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In recent years, the number of clinical academics in the UK has declined. In fact, the number of academics in 2005 was approximately 84% of that of the 2000 level. In 2005, the number of clinical academics in the UK had dropped below 3,000 for the first time, to 2,982.
Between 2000 and 2005 there was a 50% reduction in clinical lecturers, 30% reduction in senior lecturers and 7% increase in professors, with geriatrics being one of the hardest hit of the affected specialities. There were also big differences identified between medical schools, with recent surveys also suggesting differences in the numbers of clinical academics at all levels between the genders.
The reasons for this decline in clinical academia are in part related to perceived and actual difficulties, balancing the competing pressures between service, research and teaching activities and the increased length of time needed as a clinical academic to complete specialist training. It is also important to note that some of the issues around the appointment and retention of clinical academics is related to a lack of exposure to academia in postgraduate and undergraduate training programmes, particularly in specialities such as geriatric medicine.
In 2005, the UK CRN/MMC review of clinical academia noted that there was a lack of a clear route of entry and a transparent career structure in clinical academia, with a lack of flexibility when it came to balancing clinical and academic training and geographical mobility, and a shortage of properly structured and supported posts available on completion of training. All of these were considered in this report to be deterrents to a clinical academic career. In recent years there have been three key sign posts for the recovery of clinical academia which have really put the issue on the map. The first has been the appreciation by government that applied biomedicine is critical in the UK’s economic growth. The second, the Walport Report; ‘Medical and Dentally Qualified Academic Staff; Recommendations for Training of the Researchers and Educators of the Future’, has led to recognition of the need for an academic clinical career pathway and outlined the strategies for achieving such a pathway. Finally publication of the Department of Health document “Best Research for Best Health” has laid out the necessary steps to restructure NHS research and development.
MMC and the UK CRC have therefore developed properly structured and supported posts. Development of these posts has included bids to central government for approval and funding. The Walport posts include:
- academic foundation posts,
- academic clinical fellowships,
- academic clinical lecturer programme.
Academic Foundation Programme
Newcastle had the first academic foundation programme in the UK and currently has six posts. This programme has been so successful that there is a desire to expand the number of available posts in this programme in the very near future. Academic Foundation posts are designed to provide generic research training, and the Newcastle model has three four month blocks for both F1 and F2 years with one four month block in each year as the academic period. The other blocks in F1 are medicine and surgery and in F2 these generally mirror the individual’s academic interests. Individuals applying for an academic foundation post have a specific interview where foundation and academic issues are considered equally, they are supported by an Academic Foundation Mentor and both academic and clinical progress are assessed.
Academic Clinical Fellowships
Applications for round 1 of the Academic Clinical Fellowship (ACF) programmes were invited by the UK CRC in 2005. Since then there have been 2 further rounds, with round 2 focussing upon specific clinical areas and round 3 mapping to the Biomedical Research Centres. ACF’s combine 25% academic training with 75% clinical training, these posts are now centrally funded and are speciality specific. Appointment to these posts is now out with the MTAS system and the sole end point of the posts is that individuals will put together an externally funded fellowship leading to a higher degree (PhD/MD). The posts are currently competency based.
In Newcastle we now have sixteen programmes in a variety of different disciplines which were awarded after successful bids to the UK CRC. Specialities where posts are funded relevant to ageing in its broadest sense include: geriatric medicine, old age psychiatry, pathology of ageing, pulmonary immunosenesence, ophthalmology of ageing and clinical pharmacology in ageing. Newcastle over a five year period has a total of seven ACF posts in geriatric medicine.
The national picture however is less rosy. Over a 5 year period there are 8 ACF’s in geriatric medicine, with 2 in Oxford, a total of 4 at St Georges (which is combined with clinical pharmacology) and Southampton with a total of two.
Academic Clinical Lecturer
Deaneries have also had the opportunity to bid for Academic Clinical Lecturer programmes. The programmes are aimed at speciality specific trainees who have completed a higher degree to enable them to complete specialist clinical training whilst also facilitating development of a post doctoral research career. The posts combine 50% research and 50% clinical training and will allow individuals to develop their own research group. The hope is that they will also lead to an application for a senior fellowship. In Newcastle we have three academic clinical lecturer programmes, the first is in ageing specialities where we now have two posts per year for the next five years, dental specialities and psychiatry. Oxford also has one academic clinical lecturer post in geriatric medicine over the next five years.
