Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Academic Medicine is still hospital based?
- Campbell Murdoch (22 February 2002)
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Academic Medicine: Meeting the Challenge
- Mary E Manning, Mark Walport, Registrar, Academy of Medical Sciences (22 February 2002)
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Latent interest in academic medicine
- Prithwish Banerjee (22 February 2002)
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Passionate Curiosity
- Richard A Rosin (25 February 2002)
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Academic does NOT equal Research only
- Donald M McLintock (25 February 2002)
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Missed Opportunities to Recruit more Candidates into Academic Medicine.
- Mark Scoote (26 February 2002)
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New training numbers might be academic but they help
- Neil A Hanley (26 February 2002)
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Clinical academic recruitment begins at clinical departments
- M. W. Lim (28 February 2002)
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Academic medicine must not deny research training to those having completed their CCST
- Andrzej S Dzik-Jurasz (7 March 2002)
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Is medical school for students, teachers or researchers
- Michael L Snaith (27 May 2002)
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Campbell Murdoch, GP Winton NZ
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What I found really interesting about this editorial was the total lack of recognition that academic medicine includes general practice and other disciplines not included in "teaching hospitals." The "largest group of consultants in the NHS" is general practice not anaethesiology and I wonder if the author wondered how many GP trainees were contemplating an academic career. As someone who commenced an academic career in 1976 and is about to re- enter the fray let me offer a different reason why academic medicine is so unpopular. The fact is that academic medicine is still dominated by the aristocratic hospital minorities such as internal medicine and surgery which play such a small part in the modern practice of medicine. Perhaps it is because they have so much time to spare that they can spend their time administering. To become a Professor of Medicine or Surgery now you have to be young, impossibly specialised to the point of non-functionality in any clinical reality zone, and skilled either in the treatment of rats and cats or in plagiarising other peoples' research through meta-analysis . You then progress to Deanship and the task of creating academics in your own image, God help us. The hospital is now an obsolete concept and most of the departments on which academic medicine is based are as outdated as orders of the Garter, the Bath or the Chamber(pot.) What we need is for academic medicine to provide a generic training in the education of students and postgraduates for the cream of those who have shown themselves worthy by surviving in the real world for a few years. The creation of a such a community of scholars is an urgent task and needs to be well funded. If I were in the British Government I would not leave the task in the hands of Universities because they would be the last people to know what I am talking about! |
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Mary E Manning, Executive Director Academy of Medical Sciences SW1Y 5AH, Mark Walport, Registrar, Academy of Medical Sciences
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ACADEMIC MEDICINE: MEETING THE CHALLENGE A response from the Academy of Medical Sciences Dear Sir The Academy of Medical Sciences agrees with the diagnoses of the threats to academic medicine set out in the editorial by Paul Stewart. One of the first actions of the Academy, after its formation in 1998, was to set up a working party under the Chairmanship of Professor John Savill to examine academic medical careers . The main recommendation of the working party was the establishment of a tenure-track career pathway for outstanding trainee academics. Since the publication of the Savill report in April 2000, there has been considerable progress. The Department of Health, MRC and several medical research charities have responded positively, with the commitment of funds to establish a cohort of new Clinician Scientist Fellowships and a National Committee to monitor these and to award a new tranche of academic national training numbers (NTN(A)). The PPP Foundation has responded by establishing a series of earmarked fellowships to help to develop capacity in disciplines that are particularly threatened including surgery, radiology and anaesthesia. More funding is urgently needed. Mentoring is a key element of career development. Although many senior doctors can identify an outstanding person who acted as a role model and mentor during their training, this has often been a haphazard process. The Academy has set up a mentoring scheme to provide independent support and advice to young Clinician Scientists. The most recent Academy report has focused on the needs of non- clinical scientists on short-term contracts in medical research and highlights the problems of job insecurity, lack of adequate career structures or careers advice, lack of recognition and status, and the problems of remuneration. Failure of employers and funders to tackle these issues may hinder the modernization of the research infrastructure on which the future development of the UK medical science base depends. It is increasingly the case that the best research is produced by teams, bringing together a variety of specialist skills, rather than by exceptional individuals working largely on their own. The over-riding priority of the NHS is to provide the best possible medical services to the population of the UK. The support and nurturing of academic medicine must be a key element in attaining this goal. Medical education and training depends on first class teachers and researchers. The practice of evidence-based medicine is a goal for everyone who looks after patients. However, we know very little about many of the most important diseases and only new research can provide many of the answers. The Academy will continue to play an important part in promoting academic medicine. At its most recent Council meeting it agreed to set up a working party to examine impediments to medical research. It also undertook to examine ways of setting up entry-level fellowship schemes to encourage bright young doctors to explore research for a year during their early postgraduate years. Mark Walport, Registrar, Academy of Medical Sciences Mary Manning, Executive Director, Academy of Medical Sciences. |
