Smith began his academic career at the
University of Edinburgh (1978–1981 and 1985–1988) and the
University of Sheffield (1981–1985). Soon after, he served at the
University of Cambridge as Professor of
Obstetrics and
Gynaecology and Head of the Department of Obstetrics and Gynaecology (1988–2003). He was also the Clinical Director, Women's Services, at
Addenbrooke's Hospital National Health Service Trust (1997–2003). In 2004, he was appointed the
Principal of the
Faculty of Medicine of Imperial College London, heading one of Europe’s top medical schools through an active period of growth and development. At Imperial College, Smith also led the formation of the United Kingdom's first
Academic Health Science Centre as
Chief Executive. Launched in 2007, the
Imperial College Healthcare National Health Service Trust was formed from the integration of
Hammersmith Hospital National Health Service Trust and
St Mary’s National Health Service Trust with Imperial College. His pioneering role in establishing the trust was recognised at the 2009
National Health Service Leadership Awards, during which he was named Innovator of the Year. In 2010, Smith was appointed Imperial College's
Pro Rector (Health), while remaining the
Chief Executive of the Imperial College Healthcare National Health Service Trust. He took on the role of NTU’s Vice-President (Research) in September 2011 to lead the strategic development of research at the university, which is the fastest-rising Asian institution among the world’s top 100 universities in the
QS World University Rankings between 2010 and 2011. ==Research==