Taken together, these programmes underline the fact that Newcastle is the only centre in the UK to have run through training in academic geriatric medicine (ageing).
Assessment of Academic Trainees
The Academy of Medical Sciences has provided guidance regarding how academic trainees should be assessed. The training needs for these individuals must be flexible and trainee centred with mentoring to ensure the attainment of both academic and clinical goals. The focus of the training and mentoring is aimed at the development of competitive peer reviewed research training fellowships. Individual academic trainees should be assigned an academic educational supervisor in addition to their clinical educational supervisor and this individual should ideally be an established clinical academic. He/she should have a formal mentoring role and meet with the trainee within a month of their commencing their post to develop realistic, achievable, and timely goals for the delivery of their training. Academic trainees will have both clinical and academic competencies assessed. Academic competencies will be assessed generically in three domains of (i) research experience, (ii) research governance and (iii) communication and education. In addition, significant outputs should be recorded such as presentations at national or international meetings, submitting application for a grant, publishing a peer reviewed article or delivering an educational lecture or seminar.
In Newcastle the success of our bids for the academic programmes has been achieved within the context of an academic clinical career pathway committee which is chaired by our Dean of Clinical Medicine, Professor Alistair Burt. This committee brings together all the potential stakeholders including University, Trust, Royal Colleges and Post-Graduate Deanery as well as the leads of each academic programme and representatives drawn from the trainees themselves. The system in Newcastle has been such that academic interviews are performed in addition to the same clinical interviews at those level of staff, academic ARCPs and progress assessments are in addition to the same clinical assessments and the academic lead for each programme are present on the ARCP panels. Perhaps the most important has been the development of an active and effective mentorship programme.
National Institute of Health Research (NIHR)
In light of ‘Best Health for Best Research’, the Department of Health has developed a NIHR virtual National Research Facility that allows the position, management and maintenance of academic and research staff within the infrastructure of the NHS. This is intended to enable the NHS to become an organisation which supports outstanding individuals working in world class facilities and conducting leading edge research focused on the needs of patients and the public. In order to achieve this, the NIHR has built infrastructure in the form of Biomedical Research Centres (BRC). The centres are within leading NHS and University partnerships aimed at driving the progress of innovation and translational research in biomedicine within the context of NHS service, quality and safety. In 2007, eleven biomedical research centres were announced after NHS organisations and their academic partners bid to central government for this status. Newcastle Hospitals NHS Trust in combination with its academic partner Newcastle University was designated a Specialist Medical Research Centre in Ageing. This investment has led to a major focus upon age related chronic diseases and brought established clinical and basic science researchers to the study of ageing across a wide range of diseases.
Other Recent Research Developments in Newcastle
Newcastle has been awarded funding to develop a Clinical Ageing Research Unit (CARU) with the specific intention of investigating the biological basis of dementia and cognitive decline and the basic mechanisms of cell and tissue damage during ageing. All these initiatives have led to the development of significant infrastructure in Newcastle based on the Newcastle General Hospital site where a Campus for Ageing and Vitality is being developed. This exciting new initiative includes the Newcastle Magnetic Resonance Centre, Institute for Ageing and Health Research Laboratories, CARU and a Translational Research Building including new laboratories, clinical and social science facilities, incubator space and opportunities for new commercial links.
The future of Academic Geriatric Medicine
There have been many recent positive developments regarding training the future academic geriatricians. There is still much to do. It is vital that we continue to invigorate the speciality and encourage young clinicians to consider geriatric medicine as their speciality of choice and to recognise the limitless research opportunities that present themselves in ageing medicine. It is critical that we do this from the very earliest stages of medical education and ensure that geriatric medicine is fully considered in the undergraduate curriculum. We need to ensure that funders appreciate the value of research in this area and that true translation of research findings into changes in clinical practise is essential if we are to see real improvements in the care for older people.
Julia Newton
BGS Newsletter, March 2008
Issue 15 ISSN 1748-6343 15
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