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Prithwish Banerjee, Specialist registrar & clinical lecturer in cardiology Castle Hill Hospital,HULL, HU16 5JQ
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Dear Editor, Congratulations to Prof. Stewart for his excellent analysis of the current crisis in academic medicine 1. As a fifth year specialist registrar in cardiology (in my research year), who has an interest in a clinical academic post in the future,I can be honest in saying that on completion of CCST I would choose a university senior lecturer post over an NHS hospital consultant post only if academic posts were made more attractive.It would be most encouraging,if in the academic job, there was a sensible breakdown of the working week into research,teaching and clinical activities.It would be nice to have an easy,friendly relationship with the NHS colleagues and feel that academic medicine is complementary to pure clinical medicine.It would be simply lovely to be governed by a pay structure and career structure that at least mimics that in the NHS. Finally, given that a large number of academic posts are currently unfilled, it might be prudent to promise more flexibility and less pressure in meeting research deadlines once a new academic starts work. I am aware of quite a few colleagues-in-clinical-training who have a keen interest in research and teaching, apart from clinical work. Like me,they would probably be quite willing to take up academic jobs only if proper modifications were made to the academic job design.This might help in filling up current vacancies ralatively quickly. Yours sincerely P.Banerjee
E-mail : pbanerjee@ukonline.co.uk REFERENCES : 1. Stewart PM. Academic medicine: a faltering engine. BMJ 2002; 324 : 437-8 (23 February) There are no competing interests related to this letter. |
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Richard A Rosin, Consultant Geriatric Psychiatrist, Highline Community Hospital, Seattle, WA, USA
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When asked to what he attributed his genius, Albert Einstein is said to have replied with the proverbial scratching of his head, "I am not a genius, I am just passionately curious". It is of note that Einstein's work on relativity was completed outside of any academic setting and indeed it is well known that he worked in the Swiss Patent Office while doing his research after hours because he could not secure an academic post. But it is interesting that he believed that working outside of academia may have facilitated his discoveries. He once reflected that he may not have been able to avoid the tendency towards 'superficial analysis' that may have resulted from the pressures to produce research in order to maintain his post. The question is whether things have changed at all. Professor Stewart mentions in his editorial that some have gone into academic medicine after doing research in order to be competitive at interviews. This is well and good. But it is equally true that the enforced research done to gild CVs has had a backlash in that many have been put off doing research because it has been imposed upon them and in fact actively avoid it after the consultant post has been obtained. Surely passionate curiosity in the tradition of Einstein is most likely to result in happy, thoughtful and productive academics. The creation of such an environment would involve challenging the market- inspired approach to academia which has sullied the environment in recent years. If good teachers could inspire and those inclined towards research could be given a setting in which to play with their ideas and if both could be equally valued, then we would be talking. |
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Donald M McLintock, GP - and candidte for P/T teaching post Blackdown Practice EX15 2HT
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I strongly agree with Paul Stewart's dismay about the ignorant attitude of the editorial to the part that primary care does, and should increasingly, play in the education of new doctors. I have applied for a part time tutors post at the Peninsula Medical School and I will pay about £25 a session plus travelling costs for the privelege of guiding future generations of colleagues. Far too much emphasis is paid to the empire building egos of researchers in teaching units and not nearly enough to improving the learning environment of the students. My practice is part of the MRCGP Research Framework and our PCG has possibly unique research group which is not part of any academic department. Lets encourage and reward those academics who want to balance the learning with the research aspects of "Academic Medicine" |
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Mark Scoote, BHF Clinical Research Fellow National Heart & Lung Institute, Imperial College, London, SW36LY
