A brighter future for academic medicine? Postgraduate research opportunities for clinicians

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A brighter future for academic medicine?
Postgraduate research opportunities for
clinicians

• Sara Marshall
• Professor of Clinical Immunology and
• Co-director, University of Dundee Clinical PhD
  Programme
• s.e.marshall_at_dundee.ac.uk

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Background UK academic medicine 2007

• Number of UK clinical academics continues to
  decline
• Total academics decreased by 27 since 2000 (now
  lt3000)
• 57 of clinical academics are gt age 46
• Only 20 of clinical academics are women

BMA Medical Academic Staff committee, June 2007
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Undergraduate exposure to research Specific or
integrated modules in scientific
methodology Research Project Intercalated
BSc MB-PhD programmes
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
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Exposure to research during clinical
training
Simple diffusion Chance encounters
Clinical research fellowships Clinical academic
training pathways
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Career in academic medicine
Disincentives to careers in academic
medicine Lack of career structure Long and
insecure training Lack of flexibility of Calman
registrar posts Lack of undergraduate exposure to
research Lack of infrastructure and role
models Poor renumeration More in expectation
than in hopea new attitude to training in
clinical academic medicine John Savill, BMJ 2000
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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

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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
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Addressing the key problems of recruitment into
clinical academia

• 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

• Integrated academic career pathways 2007
• Academic clinical fellowships (Walport fellows)
• Clinical lectureships
• NES clinical lectureships

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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

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Research pathways for junior doctors
General Medical training
Specialist registrars
Consultant grade
Medical School
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Senior lecturer
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3
4
5
HO
SHO
Clinician scientist Fellowships Up to 4 years
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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)

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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

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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

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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)

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Why is this different from what has been on offer
before?

• Generic features of all programmes
• A single package
• Streamlined access to high quality projects
• Experienced supervisors
• Structured framework
• Mentoring programme
• Links to clinical training programmes

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Why is this different from what has been on offer
before?

• 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(!)

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Why is this different from what has been on offer
before?

• Generic features of all programmes
• A single package
• Streamlined access to high quality projects
• Experienced supervisors
• Structured framework
• Mentoring programme
• 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)
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Why is this different from what has been on offer
before?

1. A single package
2. Streamlined access to high quality basic science
   projects within well-resourced, world-class,
   cooperative environments
3. Experienced and committed supervisors
4. Structured framework tailored to needs of young
   clinicians
5. Strong mentoring programme by clinical academics
6. Links to clinical training programmes

Essential if fellows are going to write up in 3
years
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Why is this different from what has been on offer
before?

1. A single package
2. Streamlined access to high quality basic science
   projects within well-resourced, world-class,
   cooperative environments
3. Experienced and committed supervisors
4. Structured framework tailored to needs of young
   clinicians
5. Strong mentoring programme by clinical academics
6. Links to clinical training programmes

Often require intensive training in laboratory
techniques May require time out to maintain
clinical skills
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Why is this different from what has been on offer
before?

1. A single package
2. Streamlined access to high quality basic science
   projects within well-resourced, world-class,
   cooperative environments
3. Experienced and committed supervisors
4. Structured framework tailored to needs of young
   clinicians
5. Strong mentoring programme by clinical academics
6. Links to clinical training programmes

Provides essential role models and personal
advice for career decisions
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Why is this different from what has been on offer
before?
Explicit partnership with the postgraduate
deanery Possibility to continue clinical training
via NES Clinical Lectureships

1. A single package
2. Streamlined access to high quality basic science
   projects within well-resourced, world-class,
   cooperative environments
3. Experienced and committed supervisors
4. Structured framework tailored to needs of young
   clinicians
5. Strong mentoring programme by clinical academics
6. Links to clinical training programmes

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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.

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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

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www.dundee.ac.uk/wtclinicalphd Comments to
s.e.marshall_at_dundee.ac.uk