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

Sara MarshallProfessor of Clinical Immunology andCo-director, University of Dundee Clinical PhD Programmes.e.marshall@dundee.ac.uk

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

www.dundee.ac.uk/wtclinicalphd

Comments to s.e.marshall@dundee.ac.uk