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As a potential clinical academic in the early stages of training I have followed the debate surrounding the shortfall in clinical academic posts with interest as set out recently by Professor Stewarts editorial in this journal(1). In my opinion the emphasis of the National Clinical Scientist Award Scheme and the introduction of the new National Academic Training Number (2) (NATN) is directed too far down the career ladder at candidates already holding higher research degrees and/or well into specialist clinical training. I believe this is a missed opportunity and that potential clinical academics should be guided into this career path at an earlier stage As acknowledged by a recent Royal College of Physicians statement(3) many trainees are entering research prior to obtaining a National Training Number (NTN), either directly after completion of general professional training or following a further period as a Locum Appointment to Training (LAT) Specialist Registrar. As competition for NTN’s continues to intensify and indeed in some specialities is now practically mandatory, the number of doctors in this “pre NTN” research grade where there is no professional body approval of posts or structured training program is set to rise further. In theory one might expect the increasing number of trainees being exposed to research early in their careers would translate into more trainees wishing to continue down the academic route. I believe, however, that unless more is done to make this period of research a positive and rewarding experience and not simply a perceived route to obtaining a NTN then this is unlikely to happen and that such potential candidates will be lost forever as potential academic clinicians. Too often potential candidates wishing to be more competitive at SpR interview feel pressurised into taking up unsuitable research posts with only “soft funding”, no guarantee of university registration for a higher degree and little prospects of securing funding from a major grant awarding body. The pressures and difficulties experienced in such posts can cause tremendous damage to future career plans at both a practical and psychological level. As more candidates enter research between the SHO and SpR grade, surely such posts should be brought under some form of regulatory control of the Royal Colleges and Universities. This would ensure that such posts are of suitable quality, offer ongoing structured clinical experience and a realistic opportunity of obtaining a higher degree and publications. The declining number of structured clinical lectureship training programs is a disappointment. Such schemes allowed academically gifted individuals to commence specialist training with the security of a NTN, regular supervision and assessment and the ability to pursue approved research opportunities sanctioned by the relevant specialist training committee. As more and more potential academic clinicians are forced into research posts which lack these safeguards their desire to continue in the academic field is likely to decline long before they reach the stage of eligibility for NATNs and National Clinical Scientist Scheme Awards. 1: Stewart P. M. Academic Medicine: A Faltering Engine. BMJ. 2002. 324. 437-438. 2: Training in Academic Medicine. Recommendations from the Academic Medicine Committee of the Royal College of Physicians. 2000. www.rcplondon.ac.uk/pubs/wp_tiam_home.htm. 3: Research Training for Physicians. Statement by the Royal College of Physicians. College Commentary. Royal College of Physicians of London. 2002. January/February. 15. |
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Neil A Hanley, Dept. of Health Clinician Scientist Division of Human Genetics, Southampton University, Southampton Gen Hospital, Southampton, SO16 6YD
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Editor—specialist registrar training has generated a clear path for the transition from training grade to consultant. During the same decade, the training for those wishing to combine research with clinical practice became derailed. The two are related but numerous additional factors compound the problem, many of which were highlighted well in the recent BMJ editorial (1). Amongst these, protracted training carries significant financial loss for increased working hours (2). So, whereas the career structure of clinical academics still possesses enviable clarity over the foggy path of a basic scientist in the UK (lest we moan too much), direct comparison with NHS colleagues is currently unfavourable. So where is the good news to ease the concerns about getting funded, pecuniary shortfalls, and being ‘research assessment exercise ugly’? One advance not addressed by Professor Stewart (1) deserves mention. Academic national training numbers (NTN) are now allocated to clinician- scientists funded by major research charities, research council, and the Department of Health. Although short-listing for one of these fellowships by and large requires an ordinary NTN as an indication of career intention, if successful, a personalised replacement is allocated releasing the original number back to the relevant deanery. The effect of these academic NTNs is two-fold. The clinician-scientist receives some much-needed security and an opportunity to plot a cohesive (albeit protracted) training scheme. The deanery is able to re-appoint and avoid compromising its regional registrar rotation. As a consequence, both parties should be happy. Other obstacles might remain, but at least this is progress. 1. Stewart PM. Academic medicine: a faltering engine. Bmj 2002;324(7335):437-8. 2. MacDonald R. Survey shows serious shortage of medical academics in the UK. Bmj 2002;324(7335):446. |
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M. W. Lim, SpR Northampton General Hospital
