- promoting academic medicine and research

(The full paper may be found on www.bgs.org.uk/)

A thriving research culture in ageing and clinical geriatric medicine is of key importance to the future strength and influence of the Society, and to the future care of older patients.

Academic medicine in general, and academic geriatric medicine in particular, are experiencing difficult times for a variety of reasons, not least the squeeze in higher education funding and the rush to try to enhance research assessment ratings for the next research assessment exercise. The focus of the NHS on short term targets and continuing under funding of research by the NHS (<1% total expenditure) has also contributed to increased difficulties in maintaining active research programmes in geriatric medicine in many universities. It is only necessary to look at the evidence base underlying those medical specialties without significant academic activity to understand the likely long term detrimental effects of a loss of research activity within the specialty. In keeping with many other specialties, there are vacant chairs and senior lectureship posts in geriatric medicine.

Of equally great concern is the trend to disestablishing academic departments. Whilst loss of departments in itself is not a problem, loss of posts in academic geriatric medicine will have far reaching negative effects on both teaching and research. These factors have been well reviewed by Professor Stout (www.bgs.org.uk/publications/ acadmedicine.htm). If the specialty is to survive in the university sector, the BGS must actively promote its profile and nurture its trainees with independent research potential and its newly independent researchers. There are examples of successful geriatric research groups in the UK, where groups of clinical, basic and social scientists have flourished in the current academic environment. The single most powerful argument in favour of academic geriatric medicine is that population ageing is here to stay and future challenges, although not funded, are now recognised by the NHS. It is essential that the BGS and its members are seen to be united in both their conviction and their arguments in support of the continuation of academic geriatric medicine.

Identification and support of potential independent researchers
It is crucial that the “supply” of young researchers is increased and that they are supported. Research experience within SpR training should be seen as the ‘norm’ and not the exception. Without being directly exposed to a research environment it is impossible to identify, with any certainty, those that will flourish and become the future leaders of academic geriatric medicine. Nevertheless, it is possible to identify those more likely to become productive researchers. The Society can contribute towards this process in a number of ways:

Research methodology training
Working with the charity Research Into Ageing (RIA) (now part of Help the Aged), a series of research methodology workshops have been started. These workshops have been based around local experts and priority given to local SpRs. It is hoped that local contacts will result in relevant collaborations in subsequent research proposals. The first of these workshops was held in Manchester in 2001 and subsequently in Bristol in May 2003 and in Glasgow in November 2003. Whilst it continues to meet a need, this will continue as an annual event.

“Meet the Researchers”
Starting in April 2002, a lunchtime session has been organised by the former Scientific Committee and held at the national BGS meeting. The objective of the meeting is for SpRs interested in research to meet active researchers (both NHS and University employed) and to talk about how to get started. The attendance and feedback from SpRs has been excellent for the three sessions that have been held to date. These sessions will continue, initially on a bi-annual basis.

Raising the Profile of Research Active Trainees
The scientific meetings continue to provide an opportunity for research active SpRs to present their work and compete with others for the oral presentation and poster prizes. In addition, the Society’s Newsletter will become a vehicle for raising the profile of research active SpRs.

Travel Grants
At present the only research grants available to SpRs from the Society (other than the Dhole Training Fellowship), are the Start-up Grants designed to pump prime own-account research to enable external grants to be obtained subsequently. A potentially important expansion in the categories of grants available from the Society will be to include the funding of proposals to visit centres of excellence in order to learn new techniques or methods. In addition to learning methodology, it will enable aspiring researchers to experience first hand, the way large successful research groups work. This will be linked to research proposals and follow up information about successful applicants will be recorded.

Training Fellowships
Training fellowships offered by the MRC, Wellcome Trust and the recently introduced National Clinician Scientist Scheme are highly competitive and strongly favour applications associated with major research groups. Application for these will be encouraged. Substantially funded by income from the Dhole bequest left to the BGS by the late Dr Dhole, a Dhole Fellowship will be awarded every three years. The first fellowship is expected to start this year. This fellowship is jointly funded by Research into Ageing and the Society (£25K per annum for three years). The Academic and Research Committee is of the opinion that a training fellowship would have a far greater impact on the research profile of the Society than the previous use of the money to fund small individual research projects. It must be the strategy of the Society to expand this programme, initially to an annual fellowship.

Role of SIGs/Sections in research/research management
When the SIG and Section framework was set up a high priority was placed on the development of research related activities. Most of the SIGs and all the Sections include the presentation of research in their meetings, indeed this is one of the requirements for a SIG to acquire Section status. Over the last three years SIGs and Sections have sent representatives to a meeting, held within the Society’s meetings, to share information and feed back to the Academic and Research Committee.

