Rapid Responses to:
|
|
Rapid Responses: Rapid Responses published:
-
![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
‘Junior Doctors are the Key to Revitalising Academic Medicine’
- Kedar J Deogaonkar (13 August 2005)
-
Reforming Research in the NHS
- Desmond J Sheridan (4 November 2005)
|
|
|||
|
Kedar J Deogaonkar, Clinical Research Fellow University Hospital of Wales, CF23 8RG
Send response to journal:
|
Dear Mr Cole I read your article ‘NHS research programme to be transformed’ with great interest. I have also being following the related articles on this topic of academic medicine. I am working as a Clinical Research Fellow at the University Hospital of Wales for the last 1 year. I am thoroughly enjoying the experience and I intend to develop my career in the field of academic medicine. My job involves 2/3 sessions in the lab doing pure research on osteoarthritis and 1/3 sessions in the hospital managing trauma and orthopaedic patients. This unique blend of basic research and relevant clinical practice has provided me with a unique insight into the various molecular aspects of the disease process. Moreover it is a welcome change from the hectic and routine schedule in hospitals. I think that more of such jobs need to be defined and developed with a dual commitment of basic research and clinical commitments. This will involve cooperation between professors of basic science and the professors of clinical specialities so as to make basic research more clinically relevant. The junior doctors of today are the professors, academicians and clinicians of tomorrow. More efforts will be needed to design their jobs and training such that they get an exposure to basic and clinical research at an early stage of their career. This will go a long way in revitalising academic medicine and making UK a world leader in clinical research. Competing interests: None declared |
|||
|
|
|||
|
Desmond J Sheridan, Professor of Cardiology Imperial College School of Medicine, St Mary's Hospital, London W2 1NY
Send response to journal:
|
Proposals to reform Department of Health support for health research[1] are very welcome and certainly timely given the alarming state of academic medicine in the UK. Your coverage of this[2] highlights the challenge. The necessary translation of “pure” research into practice is falling behind, while the delivery-targets imposed on management, worthy though their objective may be, is disturbing both clinical and research priorities as well as inhibiting would-be clinical academics for whom the timeless ideals of creative contribution should not be under-estimated. That health research and academic medicine are in need of support are not in doubt. It would however be misleading to suggest that this reflects a failure of academic medicine. It is in no small part the very success of academic medicine that has contributed to the remarkable advances in health in recent decades, advances that also bring an increase in immediate health costs (their benefit to cost savings often left out of the equation). These costs however include a loss of that essential shared ground between clinical and academic practice in which most health research takes place. This together with an increasingly citation and commercial focused academic environment in which health-related research is less attractive, have marginalised academic medicine. The DH proposals have much to commend them. The creation of a virtual National Institute of Health Research [NIHR] in which all clinical academics would hold membership and receive support could provide a powerful and much needed national voice for clinical academics at a time of unprecedented change. It could also facilitate research collaboration and build a national networked research expertise. Separating academic performance from the health service “pay by results” would also help to restore the research priorities lost in recent years. The vision of a “virtual” structure for the NIHR may also reduce bureaucratic waste and avoid the stifling effects of “managed” research. Several fundamental consequences of the decline of clinical academic medicine, however, appear not to have been fully appreciated. The central paradigm behind the success of academic medicine has been the two way interaction between “bench and bedside”. The DH proposals emphasise support for “research involving patients”. This would be much too narrow a concept. It suggests a view of basic and clinical science as separate from each other, the former simply delivering a new concept, packaged and ready to be opened into clinical application with appropriate clinical methodology. Each needs the other and unless clinicians are actively involved in both, research insights, opportunities and mutual understanding are hindered, the two ends of the spectrum distanced, their interacting relationship attenuated. The goal therefore must be to reinforce clinical research not in isolation, but as an integral limb of the totality of biomedical research and its application. Failure to recruit and retain clinical academics is a key feature of the decline and it has been a “flight from science” of younger clinicians, which is most prominent and disturbing [3,4]. A further recent proposal from the DH to provide an additional £100m to support new clinical academic fellowships and lectureships [5] over the next 10 years, is encouraging. The clinicians appointed to this programme must be supported in undertaking creative original research, supervised by committed senior clinical academics, who must be more willing to act as role models and mentors. It is also essential to recognise that much technical work needed to undertake clinical research may offer little if any research training. Data collection for clinical trials, for example, would not be a very exciting carrot for bright young aspirants to a career in clinical academic medicine or biomedical science! They must also be protected from excessive service demands and offered career structures appropriate for clinical academics [6,7]. Recent evidence of recovery of academic medicine in the USA appears to be linked to programmes addressing specific needs of young clinicians [8] and hopefully in time similar evidence will emerge in the UK. Targeting support to resolve complex national problems inevitably raises the question of “breath versus depth”. Creating five academic medical centres by open competition will enhance the international standing of those selected. The proposal is to re-run the competition at intervals of seven years. In a scheme where “the best get more”, though, advantage defaults to the initially successful and changes are less likely in future rounds. This may improve long term continuity and international performance of the centres involved, but the broad base of academic medicine would be squeezed by a handful of elite centres isolated by competition. The aim must surely be to raise the baseline more widely, while encouraging the best. At worst the present proposals will redistribute a substantial portion of the present NHS R&D budget to a few centres, while further weakening the clinical and academic position of the majority of losing centres. Selection will be brought forward, and future career flexibility for most young clinicians will be lost. This DH proposal is a welcome initiative to restore clinical research in the UK and has much to commend it. The critical challenges are to restore academic medicine to its proper two way interaction between bench and bedside, to reverse the flight from science of young clinicians and to deliver support with sufficient depth and breadth to raise the national game. These are ambitious objectives, but nothing less is appropriate. References: 1. Best research for best health: A new national health research strategy – the NHS Contribution to Health Research in England: A Consultation. www.dh.gov.uk/Consultations/LiveConsultations/fs/en 2. Cole, A. NHS research programme to be transformed. BMJ 2005, 331; 368. 3. Council of heads of Medical Schools. Clinical academic staffing levels in UK medical and dental schools; data update 2004. www.chms.ac.uk/fchms_pubs.html (accessed September 30 2005) 4. Iaonnidis JPA. Academic medicine: the evidence base. BMJ 2004; 329: 789 -791. 5. http://www.nccrcd.nhs.uk/intetacatrain/ukcrcatp. accessed 1 November 2005. 6. Pusey C, Thakker R. Clinical academic medicine: the way forward. Clin Med 2004; 4: 483-8. 7. http://www.ukcrc.org/Workstreams/Workforce/WorkforceDetails.htm 8. Ley, TJ, Rosenberg LE. The physician-scientist career pipeline in 2005; build it, and they will come. JAMA 2005, 294; 1343-1351 Competing interests: None declared |
|||