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Recent publications have highlighted the problems faced by established and aspiring clinical academics [1,2,3]. However, the role played by clinical departments in nurturing or frustrating academic ambitions in specialist registrars, who form a major source for clinical academic recruitment, was not really mentioned. Clinical academic training usually requires external funding for the salary and project costs of full-time research [3]. But competition for such funding is intense. To have a fair chance of success, significant time and effort need to be put in for background research, networking, organisation, pilot studies, funding application drafting and revision, and other preparatory work. However, research time for trainees, in the form of study leave or research days, is not high on the priority list of clinical departments, be it in university hospitals or district general hospitals. They are already struggling with the opposing demands of improving both clinical training and service, without the additional manpower to achieve either. Therefore they guard their manpower allocations jealously. The reduction in clinical time due to New Deal working pattern changes (and the forthcoming European Working Time Directive) only exacerbates the situation. The perception that research training is an unnecessary drain of scarce manpower, is reinforced, rightly or wrongly, by the finding that most clinical fellows intend to return to clinical practice after fulfilling their interests or aims [1]. Thus, trainees wanting to do research are sometimes asked to do it on their time off, even though research training is still training and should be counted in the total hours worked. In any case, many research-related activities cannot be accurately time-tabled to fit whatever time-offs available. Trainees may also be told that taking time to do research, compromises their own or other colleagues' clinical training. (But other non-clinical activities such as rota admininstration or teaching, do not similarly detract from anyone's clinical training.) Yet others are told that requests for research time cannot be supported on a "value for leave" basis, unless research potential has first been established, which brings us to the chicken and egg question. The clinical academic career is difficult enough [1,2,3] without this additional layer of frustration. The disincentive is especially powerful since it affects some of the most important years in terms of preparation for entry into an academic career. Whatever time is lost, cannot be easily made up within the ordained period and pace of specialist training. Therefore, this approach cannot be optimal for clinical academic recruitment. Improved clinical academic training structures and clinical academic working patterns do increase the incentives [1,2,3]. But they do not actually address the problem of pre-entry obstruction. A two-pronged approach of addressing the manpower concerns of clinical departments and improving support for aspiring clinical academics, should complement the measures outlined in the publications. References 1. PM Stewart: Academic Medicine: a faltering engine. Action is needed to respond to growing need and opportunities. BMJ 2002 324:437. 2. R MacDonald: Survey shows serious shortage of medical academics in the UK. BMJ 2002 324:446. 3. F Robinson: What can you expect from a career in academic medicine? Hospital Doctor 21 Feb 2002 p.38-39. Acknowledgement I acknowledge the support of the Anaesthetic departments of Kettering General Hospital and Northampton General Hospital, with my research projects and grant application. |
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Andrzej S Dzik-Jurasz, Research Fellow Institute of Cancer Research, Royal Marsden NHS Trust
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If the sustained investment in and promotion of academic medicine as outlined by Prof. Stewart can be delivered, I agree that the future remains bright for academic medicine in the UK. The development of the tenure-track clinician post should therefore be warmly welcomed. I would, however, urge those leading academic medicine not to exclude individuals from tenure-track who might not be able to apply for a position at the career point intended by the programme. This could occur in specialties where historically, the opportunity for substantive research is encouraged only late or following completion of the CCST. Partly it is the responsibility of the professional colleges to foster the attitude that research leading to a higher degree as part of training is a worthwhile pursuit both to the individual and the health service. However, the leaders of academic medicine should not allow a group of very talented individuals to be excluded from the opportunity of developing and exploiting their research potential. |
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Michael L Snaith, Senior Lecturer in Rheumatology Sheffield University Medical School, S10 2RX
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In this debate about academic medicine the question arises as to whether the strands of research, clinical practice and teaching can continue to co-exist in any meaningful way. I believe that research should inform teaching, or else one just delivers old knowledge, freshly packaged. That is why I cannot agree entirely with Campbell Murdoch, although I can sympathise with some of his sentiments. I think he is arguing for doctors to be trained almost entirely by academic general practitioners. Whilst our students benefit greatly from the well-organised primary care teaching that they receive, I do not believe that is a reason for encouraging the further separation of the teaching of medicine from clinical or basic research As I see it, from my experience of this loosely-connected confederation known as a medical school, research is not being given adequate opportunity to inform medical teaching. The progressive disappearance of the pre-clinical course might be acceptable if some aspects of its classical teaching were to be replaced by clinicians, such as radiologists, teaching clinically relevant anatomy and physiology. However, while the RAE forces basic scientists away from teaching medical students, there is no clear directive to ensure that clinician-investigators will replace them in the revised curricula. I shall retire this year, at 60. This will be neither because of ill-health, nor weariness with medical practice, clinical investigation or teaching. It will be because the teaching of medicine is no longer the clear priority of medical schools and teaching hospitals. |
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