Identification of evidence gaps
The identification of gaps in the evidence base must be the way to drive the research agenda rather than having the agenda capacity driven by groups with expertise. The process of drawing up a coherent list of such topics should be undertaken by the SIGs/Sections as they are the experts in their fields. This fits well with the new Health Technology Assessment process of seeking suggestions for research questions.

Management of the research process
Having identified important gaps in the evidence, several SIGs/Sections have put together research grants that have been funded. These have involved multicentre studies and the process of protocol development leads to a natural management committee that meets on a regular basis. This model is one that fits well with the structure of the Society and the research interests of its members.

Involvement with outside bodies
Working with SIGs/Sections, the A&R Committee will interact with outside bodies to identify ways in which the Society can impact on the climate for research in ageing and the process by which research priorities are set. To date the BGS has had such interactions with the Health Technology Assessment agency and has submitted research questions. In the future, interactions with other Dept of Health agencies, the Medical Research Council, the Wellcome Trust and the US National Institute of Aging should be sought. In the last case this interaction might identify, possibly in collaboration with the American Geriatrics Society, collaborative research, funding or exchange facilities. A major funder of ageing research is Research Into Ageing. Close links between the BGS A&R committee and RIA Research Advisory Committee (RAC) exist with two rBGS epresentatives on the RIA RAC: usually the Chairman and one other member.

Developing the research capability of individual departments
Departments of Geriatric Medicine/academic geriatricians should critically evaluate their current strengths and weaknesses. They must be encouraged to participate fully in the research strategies of their universities and medical schools, and seek alliances with relevant disciplines in particular areas. Academic geriatricians should play a lead role in facilitating and supporting age-related research by other researchers and encourage collaboration between clinical academic geriatricians and other clinical academic specialties and non-clinical scientists in order to build a critical mass of researchers.

Role of the UK Association of Professors of Geriatric Medicine
The Association of Professors of Geriatric Medicine has traditionally met for one hour only once a year although this has recently increased to twice a year, at the national BGS meetings. The range of interests of this group covers the whole spectrum of traditional academic activities including teaching and training as well as research. During the preparation of this strategy paper, the Association has given support to expanding its activities to include areas not previously covered.

Review of job plans and job descriptions for clinical academics
This process might help to establish viable clinical academic posts by ensuring that fixed clinical sessions do not exceed half the full time NHS consultant maximum of 6, i.e. 3 fixed clinical sessions. This advice will be modified in the light of the new consultant contract.

Peer support for senior lecturers
The establishment of support mechanisms including a mentoring scheme for senior lecturers is an important step in helping senior lecturers to remain focussed on their agreed objectives, and to achieve promotion to professor within 10 years. A senior lecturers group will be part of this initiative.

Provision of support for academic geriatricians under threat
Support for Departments or individuals faced with pressure for closure/loss of academic status from their university is unlikely to have any influence. Of potentially greater value will be to recognise those at risk much earlier, and have discussions with the academic members about their strategy.

Review of Grant Applications
Particularly for training fellowship applications and probably other grant applications, the A&R Committee, together with the Association of Professors, could promote an internal review process. This will enable applicants to enhance the quality of their applications prior to submission. The process will be undertaken with a sub group composed of members of both committees charged with the responsibility for undertaking this task. The review of proposals could all be done electronically.

BGS Scientific Meetings
The BGS has the opportunity to demonstrate the quality and relevance of its members’ research at the Scientific meetings and this must be continued together with the rigorous peer review process already in place. These meetings provide an important opportunity for researchers to interact and in particular, for trainees to experience the excitement of research and see good research presented.

Lobbying
At the most senior level, the BGS must use its influence to persuade decision makers of the importance of the contribution our speciality can make to the health of the population. Further, the message must include the clear statement that without a healthy academic base, this contribution will be severely weakened. It may be productive to concentrate on the Department of Health and Department for Education and Skills. Involvement with Universities UK would seem much less likely to be productive. This role is likely to be most effective if taken on by those most likely to be heard. This will include not only some senior members of the Society, but also some of those recently retired.

Undergraduate Teaching
The recent white paper, “The Future of Higher Education”, from the Department for Education and Skills gives the impression that teaching will be given far more priority than in the past. Teaching currently continues to be sacrificed in favour of the much more lucrative 5-star research assessment rating. Without a strong academic base, undergraduate teaching quality will suffer and the best students will not be attracted into the specialty. The Society is strongly opposed to the delivery of specialist geriatric medicine teaching by those not trained in the specialty. This is a distinct risk if numbers of academic geriatricians/Departments are reduced, as multidisciplinary research groups cannot take on this role. NHS consultants not in academic posts increasingly play a major role in the delivery of teaching. Ways to provide support for and recognition of this activity will be considered by the Society’s Training Committee. The Society has recently held a symposium on teaching and training within the main meeting.

Steve Jackson
Chair, Academic & Research Committee