lost those days. There is a huge problem with accommodation in Ireland. Getting a decent apartment at a good price in big cities is almost impossible (you probably have to have a bag full of leprechauns to get lucky). For me, this meant that while studying for an exam, I constantly had to check email and websites offering accommodation to make sure I could reply as soon as possible. After 40 messages to which I got no reply, I was saved by a Czech lab colleague who was helping another newly arrived scientist find accommodation those days. I was so lucky, because the person ahead of me refused my room, so I managed to squeeze in just barely.
But in the end everything went well and I passed the last state exam successfully. One of the questions was about non-specific intestinal inflammation, where I indulged in a short reflection on the importance of the microbiome. Unfortunately, my examiners were not interested at all and quickly indicated that they wanted to hear the classic textbook information.
I didn’t have time to realize that I had passed the exam in the Czech Republic, because I took it on Tuesday, and on Friday I flew to Ireland, so I had to immediately switch to travel mode.
In J. F. Cryan’s laboratory, the gut microbiome-brain axis was studied in both mice and humans. Unfortunately with covid, human studies were quite limited and research in mice took the lead. I entered right into this force-allocation, given my background, I was logically assigned to human studies. The study I was to work on was expected to start in October. Due to the ongoing wave of covid, October happened to be January, January happened to be March, and due to all kinds of obstructions, we were not able to start until the end of April. My stay there was also meant to end at the end of April, so in the desire that we would be able to do something, I extended my Erasmus for another two months. In the end, the scope of the study was reduced to teaching another intern to be able to use EEG in research, which he would then use as a part of his Ph.D. studies. So, for me, this experience with human studies on healthy volunteers has provided one important lesson for the future – it’s damn hard to do during a pandemic.
In the meantime, to prevent myself from getting bored while waiting for human studies, I helped a Ph.D. student with her research on mice. It concerned looking for differences in the immune response of mice born by caesarean section compared to mice born the regular way. We focused primarily on the period when the mice transition from breast-feeding to receiving solid food, which had previously shown to cause a strong immune response in the intestinal tissue. My task was to slice, immunohistochemically stain, photograph under a microscope and analyze the amount of macrophage in intestinal villi and then compare these values between particular cohorts.
I was kind of hoping that this stay would turn into further Ph.D. study in John’s lab. Unfortunately, I soon lost that hope after meeting John. I learned that they didn’t have money for another student because they had already promised the position to another trainee (with whom I worked on EEG) who took the initiative a little earlier than I did. I’m not going to lie to you, I was sad about that because I already had projects in my head that I wanted to implement.
However, shortly after the start of the war in Ukraine and due to the rising inflation I preferred switching to the idea of working in Germany, which offered better financial stability.
However, a week before I was going to send out resumes and emails to new potential positions, the laboratory manager Ken summoned me. He informed me that his wife had taken a management position with another professor at APC. This professor is a gastroenterologist and is looking for someone for a Ph.D. position who has more experience with human subjects. I seemed like a perfect fit, so they asked if I were willing to informaly meet and talk to Professor Subrata Ghosh.
From my point of view, there was nothing for me to lose, so I approved it.
The meeting eventually took place the day before my birthday. I went there without much expectation, but I left with one of the best birthday presents I’ve ever received.
I was offered a Ph.D. position in Professor Ghosh’s project, where his main focus is on modulating the microbiome in patients with non-specific intestinal inflammation to improve response to immunotherapies. The next day I was sure about accepting the position. Well, with no efforts developped on my side, a Ph.D. position fell into my lap quite by accident, one that others would have gladly killed for.
- 7. studies under Subrata Ghosh at University College Cork
You keep mentioning that luck helped you, and that it’s all a fluke, but someone else could have given up anywhere during the way. Don’t you want to admit that you’ve had some merits of your own for your success?
I don’t see it that way. My genetics and upbringing have ensured that I am intelligent, stubborn, persistent and that I value education. But there are plenty of people like that. Of course, this is getting into the area of cognitive bias and survivorship bias, where, for example, successful entrepreneurs write books about what to do to be successful. Unfortunately, many other entrepreneurs who follow the same approach can’t write a book because they weren’t lucky and aren’t that successful.
In my opinion, luck is necessary for every success. I can give you an example of my favorite cycling. In the 2021 Tour de France, two favourites from Slovenia, Tadej Pogačar and Primož Roglič, both of whom were a class above the rest of the riders in the overall standings. Tadej Pogačar won in the end, not because he blew Roglic away somewhere on a hill, but because Roglic got caught up in crashes (through no fault of his own) in the opening stages and was forced to stand back. So Pogačar was lucky and Roglič was unlucky, even though both were comparable in performance.
So I guess it’s pretty logical then that I don’t want to take credit for something I’m not able to influence in any way. Not giving up easily is just my nature, which is sometimes counterproductive, so I could kind of use a button to turn it off as needed :D.
Oh, so I guess there’s no point in asking you what you consider your greatest achievement.
Not at all, it does make sense. Sure, anything I’ve achieved I credit to a great deal of luck, but the defining moment for me was my depressing episode in third year of studies. Those days I was struggling with really dark thoughts while continuing my studies. Eventually I had to say goodbye to my old Self and build a whole new Self that is capable of achieving success. That’s when I metaphorically climbed a mountain of healthy self-confidence. All my other successes are just a result of the way I now ride down the long slope of that mountain.
I understand, but surely you have some positive memories associated with studying at FMHK, right?
Well, I don’t want to take your word for it, because what I enjoy is remembering the year I spent at Erasmus in Germany, which technically isn’t FMHK itself. But I got there via studying at FMHK, and it also helped me get my priorities little bit into order, plus visit a lot of interesting places. I do not necessarilly want to say that I don’t have any nice memories of Hradec, but Erasmus stands out to me because it was a break from the semester-long study routine I was used to.
So, in conclusion, tell us what your hobbies are.
I enjoy endurance sports, so I currently train swimming, running and cycling so I can take part in an ironman competition. I also want to understand what I do and I want to do it as efficiently as possible. So I educate myself quite a bit just in sports physiology and the aforementioned nutrition, mostly in the form of podcasts and recorded lectures. As a bit of a bonus, in recent years I’ve added the prevention of the impact of aging, which vaguely relates to these interests. I am also a great lover of art history, so visiting galleries is natural for me. I also keep an eye on developments in aerospace, and finally, when I still happen to have time to be bored, I like to ponder existential philosophy. Finally, I might mention the curious hobby of collecting four-leaf clovers, which I started at the medical school to boost my exam pass rate (it takes about 100 four-leaf clovers to pass a major exam).