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

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 methodology Research Project Intercalated BSc MB-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 3 rd and 4 th 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 fellowships Clinical academic training pathways Simple diffusion Chance encounters

Medical student Junior doctor 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 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 1 Senior lecturer Medical School General Medical training Consultant grade Clinician scientist Fellowships Up to 4 years HO 2345 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 programmes 1.A single package 2.Streamlined access to high quality projects 3.Experienced supervisors 4.Structured framework 5.Mentoring programme 6.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 programmes 1.A single package 2.Streamlined access to high quality projects 3.Experienced supervisors 4.Structured framework 5.Mentoring programme 6.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 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

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

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

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 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 10 th 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

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