Intended for healthcare professionals

Career Focus

Academic general practitioner registrar extensions

BMJ 2004; 329 doi: https://doi.org/10.1136/bmj.329.7457.s13-a (Published 10 July 2004) Cite this as: BMJ 2004;329:s13
  1. Sinead Regan, GP registrar and research associate
  1. Division of Primary Health Care, University of Bristol, Bristol BS6 6JL

Abstract

Academic GP registrars Rachel Hardwick and Sinead Regan have discovered the perfect stepping stone into the world of academic primary care: a taster of research before they plunge into a long term career

General practitioner (GP) vocational training schemes, particularly those with a close connection to a university department of primary care, are increasingly offering six month to one year extensions for GP registrars interested in research.

Why academic general practice?

Research in general practice is a relatively new and expanding field. With increasing emphasis on the key role of the GP within the health service and with more patients with chronic conditions now being managed in general practice, there's a growing need for research and audit within primary care. GPs are also becoming more involved with teaching medical students, so the overall number of academic GPs taking part in teaching is on the increase too.

How do I apply?

The posts should be advertised to vocational training scheme GPs about five to six months before the posts begin. Application for places is competitive and usually entails completing an application form outlining your plans for the year and one or more ideas for research. Your ideas need not be what you actually end up researching, but you must have thought about them enough to discuss them in depth at interview.

What does the year entail?

It is your year: you are encouraged to produce a set of research aims and objectives and to identify how you want to spend the time. Your objectives will usually centre on learning more about research and academic life and trying to complete a small piece of research for publication, but they could also focus on education and teaching.

You are likely to be encouraged to spend the first few weeks brainstorming, reflecting on areas of practice that you have found interesting or challenging, and making appointments with various members of the department to see whether their ideas coincide with any of your own.

Thinking differently

This is an amazing change. It's probably the first time in your working life that you have not been launched into managing crises, new systems, new patients, and a new team all at once. This is time for proactive, not reactive, thinking. You will be given a desk and a computer and then left to think, to ponder, and to come up with ideas—a refreshing change.

The working week

You work a full 10 session week: half the time is spent on research activities (web extra) and half the time is spent at a training practice of your choice—it could be your original training practice but you can change if you prefer. You are still expected to fulfil a part time on-call commitment. You have a five session clinical commitment, but you may be able to negotiate with your training practice to spend some of your clinical sessions doing outpatients' sessions or audit. You should have an educational supervisor for both your clinical work (your trainer) and your research work.

Constraints

The aim of the year is to complete a piece of high quality research and to submit it for publication. This does impose a few constraints:

  • A more complex topic may take time to gain ethics committee approval, so you may find yourself writing up after the end of the year. (Ethics approval is a far bigger hurdle than you might think.) You may be happy with this, especially if you are planning to apply to stay on in academia. It could be a pilot or baseline study for an idea that could grow into a PhD

  • Your research must be focused and concise so that it can be completed within a few months

  • Your research must not be too expensive. Half of the trainer's grant is usually made available to the academic department to fund your stay, so costs must be kept to a minimum—patient transport and a few basic consumables are probably all you can count on.

In practical terms this leaves you with a range of options:

  • A systematic review (no ethics approval required; should be completed within a year)

  • A qualitative study (small numbers, just lots of transcribing)

  • A pilot randomised controlled trial (numbers will have to be small, making the possibilities for publication fewer)

  • A questionnaire survey

  • Retrospective case-control survey using pre-existing data.

Recent examples

The last five registrars in our deanery have done either qualitative projects or systematic reviews. The last three have done qualitative research projects into the importance of continuity of care to general practitioners, strategies used by patients to overcome barriers to treatment adherence in heart failure, and attitudes to use of pedometers for exercise promotion in patients with diabetes. The previous two did systematic reviews on lipid mediation and treatment and the efficacy of various treatment regimens for chlamydia.

