A brighter future for academic medicine? Postgraduate research opportunities for clinicians Sara...
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Transcript of A brighter future for academic medicine? Postgraduate research opportunities for clinicians Sara...
A brighter future for academic medicine? Postgraduate research opportunities for clinicians
Sara MarshallProfessor of Clinical Immunology andCo-director, University of Dundee Clinical PhD [email protected]
Background: UK academic medicine 2007
• Number of UK clinical academics continues to decline– Total academics decreased by 27% since
2000 (now <3000)– 57% of clinical academics are > age 46– Only 20% of clinical academics are women
BMA Medical Academic Staff committee, June 2007
Medical student
Undergraduate exposure to research:Specific or integrated modules in scientific methodologyResearch ProjectIntercalated BScMB-PhD programmes
Graduate attributes•Understanding of how clinical research informs clinical decisions•Improved understanding of disease pathophysiology•Balanced approach to scientific literature•Become familiar with process and conduct of research•Provide information for career decisions
Quotations from focus groups of 3rd and 4th year female students in 12 medical and dental schools. In Medical Schools Council Women in Clinical Academia Working Group report, 2007
Exposure to research during clinical training:
Junior doctor
Clinical research fellowshipsClinical academic training pathways
Simple diffusionChance encounters
Medical student
Junior doctor
Career in academic medicine
Disincentives to careers in academic medicine*Lack of career structureLong and insecure trainingLack of flexibility of Calman registrar postsLack of undergraduate exposure to researchLack of infrastructure and role modelsPoor renumeration
*“More in expectation than in hope:a new attitude to training in clinical academic medicine” John Savill, BMJ 2000
Addressing the key problems of recruitment into clinical academia
• Lack of undergraduate exposure to research
• Lack of career structure
• Long and insecure training
• Lack of infrastructure and role models
• Poor renumeration
Addressing the key problems of recruitment into clinical academia
• Lack of undergraduate exposure to research
• Lack of career structure
• Long and insecure training
• Lack of infrastructure and role models
• Poor renumeration
“…our brightest and most innovative trainees face far greater difficulty in finding a secure post
than those who conform to conventional pathways”
John Savill, BMJ 2000
Addressing the key problems of recruitment into clinical academia
• Integrated academic career pathways 2007 – Academic clinical fellowships (“Walport fellows”)– Clinical lectureships – NES clinical lectureships
•Insufficient number of posts•MTAS chaos has disproportionately affected academic trainees•Pervasive impression that PMETB will make out-of-program research opportunities increasingly difficult for non-academic track trainees
BMA Medical Academic Staff committee, June 2007
Addressing the key problems of recruitment into clinical academia
• Lack of undergraduate exposure to research
• Lack of career structure
• Long and insecure training
• Lack of infrastructure and role models
• Poor renumeration
Research pathways for junior doctors
1Senior lecturer
Medical School
General Medical training Consultant grade
Clinician scientist Fellowships
Up to 4 years
HO 2 3 4 5
Specialist registrars
Training Fellowships or Research Lectureship
2-3 years
SHO
Getting a training fellowship
• Funded by MRC, Wellcome Trust, CSO or charities– Find potential supervisor– Formulate project – Write training fellowship application– Competitive interview (usually 6 months after
initial submission)– (Try again)
Difficulties winning a competitive training fellowship
• Identifying potential supervisors within quality research environments
• To those who have shall be given….
• Uncertainty of competitive interview – Wellcome Trust success rate = 13%
• Financial disincentive – no out-of-hours payments
Alternatives to competitive research fellowship
• Soft money (drug company)– Often associated with clinical trials
• Usually for MD degree
• Experience in clinical research– Clinical governance– Research ethics– Medical statistics
• Previously much less structured
• High percentage never write up
Clinical PhD programmes: a new approach
• Wellcome Trust Clinical PhD programmes – Launched Jan 2008– 9 very different
programmes, reflecting expertise of individual institutions
– Funding for ~200 new clinical PhDs over 5 years
• (50 in Scotland)
Why is this different from what has been on offer before?
Generic features of all programmes1. A single package2. Streamlined access to high quality projects3. Experienced supervisors4. Structured framework5. Mentoring programme6. Links to clinical training programmes
Why is this different from what has been on offer before?
1. A single package– Easy application process
• Only one interview for the project and salary • Do not have to write grant applications
– Fully funded• Includes clinical salary, PhD registration fees, research
expenses, training fund, travel costs
– Overcomes the insecurity of individual clinical training fellowships
• Edinburgh scheme is fully integrated with NES lectureships (“cradle to grave training opportunity”(!)
Why is this different from what has been on offer before?
Generic features of all programmes1. A single package2. Streamlined access to high quality projects3. Experienced supervisors4. Structured framework5. Mentoring programme6. Links to clinical training programmes
Quality assured projects within well funded environment
Access to scientific areas that may not have previously
encountered (eg basic science)
Why is this different from what has been on offer before?
1. A single package2. Streamlined access to high quality basic
science projects within well-resourced, world-class, cooperative environments
3. Experienced and committed supervisors4. Structured framework tailored to needs of
young clinicians5. Strong mentoring programme by clinical
academics6. Links to clinical training programmes
Essential if fellows are going to write up in 3 years
Why is this different from what has been on offer before?
1. A single package2. Streamlined access to high quality basic
science projects within well-resourced, world-class, cooperative environments
3. Experienced and committed supervisors4. Structured framework tailored to needs of
young clinicians5. Strong mentoring programme by clinical
academics6. Links to clinical training programmes
Often require intensive training in laboratory techniques
May require time out to maintain clinical skills
Why is this different from what has been on offer before?
1. A single package2. Streamlined access to high quality basic
science projects within well-resourced, world-class, cooperative environments
3. Experienced and committed supervisors4. Structured framework tailored to needs of
young clinicians5. Strong mentoring programme by clinical
academics6. Links to clinical training programmes
Provides essential role models and personal advice for career decisions
Why is this different from what has been on offer before?
1. A single package2. Streamlined access to high quality basic
science projects within well-resourced, world-class, cooperative environments
3. Experienced and committed supervisors4. Structured framework tailored to needs of
young clinicians5. Strong mentoring programme by clinical
academics6. Links to clinical training programmes
Explicit partnership with the postgraduate deanery
Possibility to continue clinical training via NES Clinical Lectureships
Initial impressions from the Dundee programme
• Huge interest, both within and outside UK• 1822 website hits since launch on 10th January
• Junior doctors using us as information source about academic careers
• Reflects lack of information about academic medicine in larger community
• Major concern: how research integrates with clinical training
• Our biggest current problem is how to set criteria for scoring applicants….
Will this change the approach to funding of training fellowships for clinicians?
• Personal fellowships– MRC ~30/year– Wellcome Trust ~25/year– Chief Scientists Office ~6/year– CRUK, British Heart Foundation,
ARC, etc• Clinical PhD programmes
– Wellcome Trust Clinical PhD programmes
• 40 clinical PhDs/year from 2008
– Cancer Research UK • 2 clinical PhDs/year since 2007• Based Barts/Cambridge
– Arthritis Research Campaign • 2 clinical PhDs/year start 2009• sites changing every year
– Wellcome Trust Translational Medicine training programmes
• Current competition for centres• Pan Scotland bid led by Prof David Webb,
Edinburgh