Ethics approval

Once you've chosen your research topic the next hurdle is ethics approval, along with local hospital or primary care trust (PCT) approval, or both, depending on where your research will be based. This entails developing a detailed plan of your research, information sheets and letters for patients and their GPs, consent forms, and questionnaires. These should all be written in patient friendly English, ensuring that the ethics committee will have no concerns as to how patients will be approached, managed, and treated.

This may not seem too hard, but once you're on the 15th edited draft of all of the above your hair begins to look a little thin. The plus side is that it is a steep learning curve and having done it once, you can probably do it in just three or four drafts next time.

Honorary contract

You need to apply for an honorary contract with the hospital or the PCT, or both, to gain access to patients—bureaucracy is involved every step of the way. The honorary contracts each entail filling in specific forms and submitting your proposal along with all of the relevant paperwork as for ethics approval. The PCT and hospital prefer you to apply for honorary contracts about a month before you apply for ethics approval.

However, ethics is your biggest hurdle and barrier to starting (and so completing) your research within the year, so it is a good idea to apply for ethics approval as soon as possible. We also found that the PCT required us to have ethics approval for an honorary contract, while the ethics committee required us to have PCT approval before ethics approval. We found it useful to use the experience and advice of peers and supervisors and even our professor to get all sides to agree to a sensible plan. So in the initial phases of research, you need to have plenty of patience and perseverance.

Once ethics approval is granted, recruitment of participants can begin and your study is under way. You'll be supervised throughout, and regular meetings with your supervisors are helpful in solving difficulties and keeping motivated. You should be able to analyse the data and write up your study within the year.

The benefits

The academic extension year has many potential benefits (web extra). Aside from the experience of undertaking a piece of research, many other opportunities exist: the luxury of a small grant, hopefully leaving with a publication, and making contact with a department which may be able to help you with further academic applications.

The disadvantages

There are a few drawbacks to doing an academic extension year and these are mainly related to adapting to the changes in working style and environment. However, should you decide to continue in academia or teaching as a GP, some other factors should be considered (web extra).

Opportunities in academic general practice

As the end of our year approaches, we have both been encouraged to start thinking about a fellowship application as a way of staying on in the department. A number of options exist however.

Fellowship

With a fellowship you receive a training grant from a body such as the Medical Research Council (MRC) which gives you protected time for three years' research. You are expected to become trained in research methods and to complete a piece of research that could be submitted for a PhD or an MD. Some people use some of the training time and grant to study for a masters or diploma in research methods as well. It can be hard work to complete everything in three years. The advantages of this post are the protected time in which to complete your PhD, having no other university or teaching commitments, and the security of external funding so that you know your position is guaranteed through the three years. Application entails sending a proposal to the MRC or NHS grant committees when grants are advertised (once or twice a year).

Clinical lecturer

Clinical lecturer is a salaried position with your time divided between research, clinical work (on average three to five sessions a week), and some teaching. Some people aim to complete a PhD or a masters degree while in a clinical lecturer post, but with less protected time it may take longer.

Further information

Clinical teaching fellow

As a clinical teaching fellow you are employed by the university to teach undergraduates in the medical school and design and coordinate the curriculum and exams without necessarily doing research. You are encouraged to undertake one of the many courses at certificate, diploma, or masters level in medical education.

The options for combining your research with your clinical work are to work as:

  • A part time partner

  • A part time salaried doctor

  • A GP in the flexible careers scheme.

Personal view

We have really enjoyed the opportunity to experience a taste of life as a researcher, to get to know the department, and to see what everyone else is doing here. We have enjoyed our limited involvement in teaching more than we expected. The extra clinical time has also been useful in furthering our knowledge in a number of specialties through honorary senior house officer posts and sitting in on outpatient clinics. This year has opened up other worlds to us and given us an insight into a portfolio career. We have learnt much about the new ideas at the forefront of general practice and found it an interesting and stimulating environment.

Footnotes